Local Invasion of Cancer (2Q 2025 Coding Clinic)
Pathology findings indicate poorly differentiated carcinoma/right renal cell carcinoma, invading the renal vein and renal sinus after a right robotic radical nephrectomy on an inpatient stay.
Assign only code C64.1, Malignant neoplasm of right kidney, except renal pelvis, for poorly differentiated renal carcinoma with invasion into the renal vein and renal sinus. No additional code is assigned for the pathological finding of invasion into the renal vein and renal sinus.
In the inpatient setting, it is not appropriate to code diagnoses directly from the pathology report without confirmation from the patient’s provider. Additionally, the invasion into the renal vein and renal sinus are clinical findings found on the pathology report that are used as indicators to assess the aggressiveness of the patient’s malignancy and are not considered metastatic sites.
It is recommended to query the attending physician on the Pathology findings and see if he/she considers this a ‘metastatic site.’
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