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 [...]