Clinical Data: Bladder cancer.

Description: Catheterized urine sample - 60 mls of clear yellow urine received in alcohol fixative.  

Screening Type: Automated w/cell enrichment.

Interpretation: FISH study detected normal copy numbers for chromosomes 3, 17, and 9p21. 75 cells were analyzed in this evaluation. No evidence of aneuploidy for chromosomes 3, 7 or 17 or deletion of the 9p21 locus was found in cells present in this specimen. Computer assisted technology was utilized. These findings should be correlated with cytology and cystoscopy results.

Diagnosis:  Normal Profile

What are the appropriate CPT, ICD-9 and ICD-10 codes for this scenario?

Urovysion™ FISH Morphometric Testing 1

CPT:

Since 2011, the American Medical Association CPT-4 Coding Manual has provided the following two options for reporting quantitative or semi-quantitative tumor morphometric analysis by in situ hybridization (e.g., FISH) on urinary tract specimens:

Urovysion FISH Morphometric Testing

Since the documentation in our case scenario indicated the use of computer-assisted technology, CPT 88121 should be assigned.

With the changes to in situ hybridization codes for 2015, it is important for coding personnel to remember that the above ISH/FISH codes are exclusively used whenever the specimen source is from the urinary tract. All other specimen sources performed by histologic or cytologic methodologies are reported using 88364-88369, 88373-88374, or 88377 based on the reporting methodology (i.e., qualitative versus quantitative/semi-quantitative) and whether a manual or computer assisted analysis was utilized for initial or subsequent probe staining procedure, or multiplex probe staining procedure.    

ICD-9 CM:

The diagnosis code is based on the clinical information provided by the treating physician, bladder cancer, because the final diagnosis of the FISH testing did not yield a definitive diagnosis. The specific site of the bladder neoplasm was not indicated; therefore, the unspecified site code should be assigned.  Alpha: Neoplasm table – bladder (urinary) 188.9. The ICD-9 code is broken down as follows:

  • 188 is the primary description of malignant neoplasm of bladder
  • 4th digit of 9 defines the anatomic site of the bladder as unspecified

ICD-10 CM:

The same diagnosis rules apply for ICD-10. The code is based on the bladder cancer provided in the clinical information, and since the specific site of the bladder cancer was not indicated, the unspecified site code should be assigned. Alpha: Neoplasm table – bladder (urinary) C67.9.  The ICD-10 code is broken down as follows:

  • C67 is the primary description of malignant neoplasm of bladder
  • 4th digit of 9 defines the anatomic site of the bladder as unspecified

References:
2015 CPT Professional Edition Manual (American Medical Association) page 535, 542
2014 ICD-9-CM Professional Manual (AMA) pages 353, 703
2015 Draft ICD 10-CM Manual (AMA) pages 322, 451

Author - Female

About the author

Beth McDevitt, CPC is Compliance - National Pathology Coding Manager, Auditing, Pathology and Laboratory of McKesson Business Performance Services