Urology Coding Alert

Question: My urologist performed a radical nephrectomy (CPT 50230 ) and he documented the diagnosis as "renal neoplasm." Should I report ICD-9 593.9 or 239.5 as the diagnosis code?

Pennsylvania Subscriber

Answer: You should use 189.0 (Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis) since your urologist most likely removed a malignant tumor of the kidney during the radical nephrectomy (50230, Nephrectomy ... radical, with regional lymphadenectomy and/or vena caval thrombectomy). An experienced urologist can often visually determine the nature of a mass using only gross inspection.

Beware: Many commercial insurers, as well as Medicare, do not recognize 593.9 (Unspecified disorders of kidney and ureter) or 239.5 (Neoplasms of unspecified nature; other genitourinary organs) as acceptable diagnoses that show medical necessity for a radical nephrectomy.

Best bet: Ask your urologist the nature of the "neoplasm" or wait for the pathology before you choose the correct diagnostic code to report for this procedure.