ICD-10 M86.471
Billable / Specific HCC v28: 39 CCChronic osteomyelitis with draining sinus, right ankle and foot
About ICD-10-CM M86.471
ICD-10-CM code M86.471 represents Chronic osteomyelitis with draining sinus, right ankle and foot. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M86). The 2026 edition of ICD-10-CM M86.471 became effective on October 1, 2025.
Coding Tips for M86.471
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M86.471 is a CMS-HCC v28 risk-adjustment code (category 39). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
M86.471 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Chronic osteomyelitis with draining sinus, right ankle and foot. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for M86.471
Local Coverage Determinations (LCDs) from CMS MACs that list M86.471 as a covered diagnosis.
Showing top 10 of 26 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M86.471.
2 Medicare
1 Aetna
CPT Codes Commonly Billed with M86.471
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 78459 CMS LCD: Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection CMS LCD
- 78429 CMS LCD: Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection CMS LCD
- 78432 CMS LCD: Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection CMS LCD
- 78433 CMS LCD: Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection CMS LCD
Convert M86.471 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| M86.471 | 73017 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M86.471
Other codes in section M86-M90 (Other osteopathies).
ICD-10 M86.471, Billing FAQ
Is ICD-10 code M86.471 billable? +
Yes, M86.471 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M86.471 affect Medicare Advantage HCC risk adjustment? +
Yes. M86.471 maps to CMS-HCC v28 category 39. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is M86.471 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with M86.471? +
Procedures frequently paired with M86.471 include: 78459, 78429, 78432, 78433.
What ICD-9 codes does M86.471 map to? +
Per CMS GEMs, M86.471 maps to ICD-9 codes: 73017. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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