Is M86.519 a billable ICD-10-CM code?

Yes. M86.519 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does M86.519 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other osteopathies (M86-M90).

What cannot be coded together with M86.519?

M86.519 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M86.519 (M86) and apply to it just the same.

M86.519

M86.519 — Other chronic hematogenous osteomyelitis, unspecified shoulder

Billable / specific codeICD-10-CMunspecified

M86.519 is a billable, specific ICD-10-CM code for other chronic hematogenous osteomyelitis, unspecified shoulder. It is valid for submission on a claim.

Excludes1 inherited from the categories above M86.519

These are not written on M86.519, but they bind it: a note on a category applies to every code beneath it. Billing M86.519 with anything listed here is a denial.

Written on M86 — Osteomyelitis

osteomyelitis due to:
echinococcus (B67.2)
gonococcus (A54.43)
salmonella (A02.24)

Excludes2 inherited from the categories above M86.519

Also inherited, and the opposite of Excludes1: these conditions are not part of M86.519, but a patient can have both, so you may code both.

Written on M86 — Osteomyelitis

ostemyelitis of:
orbit (H05.0-)
petrous bone (H70.2-)
vertebra (M46.2-)

Risk adjustment

M86.519 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis0.479 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

M86.519 is named in 7 Medicare coverage policies — 0 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered

Code history

M86.519 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share M86.51. If M86.519 is not quite right, the correct code is usually one of these.

Questions about M86.519

Is M86.519 a billable ICD-10-CM code?: Yes. M86.519 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does M86.519 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other osteopathies (M86-M90).
What cannot be coded together with M86.519?: M86.519 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M86.519 (M86) and apply to it just the same.