C92.40
BillableAcute promyelocytic leukemia, not having achieved remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
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
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 C92.40 to 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.