# Need help w/ Dx code off of path report! Please:)



## emilyadams1993@yahoo.com (Mar 19, 2015)

Clinical History ---
Bladder cancer.  Medical History:  Gross hematuria.  Urinary frequency. 
Dysuria.  Urinary retention with incomplete bladder emptying.  Coronary
artery disease.  Lower urinary tract infection.  Back pain.  Arthritis. 
Smoking.  




---Final Pathologic Diagnosis---

A.          Left bladder wall, lesion, transurethral resection: 
-          Nephrogenic metaplasia, prominent von Brunn's nests and chronic
inflammation
-          Muscularis propria is not identified 


Comment: Immunohistochemical stains performed on block A1 for PAX8
(positive), AMACR (positive), p63 (negative), and HMWK (negative) support
the diagnosis.   



what Dx code would you give this?


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## emcee101 (Mar 19, 2015)

I would code only the chronic inflammation, 595.2 or 595.9. The other pathological symptoms - von Brunn's nests and nephrogenic metaplasia, are symptoms of cystitis or another possible diagnosis. I would defer to the provider who performed the biopsy for any additional diagnosis based on their clinical knowledge, as it would be out of a coder's scope of work and knowledge to code anything futher, in my opinion.

Side note: I have never seen the nephrogenic metaplasia on a bladder path report before so I looked into it a little. Here is one interesting webpage that I found. 

http://www.pathologyoutlines.com/topic/bladdernephroadenoma.html

Hope this helps


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