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M87.261 ICD-10-CM Code: Osteonecrosis due to previous trauma, right tibia

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 3 Excludes1 · 1 use-additional code
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 39 · RxHCC V08 category 80

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 553 — BONE DISEASES AND ARTHROPATHIES WITH MCC (MDC 08)
  • MS-DRG 554 — BONE DISEASES AND ARTHROPATHIES WITHOUT MCC (MDC 08)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis

Other models: CMS-HCC V22 HCC 39 · RxHCC V08 HCC 80

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M87.261 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on M87.261 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • avascular necrosis of bone

Source: inherited from M87

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify major osseous defect, if applicable (M89.7-)

Source: inherited from M87

Coder workflow for M87.261

MedCoder structured workflow — derived from this code’s own official record

Before you code M87.261

  1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: right). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewM87.262 · left, M87.263 · unspecified

    Guide: Laterality coding →

  2. M87.261’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with M87.261. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in M87.261’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewM96

  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewM87.262 · left, M87.263 · unspecified

Consider M87.261. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting M87.261(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with M87.261: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareM96

    See the official tabular notes · Guidelines I.A.12.a

  • Use Additional Code — after identifying M87.261(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with M87.261 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewM89.7

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition M87.261 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewM96

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewM87.262 · left, M87.263 · unspecified

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is M87.261 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Osteonecrosis due to previous trauma, right tibia is a billable ICD-10-CM diagnosis code (M87.261).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

1) Bone versus joint For certain conditions, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81).

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  2. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name M87.261 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Code First instruction: M89.7 — Major osseous defect (via M87.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 217 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 553 (MDC 08), DRG 554 (MDC 08).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MUS030 — Aseptic necrosis and osteonecrosis (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

M87.241 — Osteonecrosis due to previous trauma, right hand, M87.242 — Osteonecrosis due to previous trauma, left hand, M87.243 — Osteonecrosis due to previous trauma, unspecified hand, M87.244 — Osteonecrosis due to previous trauma, right finger(s), M87.245 — Osteonecrosis due to previous trauma, left finger(s), M87.246 — Osteonecrosis due to previous trauma, unspecified finger(s), M87.250 — Osteonecrosis due to previous trauma, pelvis, M87.251 — Osteonecrosis due to previous trauma, right femur, M87.252 — Osteonecrosis due to previous trauma, left femur, M87.256 — Osteonecrosis due to previous trauma, unspecified femur, M87.262 — Osteonecrosis due to previous trauma, left tibia, M87.263 — Osteonecrosis due to previous trauma, unspecified tibia, M87.264 — Osteonecrosis due to previous trauma, right fibula, M87.265 — Osteonecrosis due to previous trauma, left fibula, M87.266 — Osteonecrosis due to previous trauma, unspecified fibula, M87.271 — Osteonecrosis due to previous trauma, right ankle, M87.272 — Osteonecrosis due to previous trauma, left ankle, M87.273 — Osteonecrosis due to previous trauma, unspecified ankle, M87.274 — Osteonecrosis due to previous trauma, right foot, M87.275 — Osteonecrosis due to previous trauma, left foot, +196 more

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

M87.262 — Osteonecrosis due to previous trauma, left tibia (left)Compare M87.261 vs M87.262 →, M87.263 — Osteonecrosis due to previous trauma, unspecified tibia (unspecified)Compare M87.261 vs M87.263 →

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis) for risk-adjusted payment.

M87.241 — Osteonecrosis due to previous trauma, right hand, M87.242 — Osteonecrosis due to previous trauma, left hand, M87.243 — Osteonecrosis due to previous trauma, unspecified hand, M87.244 — Osteonecrosis due to previous trauma, right finger(s), M87.245 — Osteonecrosis due to previous trauma, left finger(s), M87.246 — Osteonecrosis due to previous trauma, unspecified finger(s), M87.250 — Osteonecrosis due to previous trauma, pelvis, M87.251 — Osteonecrosis due to previous trauma, right femur, M87.252 — Osteonecrosis due to previous trauma, left femur, M87.256 — Osteonecrosis due to previous trauma, unspecified femur, M87.262 — Osteonecrosis due to previous trauma, left tibia, M87.263 — Osteonecrosis due to previous trauma, unspecified tibia, M87.264 — Osteonecrosis due to previous trauma, right fibula, M87.265 — Osteonecrosis due to previous trauma, left fibula, M87.266 — Osteonecrosis due to previous trauma, unspecified fibula, M87.271 — Osteonecrosis due to previous trauma, right ankle, M87.272 — Osteonecrosis due to previous trauma, left ankle, M87.273 — Osteonecrosis due to previous trauma, unspecified ankle, M87.274 — Osteonecrosis due to previous trauma, right foot, M87.275 — Osteonecrosis due to previous trauma, left foot, +588 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Aseptic necrosis and osteonecrosis).

M87.241 — Osteonecrosis due to previous trauma, right hand, M87.242 — Osteonecrosis due to previous trauma, left hand, M87.243 — Osteonecrosis due to previous trauma, unspecified hand, M87.244 — Osteonecrosis due to previous trauma, right finger(s), M87.245 — Osteonecrosis due to previous trauma, left finger(s), M87.246 — Osteonecrosis due to previous trauma, unspecified finger(s), M87.250 — Osteonecrosis due to previous trauma, pelvis, M87.251 — Osteonecrosis due to previous trauma, right femur, M87.252 — Osteonecrosis due to previous trauma, left femur, M87.256 — Osteonecrosis due to previous trauma, unspecified femur, M87.262 — Osteonecrosis due to previous trauma, left tibia, M87.263 — Osteonecrosis due to previous trauma, unspecified tibia, M87.264 — Osteonecrosis due to previous trauma, right fibula, M87.265 — Osteonecrosis due to previous trauma, left fibula, M87.266 — Osteonecrosis due to previous trauma, unspecified fibula, M87.271 — Osteonecrosis due to previous trauma, right ankle, M87.272 — Osteonecrosis due to previous trauma, left ankle, M87.273 — Osteonecrosis due to previous trauma, unspecified ankle, M87.274 — Osteonecrosis due to previous trauma, right foot, M87.275 — Osteonecrosis due to previous trauma, left foot, +258 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Osteonecrosis”; these codes share that main term but sit in a different category of the Tabular List.

D58.2 — Other hemoglobinopathies (secondary NEC, due to, hemoglobinopathy NEC), T70.3 — Caisson disease [decompression sickness] (secondary NEC, in, caisson disease)

Contextual Map

Every relationship of M87.261 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run M87.261 with this related code in Claim Check

Hierarchy

Referenced by Code First instructions

  • M89.7 — Major osseous defect[Code First](via M87.-): “aseptic necrosis of bone (M87.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 553 — BONE DISEASES AND ARTHROPATHIES WITH MCC[MS-DRG]: “BONE DISEASES AND ARTHROPATHIES WITH MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
  • DRG 554 — BONE DISEASES AND ARTHROPATHIES WITHOUT MCC[MS-DRG]: “BONE DISEASES AND ARTHROPATHIES WITHOUT MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

  • MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "M87.261 — Osteonecrosis due to previous trauma, right tibia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/m87.261-osteonecrosis-due-to-previous-trauma-right-tibia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Osteonecrosis due to previous trauma, right tibia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M87.261 in its code family, with their registry titles.

View all codes in the M87 family