C92.42

HCC Category Mapping

What This Code Means

A rapidly developing blood cancer with abnormal promyelocytes that has returned after remission.

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.

Commonly Confused Codes