Pathology/Lab Coding Alert

Question: Our pathologist diagnosed a malignant renal neoplasm involving the kidney and ureter, and I'm having trouble with the ICD-9 code selection because of the terms "other specified" and "unspecified." Which is correct for this case?

Iowa Subscriber

Answer: You should code a malignant renal neoplasm of the kidney and ureter as 189.8 (Malignant neoplasm of kidney and other specified sites of urinary organs). Choosing the "unspecified" code (189.9, Malignant neoplasm of urinary organ, site unspecified) would be incorrect.

The text note following 189.8 states that the code represents "malignant neoplasm of contiguous or overlapping sites of kidney and other urinary organs...," which describes your pathologist's diagnosis.

Primer: To help evaluate code choices like this, you need to keep in mind the following ICD-9 terminology:

• When the medical record provides specific information, but an ICD-9 code doesn't exist that specifically incorporates that information, you should select a code that uses the terminology "other," "other specified," or "not elsewhere classifiable (NEC)." In other words, the deficiency in these cases lies with ICD-9 not providing enough specificity.
• When the opposite situation occurs -- the medical record does not provide enough specific information to select a very specific ICD-9 code -- you should select a code that uses the terminology "unspecified," or "not otherwise specified (NOS)." In these cases, the deficiency lies with the medical record not providing enough specificity.

Coder tip: Often, but not always, NEC codes end with a final digit of "8," while NOS codes end with a final digit of "9."