M87.822
BillableOther osteonecrosis, left humerus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.822 an HCC code?
Yes. M87.822 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 M87.822
For M87.822 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 M87.822 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.822 is the ICD-10-CM diagnosis code for other osteonecrosis, left humerus. Death of bone tissue in the left upper arm bone (humerus) from causes other than typical classified causes. M87.822 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, M87.822 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, M87.822 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-sided involvement is clearly documented in the clinical record. Because M87.822 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 M87.822 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left-sided involvement is clearly documented in the clinical record
- •This code applies to the entire humerus bone, not just the shoulder joint
Clinical Significance
This diagnosis represents osteonecrosis of the left humerus from causes other than the typical classified causes, which can significantly impact upper extremity function and potentially require surgical intervention. It requires identification of the underlying etiology and monitoring for progression.
Documentation Requirements
- ✓Documentation of osteonecrosis affecting left humerus
- ✓Clear description of the underlying cause (other than typical secondary causes)
- ✓Imaging findings confirming humeral bone necrosis (MRI, X-ray, CT)
- ✓Clinical symptoms such as arm pain, weakness, or limited range of motion
- ✓Specific location within humerus (proximal, mid-shaft, distal)
- ✓Functional limitations affecting arm use
- ✓Duration and progression of condition
- ✓Treatment history including conservative and surgical options
Commonly Confused Codes
- •M87.821 — Other osteonecrosis, right humerus (different laterality)
- •M87.829 — Other osteonecrosis, unspecified humerus (laterality not specified)
- •M87.322 — Other secondary osteonecrosis, left humerus (secondary vs other causes)
- •M86.122 — Acute osteomyelitis of left humerus (infection vs necrosis)
- •S42.202A — Unspecified fracture of upper end of left humerus (acute fracture vs necrosis)