What is ICD-10 code M87.812?

M87.812 is the ICD-10-CM diagnosis code for Other osteonecrosis, left shoulder. Death of bone tissue in the left shoulder joint from causes other than the typical classified causes. It belongs to the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99). M87.812 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M87.812 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. M87.812 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M87.812 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for M87.812?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For M87.812, V28 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis at RAF 0.479 while V24 mapped to Bone/Joint/Muscle Infections/Necrosis at RAF 0.401. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting M87.812?

Confirm left-sided involvement is clearly documented in the medical record Distinguish from secondary osteonecrosis codes (M87.2x) if an underlying cause is identified Because M87.812 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM M87.812: Other osteonecrosis, left

ICD-10-CM Code View

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Code lookupM87.812Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Other osteopathies (M86-M90)

M87.812

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other osteonecrosis, left shoulder

Death of bone tissue in the left shoulder joint from causes other than the typical classified causes.

Buddy Insight

This diagnosis represents osteonecrosis of the left shoulder from causes other than the typical classified causes, which can significantly impact upper extremity function and quality of life.

CMS-HCC V28

Mapped

HCC 92

Bone/Joint/Muscle/Severe Soft...

RAF 0.479

CMS-HCC V24

Mapped

HCC 39

Bone/Joint/Muscle Infections/...

RAF 0.401

ACA/HHS

Mapped

HCC 55

HHS-HCC 55

Varies by metal level

ESRD/PACE

Mapped

HCC 39

Bone/Joint/Muscle Infections/...

RAF 0.092

RXHCC

Mapped

HCC 80

Bone/Joint/Muscle Infections/...

RAF 0.204

Code Book Path

Official

M87.8Other osteonecrosis

M87.81Other osteonecrosis, shoulder

M87.812Other osteonecrosis, left shoulder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M87.812 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M87.812 in this effective period.

Related Child Codes

Official

M87.811Other osteonecrosis, right shoulder

M87.819Other osteonecrosis, unspecified shoulder

Includes

Official

ICD-10-CM does not list Includes notes for M87.812 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M87.812 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M87.812 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M87.812 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M87.812 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of osteonecrosis affecting left 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

MEAT Support

HCC Buddy guidance

Documentation of osteonecrosis affecting left 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

Audit Caution

HCC Buddy guidance

Confusing with secondary osteonecrosis when cause is typical

Mixing up laterality (left vs right shoulder)

Not documenting the specific non-secondary cause

Confusing with infectious or arthritic conditions

Common Mistakes

HCC Buddy guidance

M87.811 — Other osteonecrosis, right shoulder (different laterality)

M87.819 — Other osteonecrosis, unspecified shoulder (laterality not specified)

M87.312 — Other secondary osteonecrosis, left shoulder (secondary vs other causes)

M86.112 — Acute osteomyelitis of left shoulder (infection vs necrosis)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is M87.812 an HCC code?

Yes. M87.812 (Other osteonecrosis, left shoulder) maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24), with a community non-dual aged RAF of 0.479. It is billable for payment year 2026.

Coder answer: M87.812 is billable and maps to V28 HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: M87.812
Description: Other osteonecrosis, left shoulder
HCC (V28): HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
RAF: 0.479
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis

0.479

V24HCC 39, Bone/Joint/Muscle Infections/Necrosis

0.401

ESRDHCC 39, Bone/Joint/Muscle Infections/Necrosis

0.092

RxHCCHCC 80, Bone/Joint/Muscle Infections/Necrosis

0.204

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work M87.812 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M87.812

For M87.812 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 M87.812 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M87.812 is the ICD-10-CM diagnosis code for other osteonecrosis, left shoulder. Death of bone tissue in the left shoulder joint from causes other than the typical classified causes. M87.812 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, M87.812 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.479. Under the older CMS-HCC V24 model, M87.812 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 39) with a community, non-dual, aged base RAF weight of 0.401. 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 left-sided involvement is clearly documented in the medical record. Because M87.812 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 M87.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Confirm left-sided involvement is clearly documented in the medical record
•Distinguish from secondary osteonecrosis codes (M87.2x) if an underlying cause is identified

Clinical Significance

This diagnosis represents osteonecrosis of the left 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 left 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

Commonly Confused Codes

•M87.811: Other osteonecrosis, right shoulder (different laterality)
•M87.819: Other osteonecrosis, unspecified shoulder (laterality not specified)
•M87.312: Other secondary osteonecrosis, left shoulder (secondary vs other causes)
•M86.112: Acute osteomyelitis of left shoulder (infection vs necrosis)
•M19.012: Primary osteoarthritis of left shoulder (arthritis vs necrosis)