M87.829
BillableOther osteonecrosis, unspecified humerus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.829 an HCC code?
Yes. M87.829 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 M87.829
For M87.829 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 M87.829 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.829 is the ICD-10-CM diagnosis code for other osteonecrosis, unspecified humerus. Death of bone tissue in the upper arm bone (humerus) from causes other than typical classified causes, where the specific side is not identified. M87.829 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, M87.829 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, M87.829 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.
Use only when laterality is not documented or cannot be determined. Because M87.829 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 M87.829 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality is not documented or cannot be determined
- •Always attempt to clarify whether the right or left humerus is affected for more specific coding
Clinical Significance
Other osteonecrosis of the humerus represents a serious bone condition that can lead to joint collapse, chronic pain, and functional disability. This diagnosis is significant for risk adjustment as it indicates a chronic condition requiring ongoing orthopedic care, potential surgical intervention, and long-term monitoring for complications.
Documentation Requirements
- ✓Clear identification of osteonecrosis affecting the humerus
- ✓Documentation that the cause is not trauma-related or infectious
- ✓Specification that laterality (right or left) is unspecified or unknown
- ✓Evidence from imaging studies (MRI, X-ray, CT scan) confirming bone necrosis
- ✓Clinical symptoms such as pain, limited range of motion, or functional impairment
- ✓Exclusion of other specific causes of osteonecrosis (drug-induced, alcohol-related, etc.)
- ✓Provider assessment of the extent and severity of bone involvement
- ✓Documentation of any underlying conditions contributing to osteonecrosis