Urology Coding Alert

Right and left will matter under ICD-10.

When your urologist diagnoses that a patient has a renal tumor you have two codes to choose from under ICD-9 Codes :

• ICD-9 189.0  -- Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis
• ICD-9 189.1  -- Malignant neoplasm of renal pelvis.

Starting on Oct. 1, 2013, you will have six codes to choose from for renal tumors. Under ICD-10 you will first have to determine if the tumor is in the patient's renal pelvis or the kidney. That will lead you to the general codes C64 (Malignant neoplasm of kidney, except renal pelvis) and C65 (Malignant neoplasm of renal pelvis).

The new stuff: With ICD-10 you can't stop there, however. C64 and C65 require a fourth digit. To determine that fourth digit, you will have to scour your urologist's documentation for information about whether the tumor is in the right or left kidney or renal pelvis. Once you make that determination, you'll choose one of the following codes:

• C64.1 -- Malignant neoplasm of right kidney, except renal pelvis
• C64.2 -- ... left kidney, except renal pelvis
• C64.9 -- ... unspecified kidney, except renal pelvis
• C65.1 -- Malignant neoplasm of right renal pelvis
• C65.2 -- ... left renal pelvis
• C65.9 -- ...unspecified renal pelvis.

Physician documentation: Your urologist should already be documenting if a renal tumor affects the right or left kidney parenchyma or right or left renal pelvis, and for the most accurate ICD-10 coding you should encourage your urologist to continue being specific on every operative report.

Superbill updates: Keep in mind that because 189.0 and 189.1 won't have a one-to-one code crosswalk, you probably will need to make additional room on your superbill for these ICD-10 diagnostic codes.