Pathology/Lab Coding Alert

Question: We are trying to assign a diagnosis code for a specimen that the pathology report lists as "colon polyp." Should we report K63.5?

Kentucky Subscriber

Answer: It's possible that the correct code for your case is K63.5 (Polyp of colon). However, in addition to the specimen name, the pathology report probably provides the pathologist's findings for the tissue specimen, along with a final diagnosis statement.

If the pathology report provides more specific information, such as the location of the polyp and the histologic type, whether malignant, benign, or of undetermined significance, that could lead you to completely different code choices.

For instance, if the report indicates that the polyp is benign and designates the location, you should choose one of the following, more specific codes instead of reporting K63.5:

• D12.2 (Benign neoplasm of ascending colon)
• D12.3 (... transverse colon)
• D12.4 (... descending colon)
• D12.5 (... sigmoid colon)
• D12.6 (... unspecified).

For a malignant polyp diagnosis, turn to one of the codes in the range C18.0-C18.9 (Malignant neoplasm of colon...) based on the specific site, such as C18.6 (... descending colon).

For other histologic types, you might choose from D37.4 (Neoplasm of uncertain behavior of colon) or D01.0 (Carcinoma in situ of colon). All of these choices are preferable to K63.5 if you have documentation to support a different code.

Take away: Code the condition to the highest degree of specificity that you can, taking into account all the diagnostic information in the pathology report, not just the listed specimen.