Pathology/Lab Coding Alert

Question: The pathology report for a prostate biopsy gives this diagnosis: "high-grade prostatic intraepithelial neoplasia (PIN-III)." What ICD-9 code should I use for this diagnosis?

California Subscriber

Answer: The correct code for high-grade PIN III is 233.4 (Carcinoma in situ of breast or genitourinary system, 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 will monitor with repeat biopsy.

High-grade PIN (PIN III) is the most 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).

On the other hand, you should continue to report PIN I and PIN II as 602.3 (Dysplasia of prostate). This diagnosis represents a lesser degree of cellular abnormality of the prostate.