C94.02 ICD-10-CM Code: Acute erythroid leukemia, in relapse
C94.02 maps to CMS-HCC V28 17. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)
C94.02
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute erythroid leukemia, in relapse
A rare blood cancer where immature red blood cell precursors multiply uncontrollably, and the cancer has returned after previous treatment.
Buddy Insight
Acute erythroid leukemia in relapse represents one of the most challenging clinical scenarios in hematologic oncology, as this already-rare subtype demonstrates high resistance to salvage chemotherapy upon recurrence.
CMS-HCC V28
MappedHCC 17
Coefficient HCC 17: 4.209 (Community Non-Dual Aged (CNA))
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 19
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Acute myeloid leukemia M6(a)(b)Inherited from C94.0
- ErythroleukemiaInherited from C94.0
Excludes 2
Official- Kaposi's sarcoma of lymph nodes (C46.3)Inherited from C81-C96
- secondary and unspecified neoplasm of lymph nodes (C77.-)Inherited from C81-C96
- secondary neoplasm of bone marrow (C79.52)Inherited from C81-C96
- secondary neoplasm of spleen (C78.89)Inherited from C81-C96
Related Codes
Includes
OfficialNo Includes notes are included in this display for C94.02. Check the code and parent instructions in the Code Book.
Excludes 1
Official- leukemic reticuloendotheliosis (C91.4-)Inherited from C94
- myelodysplastic syndromes (D46.-)Inherited from C94
- personal history of leukemia (Z85.6)Inherited from C94
- plasma cell leukemia (C90.1-)Inherited from C94
Code First
OfficialNo Code First sequencing instructions are included in this display for C94.02. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for C94.02. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for C94.02. Check the code and parent instructions in the Code Book.
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 C94.02 an HCC code?
Yes. C94.02 (Acute erythroid leukemia, in relapse) maps to HCC 17, Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 4.209. 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: C94.02 is billable and maps to V28 HCC 17, Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- C94.02
- Description
- Acute erythroid leukemia, in relapse
- HCC (V28)
- HCC 17 — Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic
- RAF reference coefficient
- 4.209
- 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 C94.02 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for C94.02
For C94.02, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
C94.02 is the ICD-10-CM diagnosis code for acute erythroid leukemia, in relapse. A rare blood cancer where immature red blood cell precursors multiply uncontrollably, and the cancer has returned after previous treatment. C94.02 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, C94.02 maps to Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic (HCC 17) with a source-labeled community, non-dual, aged reference coefficient of 4.209. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Verify documentation confirms relapse status and that initial remission was achieved before coding this code. For C94.02, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 C94.02 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Acute erythroid leukemia in relapse represents one of the most challenging clinical scenarios in hematologic oncology, as this already-rare subtype demonstrates high resistance to salvage chemotherapy upon recurrence. Treatment options are limited and may include investigational agents or allogeneic stem cell transplantation if feasible.
Documentation Requirements
- ✓Documentation must establish prior remission followed by disease recurrence, with bone marrow findings showing recurrence of erythroid predominant blasts.
- ✓The time to relapse, current blast percentage, cytogenetic changes from original diagnosis, and planned salvage approach should all be documented.