General Surgery Coding Alert

Right and left will matter under ICD-10.

If your surgeon performs renal-artery catheter placement or other procedures for a patient with a kidney tumor, you can expect one of two codes to describe the neoplasm under ICD-9:

• 189.0 -- Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis
• 189.1 -- Malignant neoplasm of renal pelvis.

Starting on Oct. 1, 2013, you will have six codes to describe renal tumors. Under ICD-10 you will first have to determine if the tumor is in the patient's renal pelvis or the kidney. That will lead you to the general codes C64 (Malignant neoplasm of kidney, except renal pelvis) and C65 (Malignant neoplasm of renal pelvis).

The new stuff: With ICD-10 you can't stop there, however. C64 and C65 require a fourth digit. To determine that fourth digit, you will have to know whether the tumor is in the right or left kidney or renal pelvis. Once you make that determination, you'll choose one of the following codes:

• C64.1 -- Malignant neoplasm of right kidney, except renal pelvis
• C64.2 -- ... left kidney, except renal pelvis
• C64.9 -- ... unspecified kidney, except renal pelvis
• C65.1 -- Malignant neoplasm of right renal pelvis
• C65.2 -- ... left renal pelvis
• C65.9 -- ...unspecified renal pelvis.