Urology Coding Alert

Understanding the different grades is your best starting point.

The terminology and diagnoses associated with prostate conditions can be confusing for any coder, thanks to multiple acronyms and grades. Read on for your primer on prostatic intraepithelial neoplasia, or PIN, and what you need to consider when billing for this diagnosis.

Begin With the Basic Definitions 

You may see different terms used in your physician’s documentation of these entities, which terms will be important to your coding. Some of the most common include:

• Dysplasia – This is an erroneous development in cells at an early stage in cancer. Histological microscopic examination of prostatic tissue might show high numbers of cells with abnormal morphology and function.
• Low-grade prostatic intraepithelial neoplasia (LGPIN) – Cells from the patient’s prostate gland showed abnormal development when compared to normal prostate cells. LGPIN is not cancer and may not produce any noticeable symptoms. Because of this, most patients with LGPIN do not need any type of special treatment.
• High-grade prostatic intraepithelial neoplasia – This condition, also referred to as “high grade PIN,” HGPIN, is a precursor to prostate cancer (a precancerous lesion).
• Carcinoma in situ (CIS) – Abnormal malignant cells limited to the lining of the small acinar glands that make up the bulk of the prostate gland, an intraepithelial cancer. These cancer cells have not spread beyond the lining (beyond the basement membrane) of the small acinar prostatic cells.
• Atypical small acinar proliferation (ASAP) – Histologically representing an actual abnormal overgrowth of the small acinar glands themselves.

There are three classifications for PIN, depending on the degree of abnormal cellular morphology seen on microscopic examination of prostatic tissue, according to Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook.

• PIN I and PIN II, low-grade PIN, show slight dysplasia – so slight, in fact, that it is considered to be medically insignificant. Nearly half of all men are diagnosed with low-grade PIN by age 50. These men don’t need any type of treatment or testing other than an annual prostate cancer screening.
• PIN III, or high-grade PIN, exhibits moderate to severe dysplasia, which increases the patient’s likelihood of developing prostate cancer. A repeat biopsy normally is recommended.

“A diagnosis of PIN I, PIN II, or PIN III is only made on microscopic examination of prostatic tissue,” Dr. Ferragamo says.

Choose the Correct Diagnosis

ICD-9 included multiple diagnoses related to PIN, and ICD-10 does the same. Many of the ICD-10 descriptors mirror those from ICD-9, which makes things easier from a coding perspective.

• PIN I or PIN II (LGPIN) with no specified severity – Report N42.3 (Dysplasia of prostate)
• PIN III (HGPIN) – Submit D07.5 (Carcinoma in situ of prostate)
• ASAP – ICD-10 does not include a specific code for this diagnosis. File with N42.89 (Other specified disorders of prostate) and include documentation explaining the condition.

Final point: For cancer of the prostate, whether it be an adenocarcinoma (most common), transitional cell carcinoma, squamous cell carcinoma, or a sarcoma of the prostate gland, bill CPT^® code C61 (Malignant neoplasm of  prostate).