Pathology/Lab Coding Alert

Learn ICD-9 189.x crosswalks.

Just two codes describe kidney tumors and renal-pelvis tumors under ICD-9, but that won’t be enough when ICD-10 goes into effect on Oct. 1, 2015.

If you can’t get more specific site information from the pathology report beginning in October, you might have trouble reporting an accurate diagnosis code. See what you need to know to make sure you’re ready for the ICD-10 conversion later this year.

Distinguish Site for ICD-9

All you need to know to select the proper code for ICD-9 is whether the tumor is in the kidney itself, or elsewhere in the pelvis. You’ll choose one of the following codes based on that information:

• 189.0 — Malignant neoplasm of kidney, except pelvis
• 189.1 — Malignant neoplasm of renal pelvis.

Specify Side in Pathology Report

ICD-10 also distinguishes renal tumors by kidney versus renal pelvis, as follows:

• C64._ — Malignant neoplasm of kidney, except renal pelvis
• C65._ — Malignant neoplasm of renal pelvis.

But that information won’t be enough to select the most specific code possible under ICD-10. You’ll also need to know if the tumor is on the right or left, so that you can choose the complete code to the fourth digit. For example, a renal pelvis tumor reports to one of the following three complete codes:

• C65.1 — Malignant neoplasm of right renal pelvis.
• C65.2 — Malignant neoplasm of left renal pelvis.
• C65.9 — Malignant neoplasm of unspecified renal pelvis.

Tip: If the pathology report doesn’t distinguish side, you can crosswalk 189.1 directly to C65.9.

Training: ICD-10 introduces right/left/unspecified designation to many codes dealing with bilateral organs. Although the code set always offers the “unspecified” option, you should inform pathologists of this new standard as part of your ICD-10 training to ensure that they provide this information in pathology reports.