Oncology & Hematology Coding Alert

Question: I have a path report that says "PIN III." My problem is that the report also says "carcinoma was not identified," so I'm confused about what to report. Which ICD-9 code is best?

Wisconsin Subscriber

Answer: With a diagnosis of PIN III, you should report 233.4 (Carcinoma in situ of prostate). Pathologists frequently diagnose prostatic intraepithelial neoplasm (PIN) in prostate needle biopsy specimens. PIN involves dysplastic cellular changes (abnormal shape or size) that are distinct from a benign proliferation of normal cells. PIN is a premalignant condition that the physician typically monitors with repeat biopsy.

High-grade PIN (PIN III) is a likely precursor of invasive prostate cancer. Because this is not the same as a benign hyperplasia, you should not classify the condition to the 600 category (Hyperplasia of prostate). Instead, you should code PIN III as carcinoma in situ (233.4). Although the neoplasm table in the ICD-9 manual's index does not offer enough information to help you choose 233.4 for PIN III, you will find a "PIN III" entry in the index itself. That entry points you to 233.4.

On the other hand, you should report PIN I and PIN II using 602.3 (Dysplasia of prostate). This diagnosis represents a lesser degree of cellular abnormality of the prostate than PIN III. You also should not assign 185 (Malignant neoplasm of the prostate) for a PIN III diagnosis.