Monoclonal gammopathy of undetermined significance (MGUS)
|Dx:||Monoclonal gammopathy of undetermined significance (MGUS)|
|Pre-ICD10 counterpart:||Monoclonal Gammopathy|
|APACHE Como Component:||none|
|APACHE Acute Component:||none|
|External ICD10 Documentation|
This diagnosis is a part of ICD10 collection.
Monoclonal gammopathy of undetermined significance (MGUS, unknown or uncertain may be substituted for undetermined), formerly benign monoclonal gammopathy, is a condition in which an abnormal immunoglobin protein (known as a paraprotein) is found in the blood during standard laboratory blood tests. MGUS resembles multiple myeloma and similar diseases, but the levels of antibody are lower, the number of plasma cells (white blood cells that secrete antibodies) in the bone marrow is lower, and it has no symptoms or major problems. However, multiple myeloma develops at the rate of about 1.5% a year, so doctors recommend monitoring it yearly.
The progression from MGUS to multiple myeloma usually involves several steps. In rare cases, it may also be related with a slowly progressive symmetric distal sensorimotor neuropathy. Not to be confused with Monoclonal gammopathy.
Using ICD10 Malignancy Codes as a Comorbid Diagnosis
- Any cancer/malignancy (either a "solid tumor" or a leukemia/lymphoma/bone marrow malignancy/"liquid tumor", i.e. any ICD10 code from C00-C99) can be a comorbid diagnosis --- BUT it's vital to distinguish malignancies in this category based on whether they are believed to be cured or not.
- If it's still present (or believed to be present), then just include the code for the specific cancer as a comorbid diagnosis.
- If INSTEAD, it's presumed cured, then in the "bin" of comorbid diagnoses combine the code for the specific cancer with this code: Past history, cancer (any type), believed cured
Regarding Presumptive Diagnosis of Malignancy
- Rarely a presumptive diagnosis is made without any tissue confirmation. This generally occurs with:
- risk of obtaining tissue is very high
- plan would be palliative regardless
- patient would refuse care regardless.
- Our issue for how to code a presumed malignancy without definitive histopathologic proof is this:
- If the physicians are going to proceed with a treatment plan without that definitive histopathologic proof --- then code whatever is their best guess about what is present. Example: believed to be lung cancer with a big brain met, and they've decided NOT to do any biopsy but to give palliative radiation therapy, then you'd code lung cancer, and met to brain.
- If the plan is to obtain a definitive histopathologic diagnosis soon or in the future, then instead code: Neoplasm of uncertain behavior (i.e. not clear if benign or malignant), NOS
"work-up for cancer"
If the cancer has not been confirmed then it should not be coded as cancer. Code relevant test abnormal test results or symptoms.
"I have a patient who comes in with vague respiratory and gi symptoms. They did a chest xray and found a lung mass. They are now working him up for a probable lung ca, with mets to various places. In the old coding I would use ca-nyd. I actually use the ca nyd subcode a lot. I’ve talked to you about this before, because there is no ca nyd in icd10. You told me that you either have cancer or you don’t. For this particular patient I really wouldn’t have anything else I could code in icd10 for him. His symptoms are extremely vague. I don’t really like coding just symptoms, if there isn’t a proper admit diagnosis that fits better anyway. I found a “neoplasm of uncertain behavior (i.e. uncertain if benign or malignant), nos”, but I don’t really like that one. It doesn’t really fit. Is it possible to get something like “admit for workup of malignancy”, or something along those lines?" (Debbie, 12:40, 2018 October 4 (CDT)) How should this be coded? Ttenbergen 12:40, 2018 October 4 (CDT)
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