M89.612
BillableOsteopathy after poliomyelitis, left shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M89.612 an HCC code?
Yes. M89.612 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 M89.612
For M89.612 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 M89.612 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M89.612 is the ICD-10-CM diagnosis code for osteopathy after poliomyelitis, left shoulder. Bone changes and deterioration in the left shoulder that develop as a long-term consequence of poliomyelitis (polio) infection. M89.612 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, M89.612 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, M89.612 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.
Confirm left shoulder is documented; right shoulder would use M89.611. Because M89.612 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 M89.612 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left shoulder is documented; right shoulder would use M89.611
- •Consider documenting impact on upper extremity function and any associated muscle weakness from original polio
Clinical Significance
Left shoulder post-polio osteopathy involves chronic bone changes in the left shoulder following poliomyelitis infection, potentially compromising upper extremity function and requiring ongoing orthopedic care. This represents a late sequela of infectious disease with lasting musculoskeletal impact.
Documentation Requirements
- ✓Documented history of previous poliomyelitis infection
- ✓Specific identification of left shoulder bone involvement
- ✓Imaging evidence of post-polio osteopathic changes
- ✓Functional assessment of left upper extremity
- ✓Pain quantification and impact on daily activities
- ✓Rehabilitation therapy needs and response
- ✓Assistive device requirements and mobility aids
- ✓Integration with overall post-polio syndrome management
Commonly Confused Codes
- •G14 — Post-polio syndrome primarily neurological, not bone pathology
- •M25.512 — Left shoulder pain is symptomatic presentation
- •M75.32 — Calcific tendinitis affects soft tissue, not bone
- •M19.012 — Primary osteoarthritis lacks post-infectious etiology
- •M87.812 — Other osteonecrosis has different pathophysiology