Oncology & Hematology Coding Alert

Simplify your coding choices when documentation doesnt go into specifics.

ICD-9 2009 broadened your coding options for multiple myeloma. Follow this expert advice to take full advantage of the fifth digit changes.

The diagnosis: Multiple myeloma is a cancer of the plasma cells, which are immune system cells in bone marrow, according to Brenda Chidester-Palmer, CPC-I,CCS-P, in her Oncology and Hematology 2009 ICD-9 Updates presentation at The Coding Institutes December 2008 Oncology and Hematology Coding and Reimbursement Conference.

Treatments include chemotherapy, steroids, stem cell transplants, and thalidomide, Chidester-Palmer says.Although multiple myeloma is incurable, the patient can go into remission, she adds.

Relapse following treatment is fairly normal and is different than the initial disease not in remission, Chidester-Palmer says. Treatment can vary depending on the patients prior treatments and condition and how long remission lasted.

Heres How to Apply ICD-9 Options

ICD-9 2009 offers three fifth-digit options that apply to 203.xx (Multiple myeloma and immunoproliferative neoplasms):

" 0 -- Without mention of having achieved remission

" 1 -- In remission

" 2 -- In relapse.

0 tip: You should use the 0 fifth digit in the following situations, Chidester-Palmer says:

" You are treating the primary disease NOT in remission

" You are treating the initial phase of the disease (theinitial or first treatment)

" The physician does not state the status of the patients disease or condition

" The physician doesnt state if this is initial or primary treatment

" The physician doesnt state in remission

" The physician doesnt state in relapse (recurrent disease following previous treatment).

And a note in the ICD-9 manual clarifies that failed remission qualifies as another reason to report fifth digit 0.

Example: The diagnosis code for a patient who has just been diagnosed with multiple myeloma and is receiving his first treatment would be 203.00 (Multiple myeloma; without mention of having achieved remission).

Resource: To order recordings of the conference sessions, go to www.codingconferences.com.