M87.811
BillableOther osteonecrosis, right shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.811 an HCC code?
Yes. M87.811 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 M87.811
For M87.811 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 M87.811 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.811 is the ICD-10-CM diagnosis code for other osteonecrosis, right shoulder. Death of bone tissue in the right shoulder joint from causes other than the typical classified causes. M87.811 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, M87.811 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, M87.811 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 laterality is documented as right before assigning this code. Because M87.811 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 M87.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as right before assigning this code
- •This code may be used for idiopathic osteonecrosis or other non-secondary causes
Clinical Significance
This diagnosis represents osteonecrosis of the right shoulder from causes other than the typical classified causes, which can significantly impact upper extremity function and quality of life. It requires identification of the underlying etiology and monitoring for joint complications.
Documentation Requirements
- ✓Documentation of osteonecrosis affecting right shoulder
- ✓Clear description of the underlying cause (other than typical secondary causes)
- ✓Imaging findings confirming shoulder bone necrosis (MRI, X-ray, CT)
- ✓Clinical symptoms such as shoulder pain, stiffness, or limited range of motion
- ✓Specific shoulder structures affected (humeral head, glenoid, etc.)
- ✓Functional limitations affecting arm use
- ✓Duration and progression of condition
- ✓Treatment history including conservative and surgical options