C92.40

HCC Category Mapping

What This Code Means

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.

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