Skip to content
HCC Buddy home

C92.12 ICD-10-CM Code: Chronic myeloid leukemia, BCR/ABL-positive, in relapse

C92.12 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupC92.12

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)

C92.12

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Chronic myeloid leukemia, BCR/ABL-positive, in relapse

A type of blood cancer (chronic myeloid leukemia) with a specific genetic mutation that has returned after initial treatment.

Buddy the Bee presenting code insight

Buddy Insight

Chronic myeloid leukemia, BCR/ABL-positive, in relapse indicates loss of previously achieved treatment response, which may manifest as hematologic, cytogenetic, or molecular relapse.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 22

Coefficient HCC 22: 0.363 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 009

Code-level coefficient reference

ESRD/PACE

HCC 9

Code-level coefficient reference

RXHCC

HCC 15

Code-level coefficient reference

Code Book Path

Official
C92Myeloid leukemiaC92.1Chronic myeloid leukemia, BCR/ABL-positiveC92.12Chronic myeloid leukemia, BCR/ABL-positive, in relapse

Inclusion Terms

Official
  • Chronic myelogenous leukemia, Philadelphia chromosome (Ph1) positiveInherited from C92.1
  • Chronic myelogenous leukemia, t(9;22) (q34;q11)Inherited from C92.1
  • Chronic myelogenous leukemia with crisis of blast cellsInherited from C92.1

Excludes 2

Official
  • Kaposi's sarcoma of lymph nodes (C46.3)Inherited from C81-C96
  • secondary and unspecified neoplasm of lymph nodes (C77.-)Inherited from C81-C96
  • secondary neoplasm of bone marrow (C79.52)Inherited from C81-C96
  • secondary neoplasm of spleen (C78.89)Inherited from C81-C96

Related Codes

Official
C92.10Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remissionC92.11Chronic myeloid leukemia, BCR/ABL-positive, in remission

Includes

Official
  • granulocytic leukemiaInherited from C92
  • myelogenous leukemiaInherited from C92

Excludes 1

Official
  • personal history of leukemia (Z85.6)Inherited from C92, C92.1
  • atypical chronic myeloid leukemia BCR/ABL-negative (C92.2-)Inherited from C92, C92.1
  • chronic myelomonocytic leukemia (C93.1-)Inherited from C92, C92.1
  • chronic myeloproliferative disease (D47.1)Inherited from C92, C92.1

Code First

Official

No Code First sequencing instructions are included in this display for C92.12. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C92.12. Check the code and parent instructions in the Code Book.

Code Also

Official
  • , if applicable, pancytopenia (acquired) (D61.818)Inherited from C92

Buddy Documentation Tip

HCC Buddy guidance
Documentation must confirm prior remission and evidence of relapse, including rising BCR-ABL1 transcript levels, loss of cytogenetic response, or hematologic recurrence.
BCR-ABL1 kinase domain mutation testing should be documented at relapse to guide TKI selection.
Current disease phase (chronic, accelerated, blast crisis) must be specified, as some relapses present with disease acceleration.

MEAT Support

HCC Buddy guidance
Documentation must confirm prior remission and evidence of relapse, including rising BCR-ABL1 transcript levels, loss of cytogenetic response, or hematologic recurrence.
BCR-ABL1 kinase domain mutation testing should be documented at relapse to guide TKI selection.
Current disease phase (chronic, accelerated, blast crisis) must be specified, as some relapses present with disease acceleration.

Audit Caution

HCC Buddy guidance
Distinguish between molecular relapse (rising BCR-ABL1 without hematologic changes), cytogenetic relapse, and hematologic relapse -
all warrant this code but have different clinical urgency. Loss of MMR after TKI discontinuation in treatment-free remission is a relapse even though it may respond to TKI reinitiation. BCR-ABL1 kinase domain mutation testing is essential at relapse to guide therapy. Do not assume the same TKI resistance profile as the original disease.

Common Mistakes

HCC Buddy guidance
C92.10 (CML not in remission) is for primary TKI failure without prior remission.
C92.11 (CML in remission) is for controlled disease.
C92.00 (acute myeloblastic leukemia) may apply if CML has progressed to myeloid blast crisis.
C92.22 (atypical CML in relapse) lacks the BCR/ABL positivity.

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 C92.12 an HCC code?

Yes. C92.12 (Chronic myeloid leukemia, BCR/ABL-positive, in relapse) maps to HCC 22, Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.363. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C92.12 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
C92.12
Description
Chronic myeloid leukemia, BCR/ABL-positive, in relapse
HCC (V28)
HCC 22 — Bladder, Colorectal, and Other Cancers
RAF reference coefficient
0.363
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers
0.363
ESRDHCC 9, Lung and Other Severe Cancers
Not separately weighted
RxHCCHCC 15, Chronic Myeloid Leukemia
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C92.12 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C92.12

For C92.12, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

C92.12 is the ICD-10-CM diagnosis code for chronic myeloid leukemia, bcr/abl-positive, in relapse. A type of blood cancer (chronic myeloid leukemia) with a specific genetic mutation that has returned after initial treatment. C92.12 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of lymphoid, hematopoietic and related tissue (c81-c96).

Under the CMS-HCC V28 risk adjustment model, C92.12 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for C92.12; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Verify BCR/ABL positivity is documented in the pathology report before assigning this code. For C92.12, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for C92.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Verify BCR/ABL positivity is documented in the pathology report before assigning this code
  • •Ensure relapse status is clearly documented; do not assume relapse without explicit physician documentation

Clinical Significance

Chronic myeloid leukemia, BCR/ABL-positive, in relapse indicates loss of previously achieved treatment response, which may manifest as hematologic, cytogenetic, or molecular relapse. CML relapse while on TKI therapy may indicate development of resistance mutations (e.g., T315I) and often requires switching to an alternative TKI or consideration of allogeneic transplant. Relapse after TKI discontinuation during treatment-free remission is also captured by this code.

Documentation Requirements

  • ✓Documentation must confirm prior remission and evidence of relapse, including rising BCR-ABL1 transcript levels, loss of cytogenetic response, or hematologic recurrence.
  • ✓BCR-ABL1 kinase domain mutation testing should be documented at relapse to guide TKI selection.
  • ✓Current disease phase (chronic, accelerated, blast crisis) must be specified, as some relapses present with disease acceleration.

Commonly Confused Codes

  • •C92.10 (CML not in remission) is for primary TKI failure without prior remission.
  • •C92.11 (CML in remission) is for controlled disease.
  • •C92.00 (acute myeloblastic leukemia) may apply if CML has progressed to myeloid blast crisis.
  • •C92.22 (atypical CML in relapse) lacks the BCR/ABL positivity.

Child Codes

C92.10Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
HCC 22
C92.11Chronic myeloid leukemia, BCR/ABL-positive, in remission
HCC 22
C92.12Chronic myeloid leukemia, BCR/ABL-positive, in relapse
HCC 22

Code Hierarchy

└C92Myeloid leukemia└C92.1Chronic myeloid leukemia, BCR/ABL-positive└C92.12Chronic myeloid leukemia, BCR/ABL-positive, in relapse
└C92.12Chronic myeloid leukemia, BCR/ABL-positive, in relapse

Also searched as

  • C92 12
  • C9212

For C92.12, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

C92.12 maps to CMS-HCC V28 category 22, Bladder, Colorectal, and Other Cancers. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for C92.12. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

More on C92.12

Code family

Every C92 code with its CMS-HCC V28 statusMyeloid leukemia, 30 billable codes

Work C92.12 in HCC Buddy

Open C92.12 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

Open in Code BookOpen in EncoderStart Pro