C92.92
BillableMyeloid leukemia, unspecified in relapse
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.92 an HCC code?
Yes. C92.92 maps to Lung and Other Severe Cancers under the CMS-HCC V28 risk adjustment model (and Lung and Other Severe Cancers 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 C92.92
For C92.92 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 C92.92 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.92 is the ICD-10-CM diagnosis code for myeloid leukemia, unspecified in relapse. A type of myeloid blood cancer that cannot be more specifically classified and has returned after a period of remission. C92.92 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, C92.92 maps to Lung and Other Severe Cancers (HCC 20) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, C92.92 mapped to the same category but with a base RAF weight of 0.973 — 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.
Ensure documentation clearly indicates relapse rather than initial presentation or persistent disease. Because C92.92 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 C92.92 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation clearly indicates relapse rather than initial presentation or persistent disease
- •Note the timeline between remission and relapse when available
Clinical Significance
Myeloid leukemia, unspecified, in relapse indicates recurrence of an unspecified myeloid leukemia after prior remission. At the relapse stage, the subtype should be well-characterized from prior diagnostic workup, making this unspecified code inappropriate in most clinical situations. Updated diagnostic testing at relapse should allow reclassification to a more specific code.
Documentation Requirements
- ✓Documentation must confirm prior remission and current relapse.
- ✓Updated bone marrow biopsy, cytogenetics, and molecular testing at relapse should be documented and will typically allow reclassification to a specific subtype.
- ✓Prior treatment history, duration of remission, and salvage treatment plan must be recorded.
- ✓Query the provider for subtype clarification if not documented.
Commonly Confused Codes
- •More specific relapse codes should be used: C92.02 (AML in relapse), C92.12 (CML in relapse), C92.42 (APL in relapse), C92.52 (AMML in relapse).
- •C92.90 (myeloid leukemia, unspecified, not in remission) should not be used interchangeably with relapse.
- •C95.92 (leukemia, unspecified, in relapse) is even less specific.