M87.850 ICD-10-CM Code: Other osteonecrosis, pelvis
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Other osteopathies (M86-M90)
M87.850
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther osteonecrosis, pelvis
Death of bone tissue in the pelvis due to loss of blood supply, affecting the hip bone structure.
Buddy Insight
Osteonecrosis of the pelvis represents a serious condition affecting the hip bones and potentially compromising weight-bearing function and mobility.
CMS-HCC V28
MappedHCC 92
RAF 0.479
CMS-HCC V24
MappedHCC 39
RAF 0.401
ACA/HHS
MappedHCC 55
Varies by metal level
ESRD/PACE
MappedHCC 39
RAF 0.092
RXHCC
MappedHCC 80
RAF 0.204
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M87.850 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M87.850 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M87.850 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M87.850 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M87.850 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M87.850 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M87.850 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 M87.850 an HCC code?
Yes. M87.850 (Other osteonecrosis, pelvis) 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: M87.850 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
- M87.850
- Description
- Other osteonecrosis, pelvis
- HCC (V28)
- HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- RAF
- 0.479
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 M87.850 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M87.850
For M87.850 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 M87.850 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M87.850 is the ICD-10-CM diagnosis code for other osteonecrosis, pelvis. Death of bone tissue in the pelvis due to loss of blood supply, affecting the hip bone structure. M87.850 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, M87.850 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, M87.850 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.
Pelvic osteonecrosis is less common; ensure documentation clearly indicates pelvic involvement rather than femoral head. Because M87.850 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 M87.850 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Pelvic osteonecrosis is less common; ensure documentation clearly indicates pelvic involvement rather than femoral head
- •Consider associated conditions like sickle cell disease or prolonged corticosteroid use
Clinical Significance
Osteonecrosis of the pelvis represents a serious condition affecting the hip bones and potentially compromising weight-bearing function and mobility. This diagnosis has significant risk adjustment implications due to the complex care requirements, potential need for major surgical intervention, and impact on ambulation and quality of life.
Documentation Requirements
- ✓Specific identification of pelvic bone involvement in osteonecrosis
- ✓Documentation of causes other than idiopathic or drug-induced osteonecrosis
- ✓Advanced imaging (MRI, CT, bone scan) confirming pelvic bone necrosis
- ✓Clinical presentation including pelvic pain, hip dysfunction, and mobility limitations
- ✓Exclusion of infectious or traumatic causes as primary etiology
- ✓Assessment of impact on weight-bearing capacity and ambulation
- ✓Documentation of any underlying conditions or risk factors
- ✓Provider evaluation of treatment complexity and surgical considerations
Commonly Confused Codes
- •M87.050: Idiopathic aseptic necrosis of pelvis - specifically idiopathic etiology
- •M87.00: Idiopathic aseptic necrosis of unspecified bone - lacks specificity to pelvis
- •M86.850: Other osteomyelitis, pelvis - infectious bone disease rather than necrosis
- •S32.9XXA: Fracture of unspecified parts of pelvis - acute trauma rather than chronic necrosis
- •M25.55: Pain in hip - symptom rather than specific bone pathology