M87.261
BillableOsteonecrosis due to previous trauma, right tibia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.261 an HCC code?
Yes. M87.261 maps to Bone/Joint/Muscle Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M87.261
For M87.261 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M87.261 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.261 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, right tibia. Death of bone tissue in the right shinbone (tibia) caused by a previous injury or trauma to that area. M87.261 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other osteopathies (m86-m90).
Under the CMS-HCC V28 risk adjustment model, M87.261 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M87.261 mapped to the same category but with a base RAF weight of 0.482 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Ensure documentation clearly identifies the tibia (not fibula) and specifies right side to avoid confusion with fibular osteonecrosis codes. Because M87.261 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M87.261 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation clearly identifies the tibia (not fibula) and specifies right side to avoid confusion with fibular osteonecrosis codes
- •Review imaging reports to confirm osteonecrosis diagnosis and verify it is attributed to previous trauma
Clinical Significance
Right tibial osteonecrosis following trauma affects a major weight-bearing bone critical for ambulation and stability. This condition can lead to significant functional impairment, chronic pain, and potential need for complex orthopedic procedures including bone grafting or joint reconstruction.
Documentation Requirements
- ✓Specific identification of right tibia involvement
- ✓Documentation of previous trauma to right lower leg
- ✓Clinical or radiological evidence of bone necrosis in tibial bone
- ✓Location within tibia (proximal, shaft, distal) if specified
- ✓Current weight-bearing status and ambulation capacity
- ✓Assessment of pain levels and functional limitations
- ✓Treatment history and response to interventions
- ✓Impact on mobility and activities of daily living
Commonly Confused Codes
- •M87.262 — Osteonecrosis due to previous trauma, left tibia (wrong laterality)
- •M87.263 — Osteonecrosis due to previous trauma, unspecified tibia (when laterality is documented)
- •M87.361 — Other secondary osteonecrosis, right tibia (non-traumatic secondary cause)
- •M84.361A — Stress fracture, right tibia (acute injury, not chronic necrosis)
- •S82.101A — Unspecified fracture of upper end of right tibia (acute fracture)