M87.274
BillableOsteonecrosis due to previous trauma, right foot
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.274 an HCC code?
Yes. M87.274 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 M87.274
For M87.274 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 M87.274 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.274 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, right foot. Death of bone tissue in the right foot caused by a previous injury or trauma. M87.274 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, M87.274 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, M87.274 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.
Confirm documentation specifies 'right foot' and clarify if osteonecrosis affects tarsal bones, metatarsals, or other foot structures. Because M87.274 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 M87.274 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm documentation specifies 'right foot' and clarify if osteonecrosis affects tarsal bones, metatarsals, or other foot structures
- •Distinguish between foot osteonecrosis and toe osteonecrosis for accurate code selection
Clinical Significance
Right foot osteonecrosis following trauma affects the complex bone structure essential for weight-bearing and ambulation, potentially leading to chronic pain and significant functional impairment. This condition may require specialized podiatric or orthopedic management and can impact overall mobility.
Documentation Requirements
- ✓Specific identification of right foot involvement
- ✓Documentation of previous trauma to right foot area
- ✓Clinical or radiological evidence of bone necrosis in foot structures
- ✓Specific bones affected within the foot when documented
- ✓Assessment of weight-bearing capacity and gait impact
- ✓Current pain levels and functional limitations
- ✓Treatment history and response to interventions
- ✓Impact on mobility and activities of daily living