Urology Coding Alert

Question: What ICD-9 code should I use for a bladder cancer pathology report with the diagnosis of PUNLMP?

Kansas Subscriber

Answer: The condition you’re asking about is fairly newly recognized — papillary urothelial neoplasm of low malignant potential (PUNLMP). The condition is considered pre-malignant. That said, there’s not an "accepted" understanding of whether you should code this as benign, malignant, or uncertain.

Because there’s not a lot of specific information available about this condition, you should fall back on basic ICD-9 coding rules.

If the neoplasm has not been biopsied or examined pathologically, then code the lesion as "unspecified" (239.4, Neoplasm of unspecified nature of bladder) and indicating "path pending" when awaiting biopsy reports.

If there is a biopsy but the pathology report is non-diagnostic, showing mixed cellular characteristics, you should use the "uncertain" code — 236.7 (Neoplasm of uncertain behavior of bladder). Because this is a neoplasm that rarely evolves into a malignancy, this may be the safest code choice if the pathology report identifies PUNLMP but doesn’t specify cellular characteristics.

If the report identifies the lesion as benign, choose 223.3 (Benign neoplasm of bladder). If the report states the lesion is malignant, choose a code from the 188.0-188.9 range (Malignant neoplasm of bladder …), depending on the site of the lesion within the bladder. Remember that with ICD-9 coding there is no way to indicate the aggressiveness of a malignant tumor (grade) nor its invasiveness (stage).