Q92.1
BillableWhole chromosome trisomy, mosaicism (mitotic nondisjunction)
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q92.1 an HCC code?
No. Q92.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 Q92.1
For Q92.1to 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 Q92.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q92.1 is the ICD-10-CM diagnosis code for whole chromosome trisomy, mosaicism (mitotic nondisjunction). A chromosomal condition where a person has three copies of an entire chromosome instead of the normal two, with some cells having the extra chromosome and others not (mosaic pattern). Q92.1 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering chromosomal abnormalities, not elsewhere classified (q90-q99).
Q92.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Maps to RxHCC 148 (Mild Intellectual Disabilities) with RAF weight 0.0 in the RxHCC model only. This condition does not affect CMS-HCC risk scores despite ongoing medical management and developmental support needs. Coders reviewing Q92.1 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC — capturing the correct specificity is the highest-leverage RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q92.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify which chromosome is affected (e.g., trisomy 21, 18, or 13) if documented
- •Distinguish between mosaicism (some cells affected) and non-mosaic forms for accurate coding
Clinical Significance
Whole chromosome trisomy with mosaicism typically results in milder phenotypic expression than complete trisomy, as some cells maintain normal chromosome complement. The percentage of trisomic cells and specific chromosome involved significantly influence clinical presentation and long-term outcomes.
Documentation Requirements
- ✓Karyotype showing mosaic trisomy pattern
- ✓Documentation of mitotic nondisjunction mechanism
- ✓Percentage of trisomic vs normal cell lines
- ✓Specific chromosome identification
- ✓Clinical phenotype assessment
- ✓Comparison with complete trisomy features
- ✓Developmental potential evaluation
- ✓Long-term monitoring plan