Q92.5
BillableDuplications with other complex rearrangements
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q92.5 an HCC code?
No. Q92.5 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 Q92.5
For Q92.5to 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 Q92.5 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q92.5 is the ICD-10-CM diagnosis code for duplications with other complex rearrangements. A chromosomal abnormality involving duplicated chromosome segments combined with other structural rearrangements or abnormalities of the chromosomes. Q92.5 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).
Q92.5 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. Despite the complex genetics and individualized care needs, this condition does not contribute to CMS-HCC risk adjustment. Coders reviewing Q92.5 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 Q92.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is used when duplications occur alongside other complex chromosomal changes
- •Genetic counseling documentation should be reviewed for complete clinical picture
Clinical Significance
Duplications with complex chromosomal rearrangements represent highly individualized genetic conditions that may have unpredictable phenotypic effects. These cases require specialized genetic analysis and individualized management approaches based on the specific genes and regulatory regions involved.
Documentation Requirements
- ✓Detailed chromosomal analysis showing complex rearrangement
- ✓Documentation of all structural abnormalities present
- ✓Breakpoint analysis results
- ✓Gene content analysis of affected regions
- ✓Clinical phenotype assessment
- ✓Comparison with similar reported cases
- ✓Genetic counseling documentation
- ✓Recommendations for family screening
Code Also
- any associated deletions due to unbalanced translocations, inversions and insertions (Q93.7)