ICD-10 Coding for Waldenström's Macroglobulinemia(C88.00, C88.01)
Complete ICD-10-CM coding and documentation guide for Waldenström's Macroglobulinemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Waldenström's Macroglobulinemia
C88.0-C88.9Primary Range
Malignant immunoproliferative diseases
This range includes codes for Waldenström's macroglobulinemia and related immunoproliferative disorders.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C88.00 | Waldenström's macroglobulinemia without complications | Use when WM is confirmed without any complications. |
|
| C88.01 | Waldenström's macroglobulinemia with refractory/relapsed disease | Use when WM is refractory or relapsed after treatment. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for Waldenström's macroglobulinemia
Essential facts and insights about Waldenström's Macroglobulinemia
Primary ICD-10-CM Codes for waldenstrom's
Decision Criteria
clinical Criteria
- Confirmed diagnosis of WM with bone marrow biopsy and MYD88 mutation.
Applicable To
- Asymptomatic Waldenström's macroglobulinemia
Excludes
- Small cell B-cell lymphoma (C83.0)
Clinical Validation Requirements
- Bone marrow biopsy showing ≥10% lymphoplasmacytic infiltration
- MYD88 L265P mutation detected by PCR
Code-Specific Risks
- Misclassification with other lymphomas due to similar symptoms.
Coding Notes
- Ensure documentation explicitly states Waldenström's macroglobulinemia.
C88.01 - Waldenström's macroglobulinemia with refractory/relapsed disease
Use when WM is refractory or relapsed after treatment.
Applicable To
- Refractory Waldenström's macroglobulinemia
Excludes
- Small cell B-cell lymphoma (C83.0)
Clinical Validation Requirements
- Progression after 2+ lines of therapy
- Documented resistance to treatments like ibrutinib
Coding Notes
Ensure documentation reflects treatment history and refractory status.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Hyperviscosity syndrome
R70.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Waldenström's Macroglobulinemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C88.00.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Ensure clinical documentation supports lab findings.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Ensure documentation specifies WM with supporting lab results.
Impact
Inadequate documentation of diagnostic criteria.
Mitigation Strategy
Ensure all diagnostic criteria are documented in the patient's record.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Waldenström's Macroglobulinemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Waldenström's Macroglobulinemia
Use these documentation templates to ensure complete and accurate documentation for Waldenström's Macroglobulinemia. These templates include all required elements for proper coding and billing.
New Diagnosis
Specialty: OncologyRequired Elements
- Patient history
- Lab results
- Bone marrow biopsy findings
- Mutation analysis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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