M90.511
BillableOsteonecrosis in diseases classified elsewhere, right shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M90.511 an HCC code?
Yes. M90.511 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 M90.511
For M90.511 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 M90.511 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M90.511 is the ICD-10-CM diagnosis code for osteonecrosis in diseases classified elsewhere, right shoulder. Death of bone tissue in the right shoulder caused by another disease. M90.511 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, M90.511 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, M90.511 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.
Always code the underlying disease (such as sickle cell disease, HIV, or corticosteroid use) in addition to this code. Because M90.511 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 M90.511 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always code the underlying disease (such as sickle cell disease, HIV, or corticosteroid use) in addition to this code
- •Verify laterality is documented as right shoulder before assigning this specific code
Clinical Significance
Secondary osteonecrosis of the right shoulder indicates bone death in a weight-bearing joint caused by underlying systemic disease, requiring aggressive management to preserve joint function. This diagnosis represents significant morbidity with high healthcare resource utilization.
Documentation Requirements
- ✓Underlying disease causing osteonecrosis documented and coded first
- ✓Right shoulder specifically identified as affected site
- ✓Clinical evidence of bone necrosis in shoulder joint
- ✓Imaging studies confirming osteonecrosis (MRI, bone scan, or X-ray)
- ✓Functional assessment of shoulder mobility and strength
- ✓Treatment plan for both underlying condition and bone necrosis
- ✓Staging of osteonecrosis if applicable