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C92.40 ICD-10-CM Code: Acute promyelocytic leukemia, not having achieved remission

C92.40 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 · free HCC coding tools

ICD-10-CM Code View

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

Code lookupC92.40

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 the Bee presenting code insight

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.

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 008

Code-level coefficient reference

ESRD/PACE

HCC 8

Code-level coefficient reference

RXHCC

HCC 21

Code-level coefficient reference

Code Book Path

Official
C92Myeloid leukemiaC92.4Acute promyelocytic leukemiaC92.40Acute promyelocytic leukemia, not having achieved remission

Inclusion Terms

Official
  • Acute promyelocytic leukemia with failed remission
  • Acute promyelocytic leukemia NOS
  • AML M3Inherited from C92.4
  • AML Me with t(15;17) and variantsInherited from C92.4

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
C92.41Acute promyelocytic leukemia, in remissionC92.42Acute promyelocytic leukemia, in relapse

Includes

Official
  • granulocytic leukemiaInherited from C92
  • myelogenous leukemiaInherited from C92

Excludes 1

Official
  • personal history of leukemia (Z85.6)Inherited from C92

Code First

Official

No Code First sequencing instructions are included in this display for C92.40. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C92.40. 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 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.

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 C92.40 an HCC code?

Yes. C92.40 (Acute promyelocytic leukemia, not having achieved remission) 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: C92.40 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
C92.40
Description
Acute promyelocytic leukemia, not having achieved remission
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 8, Metastatic Cancer and Acute Leukemia
Not separately weighted
RxHCCHCC 21, Lymphomas and Other Hematologic Cancers
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 C92.40 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C92.40

For C92.40, 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

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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 Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. 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 documentation clearly states 'not in remission' or 'not having achieved remission' before assigning this code; if remission status is unclear, query the physician. For C92.40, 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 C92.40 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.

Child Codes

C92.40Acute promyelocytic leukemia, not having achieved remission
HCC 22
C92.41Acute promyelocytic leukemia, in remission
HCC 22
C92.42Acute promyelocytic leukemia, in relapse
HCC 22

Code Hierarchy

└C92Myeloid leukemia└C92.4Acute promyelocytic leukemia└C92.40Acute promyelocytic leukemia, not having achieved remission
└C92.40Acute promyelocytic leukemia, not having achieved remission

Also searched as

  • C92 40
  • C9240

For C92.40, 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.

C92.40 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 C92.40. 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 C92.40

Code family

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

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