C92.42
BillableAcute promyelocytic leukemia, in relapse
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.42 an HCC code?
Yes. C92.42 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 C92.42
For C92.42 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 C92.42 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.42 is the ICD-10-CM diagnosis code for acute promyelocytic leukemia, in relapse. A rapidly developing blood cancer with abnormal promyelocytes that has returned after remission. C92.42 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, C92.42 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, C92.42 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.
APL relapse requires urgent treatment; ensure relapse is clearly documented. Because C92.42 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 C92.42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •APL relapse requires urgent treatment; ensure relapse is clearly documented
- •Document prior remission status to support the relapse designation
Clinical Significance
Acute promyelocytic leukemia in relapse indicates molecular or hematologic recurrence after prior remission. APL relapse occurs in approximately 10-15% of patients and may present with molecular relapse (rising PML-RARA transcripts) before hematologic relapse. Relapsed APL can be retreated successfully with arsenic trioxide-based regimens, and second complete molecular remissions are achievable, often followed by autologous or allogeneic stem cell transplantation.
Documentation Requirements
- ✓Documentation must confirm prior molecular remission and evidence of relapse, either molecular (reappearance of PML-RARA by PCR on two successive samples) or hematologic (rising blasts, recurrent DIC).
- ✓Coagulation studies at relapse should be documented given the renewed DIC risk.
- ✓Prior treatment history, interval since remission, and salvage treatment plan (arsenic trioxide-based, transplant consideration) must be recorded.