ICD Code C90.00

ICD code C90.00 is used to classify and document cases of multiple myeloma where the patient has not yet achieved remission. Multiple myeloma is a type of cancer that affects plasma cells in the bone marrow, and this specific code indicates that the disease is still active and has not responded to treatment to the point of remission. This code is crucial for healthcare providers to accurately record the patient's current health status and to guide ongoing treatment and management strategies.

When using the ICD code for multiple myeloma not having achieved remission, healthcare providers should consider the following diagnostic criteria and symptoms:

1. Presence of Monoclonal Protein (M Protein): Detection of M protein in the blood or urine, which is a hallmark of multiple myeloma.

2. Bone Marrow Plasma Cell Percentage: Bone marrow biopsy showing 10% or more clonal plasma cells, indicating active disease.

3. CRAB Criteria:

• Calcium Elevation: Hypercalcemia, with serum calcium levels above the normal range.
• Renal Insufficiency: Evidence of kidney dysfunction, often indicated by elevated serum creatinine levels.
• Anemia: Hemoglobin levels below the normal range, often resulting in fatigue and weakness.
• Bone Lesions: Presence of lytic bone lesions or osteoporosis, often confirmed through imaging studies such as X-rays, CT scans, or MRIs.

4. Recurrent Infections: Increased susceptibility to infections due to compromised immune function.

5. Hyperviscosity Syndrome: Symptoms such as blurred vision, headaches, or dizziness due to increased blood viscosity.

6. Neurological Symptoms: Peripheral neuropathy or other neurological manifestations related to the disease.

7. Unexplained Weight Loss: Significant and unintentional weight loss over a short period.

8. Fatigue and Weakness: Persistent fatigue not attributable to other causes, impacting daily activities.

9. Laboratory Findings: Abnormal laboratory results, including elevated beta-2 microglobulin and decreased albumin levels.

10. Absence of Remission: Lack of response to treatment, with persistent or progressive disease symptoms and laboratory findings.

Healthcare providers should use this ICD code when these criteria are met, indicating that the patient has multiple myeloma that has not achieved remission. Proper documentation and coding are essential for accurate billing and effective management of the patient's condition.

For the ICD code C90.00, which pertains to multiple myeloma not having achieved remission, the relevant CPT codes that may be applicable for treatment and management include:

1. CPT 96413 - Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug.

2. CPT 96415 - Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary procedure).

3. CPT 96417 - Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour.

4. CPT 96365 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.

5. CPT 96366 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure).

6. CPT 96367 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour.

7. CPT 96372 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.

8. CPT 38220 - Bone marrow aspiration only.

9. CPT 38221 - Bone marrow biopsy, needle or trocar.

10. CPT 38222 - Diagnostic bone marrow; biopsy(ies) and aspiration(s).

These CPT codes are commonly used in the treatment and management of multiple myeloma, particularly when the condition has not achieved remission. It is important for healthcare providers to select the appropriate codes based on the specific services rendered to ensure accurate billing and reimbursement.

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