C92.60
BillableAcute myeloid leukemia with 11q23-abnormality not having achieved remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.60 an HCC code?
Yes. C92.60 maps to Metastatic Cancer and Acute Leukemia 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 C92.60
For C92.60 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 C92.60 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.60 is the ICD-10-CM diagnosis code for acute myeloid leukemia with 11q23-abnormality not having achieved remission. A specific type of acute myeloid leukemia with a chromosomal abnormality (11q23) that has not responded adequately to initial treatment. C92.60 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, C92.60 maps to Metastatic Cancer and Acute Leukemia (HCC 17) with a community, non-dual, aged base RAF weight of 0.368. Under the older V24 model, C92.60 mapped to the same category but with a base RAF weight of 2.484 — V28 recalibrated weights across the entire model. 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.
The 11q23-abnormality is a cytogenetic finding that should be documented in the pathology report. Because C92.60 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 C92.60 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The 11q23-abnormality is a cytogenetic finding that should be documented in the pathology report
- •This code indicates the patient has not achieved remission status after treatment attempts
Clinical Significance
Acute myeloid leukemia with 11q23-abnormality represents a cytogenetically defined AML subtype involving rearrangements of the KMT2A (MLL) gene at chromosome 11q23. This abnormality is found in approximately 5-10% of adult AML cases and is associated with monocytic differentiation, extramedullary disease, and intermediate-to-poor prognosis depending on the specific fusion partner. The 'not in remission' designation indicates active disease not responding to treatment.
Documentation Requirements
- ✓Documentation must confirm the 11q23/KMT2A rearrangement by cytogenetics or FISH, specifying the fusion partner gene when identified (common partners include MLLT3/AF9, MLLT1/ENL, MLLT4/AF6).
- ✓Active disease status, blast percentage, and monocytic component should be documented.
- ✓Treatment response assessment and current therapeutic plan must be recorded.
- ✓Additional molecular mutations (FLT3, NPM1) should be documented when tested.
Commonly Confused Codes
- •C92.00 (acute myeloblastic leukemia, not in remission) is less specific and does not capture the 11q23 abnormality.
- •C92.50 (acute myelomonocytic leukemia) may overlap clinically due to monocytic features.
- •C92.40 (acute promyelocytic leukemia) has a different cytogenetic abnormality.
- •C92.A0 (AML with multilineage dysplasia) is a different morphologic subtype.
- •C91.00 (ALL with 11q23) may occur in infants/children and should not be confused.