What is ICD-10 code C92.40?

C92.40 is the ICD-10-CM diagnosis code for Acute promyelocytic leukemia, not having achieved remission. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C92.40 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C92.40 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C92.40 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C92.40 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for C92.40?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C92.40, V28 maps to Colorectal, Bladder, and Other Cancers at RAF 0.000 while V24 mapped to Metastatic Cancer and Acute Leukemia at RAF 2.484. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting C92.40?

Verify documentation clearly states 'not in remission' or 'not having achieved remission' before assigning this code; if remission status is unclear, query the physician This code is specific to acute promyelocytic leukemia (APL) - do not use for other acute myeloid leukemia subtypes; ensure the leukemia type is confirmed in the medical record Because C92.40 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

C92.40 ICD-10 Code: Acute promyelocytic leukemia,

ICD-10-CM Code View

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Code lookupC92.40Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C92.40

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

Acute promyelocytic leukemia, not having achieved remission

This is a type of blood cancer where immature cells called promyelocytes grow uncontrollably in the bone marrow, and the patient has not yet responded to treatment or achieved remission. It is an aggressive form of leukemia that requires immediate medical intervention.

Buddy Insight

Acute promyelocytic leukemia (APL), not in remission, is a distinct subtype of AML characterized by the t(15;17) translocation creating the PML-RARA fusion gene.

CMS-HCC V28

Mapped

HCC 22

Colorectal, Bladder, and Othe...

RAF 0.0

CMS-HCC V24

Mapped

HCC 8

Metastatic Cancer and Acute L...

RAF 2.484

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 8

Metastatic Cancer and Acute L...

RAF 0.0

RXHCC

Mapped

HCC 21

Hodgkin Lymphoma and Other Ca...

RAF 0.0

Code Trumping

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Code Book Path

Official

C92Myeloid leukemia

C92.4Acute promyelocytic leukemia

C92.40Acute promyelocytic leukemia, not having achieved remission

Inclusion Terms

Official

Acute promyelocytic leukemia with failed remission
Acute promyelocytic leukemia NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C92.40 in this effective period.

Related Child Codes

Official

C92.41Acute promyelocytic leukemia, in remission

C92.42Acute promyelocytic leukemia, in relapse

Includes

Official

ICD-10-CM does not list Includes notes for C92.40 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C92.40 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C92.40 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C92.40 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C92.40 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must confirm the PML-RARA fusion by cytogenetics, FISH, or molecular testing.

The coagulation profile (DIC parameters) and bleeding complications should be documented.

Disease status as not in remission must be explicitly stated, along with treatment (ATRA/arsenic trioxide-based vs.

chemotherapy-based) and response assessment.

MEAT Support

HCC Buddy guidance

Documentation must confirm the PML-RARA fusion by cytogenetics, FISH, or molecular testing.

The coagulation profile (DIC parameters) and bleeding complications should be documented.

Disease status as not in remission must be explicitly stated, along with treatment (ATRA/arsenic trioxide-based vs.

chemotherapy-based) and response assessment.

Audit Caution

HCC Buddy guidance

APL must be suspected and treated on clinical suspicion (hypergranular promyelocytes, DIC) before molecular confirmation, as delays increase hemorrhagic death risk.

The microgranular variant of APL may be morphologically subtle but still carries the PML-RARA fusion.

Do not confuse APL differentiation syndrome (a treatment complication) with active disease.

Accurate subtype coding is critical because APL treatment is fundamentally different from other AML subtypes.

Common Mistakes

HCC Buddy guidance

C92.00 (acute myeloblastic leukemia, not in remission) is for non-APL AML subtypes.

C92.50 (acute myelomonocytic leukemia) has monocytic differentiation.

C92.60 (AML with 11q23-abnormality) is a different cytogenetically defined subtype.

C92.A0 (AML with multilineage dysplasia) has myelodysplastic features.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is C92.40 an HCC code?

Yes. C92.40 maps to Colorectal, Bladder, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Metastatic Cancer and Acute Leukemia under V24).

HCC Category Mapping

V28HCC 22 — Colorectal, Bladder, and Other Cancers

0.000

V24HCC 8 — Metastatic Cancer and Acute Leukemia

2.484

ESRDHCC 8 — Metastatic Cancer and Acute Leukemia

0.000

RxHCCHCC 21 — Hodgkin Lymphoma and Other Cancers

0.000

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 C92.40

For C92.40to 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 C92.40 during that encounter — not just copy-forwarded from a problem list.

What This Code Means

C92.40 is the ICD-10-CM diagnosis code for acute promyelocytic leukemia, not having achieved remission. This is a type of blood cancer where immature cells called promyelocytes grow uncontrollably in the bone marrow, and the patient has not yet responded to treatment or achieved remission. It is an aggressive form of leukemia that requires immediate medical intervention. C92.40 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, C92.40 maps to Colorectal, Bladder, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, C92.40 maps to Metastatic Cancer and Acute Leukemia (HCC 8) with a community, non-dual, aged base RAF weight of 2.484. 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.

Verify documentation clearly states 'not in remission' or 'not having achieved remission' before assigning this code; if remission status is unclear, query the physician. Because C92.40 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 C92.40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation clearly states 'not in remission' or 'not having achieved remission' before assigning this code; if remission status is unclear, query the physician
•This code is specific to acute promyelocytic leukemia (APL) - do not use for other acute myeloid leukemia subtypes; ensure the leukemia type is confirmed in the medical record

Clinical Significance

Acute promyelocytic leukemia (APL), not in remission, is a distinct subtype of AML characterized by the t(15;17) translocation creating the PML-RARA fusion gene. APL is a medical emergency due to the high risk of fatal hemorrhage from associated disseminated intravascular coagulation (DIC). However, APL has the best prognosis among AML subtypes when promptly treated with all-trans retinoic acid (ATRA) and arsenic trioxide, with cure rates exceeding 90%.

Documentation Requirements

✓Documentation must confirm the PML-RARA fusion by cytogenetics, FISH, or molecular testing.
✓The coagulation profile (DIC parameters) and bleeding complications should be documented.
✓Disease status as not in remission must be explicitly stated, along with treatment (ATRA/arsenic trioxide-based vs.
✓chemotherapy-based) and response assessment.
✓Document any delay in ATRA initiation, as prompt treatment is critical.

Commonly Confused Codes

•C92.00 (acute myeloblastic leukemia, not in remission) is for non-APL AML subtypes.
•C92.50 (acute myelomonocytic leukemia) has monocytic differentiation.
•C92.60 (AML with 11q23-abnormality) is a different cytogenetically defined subtype.
•C92.A0 (AML with multilineage dysplasia) has myelodysplastic features.
•Using the wrong AML subtype code for APL can result in incorrect treatment protocols.