Oncology & Hematology Coding Alert

Question: I'm confused as to whether tubulovillous adenoma colon polyps are classified as benign or uncertain behavior -- what is the correct ICD-9 code for this condition?

Maine Subscriber

Answer: The ICD-9 book will lead you to 211.3 (Benign neoplasm of colon), but in some circumstances will allow you to report 235.2 (Neoplasm of uncertain behavior of stomach, intestines, and rectum).

Follow pathology report: You should always code a specimen based on the pathologist's determination, which may vary from the ICD-9 statement regarding the "usual" neoplasm behavior. Because the condition is a combination of the tubular and villous adenomas, the pathologist may indicate that the condition is benign or demonstrates "uncertain behavior." If the pathologist indicates uncertain behavior, you should code the tubulovillous adenoma as 235.2, despite the ICD-9 indication that the condition is usually benign.

Remember: Consider whether the diagnosis contained on the pathology report has been confirmed by a physician and has been acknowledged by the provider for which you are billing.