M89.619 ICD-10-CM Code: Osteopathy after poliomyelitis, unspecified shoulder
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)
M89.619
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOsteopathy after poliomyelitis, unspecified shoulder
Bone changes and deterioration in the shoulder area that develop as a long-term consequence of poliomyelitis (polio) infection, but the specific side is not documented.
Buddy Insight
Unspecified shoulder post-polio osteopathy represents bone deterioration in the shoulder region following poliomyelitis without documented laterality, potentially indicating bilateral involvement or incomplete documentation.
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
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M89.619 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M89.619 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M89.619 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M89.619 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M89.619 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M89.619 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M89.619 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 M89.619 an HCC code?
Yes. M89.619 (Osteopathy after poliomyelitis, unspecified shoulder) 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: M89.619 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
- M89.619
- Description
- Osteopathy after poliomyelitis, unspecified shoulder
- 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 M89.619 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M89.619
For M89.619 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 M89.619 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M89.619 is the ICD-10-CM diagnosis code for osteopathy after poliomyelitis, unspecified shoulder. Bone changes and deterioration in the shoulder area that develop as a long-term consequence of poliomyelitis (polio) infection, but the specific side is not documented. M89.619 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, M89.619 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, M89.619 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.
Use only when laterality cannot be determined; request clarification to assign M89.611 or M89.612 if possible. Because M89.619 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 M89.619 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Unspecified shoulder post-polio osteopathy represents bone deterioration in the shoulder region following poliomyelitis without documented laterality, potentially indicating bilateral involvement or incomplete documentation. This condition affects upper extremity function and requires comprehensive management.
Documentation Requirements
- ✓Clear history of previous poliomyelitis infection
- ✓Documentation of shoulder osteopathy without laterality specification
- ✓Assessment for bilateral shoulder involvement
- ✓Imaging studies of shoulder region showing post-polio changes
- ✓Functional evaluation of both upper extremities if bilateral
- ✓Pain assessment and activity limitations
- ✓Rehabilitation needs and adaptive strategies
- ✓Coordination with neurological post-polio syndrome care
Commonly Confused Codes
- •G14: Post-polio syndrome involves neurological rather than bone pathology
- •M25.519: Unspecified shoulder pain is symptomatic, not structural
- •M75.30: Calcific tendinitis affects soft tissue structures
- •M19.019: Primary osteoarthritis is degenerative, not post-infectious
- •M87.819: Other osteonecrosis has different underlying pathophysiology