Q92.61
BillableMarker chromosomes in normal individual
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q92.61 an HCC code?
No. Q92.61 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 Q92.61
For Q92.61to 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 Q92.61 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q92.61 is the ICD-10-CM diagnosis code for marker chromosomes in normal individual. Small extra chromosomal fragments (marker chromosomes) found in a person with otherwise normal chromosomal structure and no developmental abnormalities. Q92.61 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).
Q92.61 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 benign finding does not affect CMS-HCC risk scores and typically requires minimal ongoing medical management. Coders reviewing Q92.61 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 Q92.61 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates marker chromosomes in individuals with normal phenotype
- •Distinguish from Q92.62 which is used when marker chromosomes are associated with abnormalities
Clinical Significance
Marker chromosomes in phenotypically normal individuals represent incidental genetic findings that typically do not affect health but may have implications for genetic counseling and family planning. Documentation helps distinguish between clinically significant and benign chromosomal variants.
Documentation Requirements
- ✓Karyotype analysis showing marker chromosome presence
- ✓Documentation of normal phenotype
- ✓Absence of developmental delays or congenital anomalies
- ✓Reason for chromosomal analysis
- ✓Family history assessment
- ✓Genetic counseling regarding inheritance
- ✓Recommendations for offspring screening
- ✓Follow-up plan if any