# Coding "CIN 2-3" or "CIN 2/3"



## bbooks (Sep 5, 2012)

How do you code "CIN 2-3" or "CIN 2/3"

Do you use just 233.1,or 233.1 and 622.12, or something else? Here is the info from the path report:

Micro: Cervical transformation zone epithelium is identified. The squamous mucosa shows moderate to severe squamous dysplasia with other areas of mild dysplasia and koilocytic change. The glandular mucosa shows mixed acute and chronic cervicitis.

Diagnosis:  Cervix, 10:00, biopsy: Moderate to severe squamous dysplasia (CIN 2-3)


----------



## salCCS (Sep 5, 2012)

233.1 Cervix uteri
Adenocarcinoma in situ of cervix
Cervical intraepithelial glandular neoplasia, grade III
Cervical intraepithelial neoplasia III [CIN III]
Severe dysplasia of cervix

Excludes:
cervical intraepithelial neoplasia II [CIN II] (622.12)
cytologic evidence of malignancy without histologic confirmation (795.06)
high grade squamous intraepithelial lesion (HGSIL) (795.04)
moderate dysplasia of cervix (622.12) 


so only code the 233.1


----------



## bbooks (Sep 5, 2012)

Thanks much for your input. 

The reason I was asking (and I should have said this in my first message) is that I see "CIN 2-3" reported differently than when I read something like "squamous mucosa showing some areas of moderate dysplasia an some areas of severe dysplasia." In this instance it is usually reported out as "CIN 2 and CIN 3."


----------



## JEYCPC (Sep 13, 2012)

Glad you asked, I see this often.  And thanks for the answer.


----------



## bbooks (Sep 16, 2012)

I talked with one of my pathologists about this. He says that pathologists are to be moving away from the terminology of mild, moderate, and severe dysplasia to either low grade or high grade squamous intraepithelial lesions only. Low grade incorporates CIN1 and high grade incorporates CIN2 and CIN3 and carcinoma in-situ. This explains sometimes seeing CIN2-3 or CIN2/3. He indicated that it seemed appropriate then to use code 233.1 for these types of reports until the coding terminology catches up.


----------



## JEYCPC (Sep 25, 2012)

After reading this post, I received another report that reported the CIN 2-3.  But there was another specimen that was a CIN 2.  So would it then be appropriate to use both 233.1 and 622.12?

THanks!


----------



## bbooks (Oct 21, 2012)

Sorry...pretty late on responding. If the two biopsies were from the same cervix, you would put one code - the highest one. In this case, 233.1.

As an added point, I am sometimes seeing "high grade squamous intraepithelial lesion (CIN 2)." In this case, even though it's "high grade" they aren't quite convinced it is equivalent to CIN 3 and 233.1. In this case, I have been coding 622.12.


----------



## bbooks (Jan 3, 2013)

Here is the journal article that explains the new terminology:
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.LGT200570

And here is a nice summary of the recommendation from the CAP web site:
http://www.cap.org/apps/docs/membership/transformation/new/asccp_sum_last_recom.pdf

To make matters a bit more confusing, I've discovered that my docs are split on their interpretation of the new recommendations. Some do not want to use CIN II at all, some still want to still use that terminology.


----------



## bbooks (Feb 4, 2013)

The pathologists that I work for have come to consensus that for diagnoses coding of anogenital lesions, they would like me to code for "low grade" and "high grade" lesions using only the codes for CIN I and CIN III. They have agreed to consistently use that terminology in their diagnosis, however, some may continue to also note a moderate (CIN II) component for clarification during this time of terminology transition.


----------

