Urology Coding Alert

Location is your key concern when narrowing the choices.

When coding for a patient who has been diagnosed with malignant neoplasm of the bladder, the urologist must document specific locations of the tumor(s) before you can select the correct ICD-10 code. 

Here’s why: ICD-10 includes numerous diagnoses for malignant neoplasm of bladder, and they’re all based on pinpointing the site of the tumor. 

The choices are as follows:

• C67.0 – Malignant neoplasm of trigone of bladder
• C67.1 – Malignant neoplasm of dome of bladder
• C67.2 – Malignant neoplasm of lateral wall of bladder
• C67.3 – Malignant neoplasm of anterior wall of bladder
• C67.4 – Malignant neoplasm of posterior wall of bladder
• C67.5 – Malignant neoplasm of bladder neck 
• C67.6 – Malignant neoplasm of ureteric orifice
• C67.7 – Malignant neoplasm of urachus
• C67.8 – Malignant neoplasm of overlapping sites of bladder
• C67.9 – Malignant neoplasm of bladder, unspecified.

Further explanation: Diagnosis C67.8 is used when the patient has a primary malignant neoplasm that overlaps two or more contiguous (side-by-side) sites in the bladder. If a bladder tumor on the trigone also extends and involves the posterior bladder wall, diagnosis C67.8 would be appropriate. If the patient has multiple malignant neoplasms within the bladder that are not contiguous, such as one on the lateral wall and another on the anterior wall, you should report the specific codes for each site. In this example, you would report C67.2 and C67.3, respectively. 

Benign makes it easy: If the pathology report shows a bladder neoplasm is benign, however, you have a single code to report: D30.3 (Benign neoplasm of bladder). Coding notes explain that D30.3 also includes benign neoplasm of both the ureteric orifice and urethral orifice of the bladder. 

According to the latest American Cancer Society statistics, about half of all bladder cancers are first diagnosed when the cancer is still confined to the inner lining of the bladder wall (known as non-invasive or in situ cancers). About one in three bladder cancers have extended into deeper layers (becoming invasive) when first diagnosed, but are still confined to the bladder.

Code D09.0 is the ICD-10 diagnosis for carcinoma in situ (CIS) of the bladder, but, unfortunately, there are no specific ICD-10 diagnoses to indicate the pathological stages of superficial or invasive bladder cancer.

Bladder cancer accounts for about 5 percent of all new cancers in the US. It is the fourth most common cancer in men, but less common in women.