M87.862
BillableOther osteonecrosis, left tibia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.862 an HCC code?
Yes. M87.862 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 M87.862
For M87.862 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 M87.862 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.862 is the ICD-10-CM diagnosis code for other osteonecrosis, left tibia. Death of bone tissue in the left tibia (shin bone) due to causes other than trauma or radiation. M87.862 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, M87.862 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, M87.862 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 the laterality is documented as left in the medical record before assigning this code. Because M87.862 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 M87.862 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the laterality is documented as left in the medical record before assigning this code
- •Investigate the underlying cause of osteonecrosis (idiopathic, corticosteroid use, sickle cell disease, etc.) for complete coding
Clinical Significance
Left tibial osteonecrosis indicates avascular bone death requiring intensive management to prevent joint collapse and preserve function. This chronic condition significantly affects patient mobility and may require surgical intervention including joint replacement.
Documentation Requirements
- ✓Specific anatomical location (left tibia) clearly documented
- ✓Radiological evidence of osteonecrosis (MRI preferred for early detection)
- ✓Exclusion of trauma, radiation, or infectious causes
- ✓Documentation of risk factors (corticosteroids, alcohol, connective tissue disorders)
- ✓Pain assessment and functional impact evaluation
- ✓Weight-bearing status and mobility restrictions
- ✓Staging of disease progression if available
- ✓Multidisciplinary care plan documentation