M87.262
BillableOsteonecrosis due to previous trauma, left tibia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.262 an HCC code?
Yes. M87.262 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 M87.262
For M87.262 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 M87.262 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.262 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, left tibia. Death of bone tissue in the left shinbone (tibia) caused by a previous injury or trauma to that area. M87.262 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, M87.262 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, M87.262 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.
Verify left tibia is documented and distinguish from fibula involvement, which uses different codes (M87.264-M87.266). Because M87.262 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 M87.262 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Left tibial osteonecrosis secondary to trauma represents a serious complication affecting a primary weight-bearing bone essential for normal ambulation. This condition often requires specialized orthopedic management and may significantly impact patient mobility and independence, necessitating comprehensive rehabilitation.
Documentation Requirements
- ✓Clear identification of left tibia involvement
- ✓Documentation of previous trauma to left lower leg area
- ✓Imaging evidence of bone necrosis in left tibial structures
- ✓Specific anatomical location within tibia if documented
- ✓Current weight-bearing ability and gait assessment
- ✓Pain evaluation and functional capacity assessment
- ✓Treatment modalities attempted and effectiveness
- ✓Impact on patient mobility and quality of life
Commonly Confused Codes
- •M87.261 — Osteonecrosis due to previous trauma, right tibia (wrong laterality)
- •M87.263 — Osteonecrosis due to previous trauma, unspecified tibia (when laterality is known)
- •M87.362 — Other secondary osteonecrosis, left tibia (non-traumatic secondary cause)
- •M84.362A — Stress fracture, left tibia (acute injury versus chronic necrosis)
- •M87.265 — Osteonecrosis due to previous trauma, left fibula (different bone)