General Surgery Coding Alert

Question: What ICD-9 code should I use for a bladder cancer pathology report diagnosis of PUNLMP?

Kansas Subscriber

Answer: The condition you’re asking about is fairly newly recognized — papillary urothelial neoplasm of low malignant potential (PUNLMP). The condition is considered pre-malignant. That said, there’s not an “accepted” understanding of whether you should code this as benign, malignant, or uncertain.

Because there’s not a lot of specific information available about the condition, you should fall back on basic ICD-9 coding rules.

If the neoplasm hasn’t been biopsied or had any pathologic examination, then you must code it as “unspecified”(239.4, Neoplasm of unspecified nature of bladder)

If there’s a biopsy and the pathology report shows mixed cellular characteristics, you should use the “uncertain” code — 236.7 (Neoplasm of uncertain behavior of bladder) Because this is a neoplasm that rarely evolves into a malignancy, this may be the safest code choice if the pathology report identifies PUNLMP but doesn’t specify cellular characteristics. If the report identifies the lesion as benign, choose 223.3 (Benign neoplasm of bladder) or malignant, choose (Malignant neoplasm of bladder part unspecified).