C92.42 ICD-10-CM Code: Acute promyelocytic leukemia, in relapse
C92.42 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)
C92.42
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute promyelocytic leukemia, in relapse
A rapidly developing blood cancer with abnormal promyelocytes that has returned after remission.
Buddy Insight
Acute promyelocytic leukemia in relapse indicates molecular or hematologic recurrence after prior remission.
CMS-HCC V28
MappedHCC 22
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 008
Code-level coefficient reference
ESRD/PACE
MappedHCC 8
Code-level coefficient reference
RXHCC
MappedHCC 21
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- AML M3
- AML Me with t(15;17) and variants
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for C92.42 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for C92.42 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for C92.42 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for C92.42 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for C92.42 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for C92.42 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 C92.42 an HCC code?
Yes. C92.42 (Acute promyelocytic leukemia, in relapse) 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: C92.42 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
- C92.42
- Description
- Acute promyelocytic leukemia, in relapse
- HCC (V28)
- HCC 22 — Bladder, Colorectal, and Other Cancers
- RAF reference coefficient
- 0.363
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 C92.42 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
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.
Coder workflow notes
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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 Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for C92.42; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.
APL relapse requires urgent treatment; ensure relapse is clearly documented. Because C92.42 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 C92.42 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.