Urology Coding Alert

Watch out for metastasis rules.

If your urologist treats patients with cancer, you’ll need to familiarize yourself with pieces of ICD-10’s Chapter 2. This is where you’ll find the malignant neoplasm codes relating to genitourinary and male genital areas your urologist might treat. 

Read on to learn how to navigate this section of ICD-10.

Learn the Guidelines

All neoplasms, whether functionally active or not, are classified by the following:

• Site (organ, right/left, etc.)
• Behavior (malignant, in situ, benign)
• Location (laterality, quadrant, etc.)
• Histology (melanoma, neuroendocrine)

Focus on Site

Once you know the patient has a malignant tumor, you’ll choose a code from the C60-C68 categories as shown in the table below. 

Note: If you have more than one tumor, you’ll need to determine if they are in contiguous sites. If you have two or more contiguous sites, you’ll use a subcategory, .8 to indicate the cancer is located in more than one site

For example, if your urologist documents lateral and dome bladder cancer, “you’ll use the .8 (C67.8, Malignant neoplasm of overlapping sites of the bladder), showing that it is more than one site,” said Jonathan Rubenstein, MD, director of coding and physician compliance for Chesapeake Urology Associates in Baltimore, in his CodingCon 2014 session “ICD-10 in Urology” in Orlando, Fla.

Tip: Keep in mind that if you are coding for a tumor that is metastasized to another location, you should use the ICD-10 code for the site it is metastatic to, Rubenstein explains. For example, if you are reporting prostate cancer that has metastasized to the bones, you’ll report C79.51 (Secondary malignant neoplasm of bone) for the site of the metastasis in addition to C61 for the primary tumor.