Wiki Monoclonal Gammopathy of Renal Significance (MGRS) Diagnosis Coding Help

[windysioux67@gmail.com]

I am struggling to adequately code MGRS, which is a subset of MGUS (Monoclonal Gammopathy of Unknown Significance). The only thing I can come up with is to code MGUS, Chronic Renal Failure (CRF), and Abnormal Plasma Protein (Elevated Free Light Chain). The NCCN guidelines for treating MGRS are found within the guide for Multiple Myeloma (MM). Following the pathway to treatment, for IgG, IgA, or Free Light Chain (FLC) MGRS, you are instructed to use the management algorithm for MM. Is it inappropriate to code for Multiple Myeloma, if that is the treatment pathway we are using? As a coder, ever fiber of my being tells me I cannot use a diagnosis that has not been pathologically confirmed. How would you code it, so the MM treatment would be covered by Medicare, but the patient has MGRS and not MM? Patient also does not have Amyloidosis, so FLC Amyloidosis is not exactly appropriate either. I appreciate any additional insight I can get.
Thank you,
Wendy B

 

[danachock]

Hi windysioux67@gmail.com
Wow - oh goodness, this coding scenario is absolutely brand new to me too - no kidding, I actually reviewed documentation with this very same diagnosis earlier this evening tending to a pathology denial (not related to this diagnosis). From my research - no, I have not found any documentation to support billing a Multiple Myeloma diagnosis (even if that is the treatment plan that is being followed by the provider), we would not want to assign that diagnosis code (especially if not confirmed and if it is a subset of MGUS). This is a completely new whirlwind (diagnosis) "in my opinion" within our coding industry that is always continuously changing that may possibly include new diagnosis code(s) for this very scenario in the future.

So, I will offer what I came up with earlier today reviewing/researching this scenario.
This is my homework on this coding scenario. For our coding colleagues, please just tell me if I'm wrong and why, if you disagree.
I am always very appreciative for additional resources to lean on in these coding areas.
My rationale is that the MGUS is of renal significance
Therefore, I reviewed my ICD book and came up with D47.2 (yes, we already know that this medical condition is a subset for MGUS - but we don't have a more medical specificity code to provide it reviewing the ICD book).
Renal significance I applied N08 as my second diagnosis for this coding scenario.
Inconclusion D47.2, D08 is how I would have coded this new discovery.

Again, if any of our coding colleagues have something to offer/provide on why this coding scenario isn't the proper diagnosis code assignment, please do share.
Thank you for listening have a great evening!

Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT