Pathology/Lab Coding Alert

Question: If pathologic findings from a bone marrow biopsy and immunohistochemistry indicate multiple myeloma, what ICD-9 code should we use if we don't have clinical information regarding remission or relapse?

Florida Subscriber

Answer: You should report 203.00 (Multiple myeloma without mention of having achieved remission) if you don't have clinical documentation of remission or relapse.

Multiple myeloma is a cancer of the plasma cells, which are immune system cells in bone marrow. Multiple myeloma is treatable and the patient can go into remission. Relapse following treatment is fairly normal and manifests differently than the initial disease not in remission.

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:

• Patient with primary disease NOT in remission

• Patient with primary disease undergoing first treatment

• The physician does not state the status of the patient's disease or condition

• The physician doesn't state if this is initial or primary treatment

• The physician doesn't state "in remission"

• The physician doesn't state "in relapse" (recurrent disease following previous treatment).

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

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.