STRs Urinary Tumors

Written By Barbara Dearmon, BS, ODS-C, Ofelia Fernandez, ODS-C

The blog highlights frequent discrepancies in coding urinary tumors, focusing on histology assignment and determining multiple primaries using the Solid Tumor Rules (STRs).

 Histology Coding

  • Urothelial carcinoma (8120) is the most common urinary cancer.

  • Papillary urothelial carcinoma (8130) is a subtype.

  • Micropapillary urothelial carcinoma (8131) is another variant.

  • Histology should be coded based on the most specific diagnosis, regardless of biopsy or resection.

  • Refer to the Solid Tumor Rules (STRs) and ICD-0 updates for correct coding of histology and primary sites.

 Primary Site Determination  

  • Urothelial carcinoma of the prostatic urethra is rare and coded to C680.

  • The STRs guide whether a tumor is a single or multiple primaries, based on diagnosis date and tumor characteristics.

 

Key STR Rules for Urinary Multiple Primaries

 

Multiple Primary Rule

 

Description and example

Rule M6

Abstract multiple primaries when an invasive urothelial carcinoma of the bladder is diagnosed, greater > 60 days after, and in situ is a single primary.

 

6/24/2024 Large area of tumor at Rt ureteral orifice, biopsy reveals Low-grade urothelial carcinoma, non-invasive 8120/2

 

8/27/2024 TURBT: Large area of papillary tumor at Rt ureteral orifice reveals high-grade invasive urothelial carcinoma 8130/3

 

Rule M7

Multiple occurrences of urothelial carcinoma noninvasive in situ cancers abstract a single primary: only one non-invasive urothelial bladder primary per the patient’s lifetime. Timing does not matter.

 

1/3/2018: Bladder dome, TURBT - in situ urothelial

carcinoma 8120/2

• 5/8/2019: Bladder lateral wall, TURBT - papillary

urothelial carcinoma non-invasive 8130/2

• 7/14/2022: Bladder base, TURBT – urothelial carcinoma

in situ 8120/2

 

Rule M8

Micropapillary and urothelial carcinoma are multiple primaries.7/2019 Renal pelvis mass bx: papillary urothelial carcinoma 8130/3 and 6/2022 Prostatic urethra, bx: micropapillary urothelial carcinoma are two primaries

 

Rule M9

Multiple occurrences of invasive urothelial carcinoma or subtypes in the bladder only, or multiple occurrences of invasive micropapillary urothelial carcinomas, is a single primary. The timing is irrelevant.

 

1/3/2018: Bladder dome, TURBT – micropapillary

urothelial carcinoma 8131/3

• 5/8/2019: Bladder lateral wall, TURBT - micropapillary

urothelial carcinoma 8131/3

• 7/14/2022: Bladder base, TURBT – micropapillary

urothelial carcinoma 8131/3

 

Rule M11

Abstract a single primary when there are urothelial ca multiple urinary organs renal pelvis, ureter, bladder, and urethra.

 

1/2018: Multicentric urothelial carcinoma in Rt

ureter and Rt renal pelvis 8120/3

• 2/2018: Rt nephroureterectomy - urothelial carcinoma 81/20/3

• 6/2020 Bladder neck, bx: papillary urothelial

carcinoma 8130/3

 

Rule M14

Abstract multiple primaries when the ICD-O site code differs at the second (CXxx) and/or third (CxXx) character. Separate non-contiguous.

 

Patient dx with non-Hodgkin lymphoma C42 in Jan.2020, followed by dx of urothelial carcinoma, non-invasive of ureters C66 in Feb. 2020, and invasive urothelial carcinoma of renal pelvis diagnosed Aug. 2021 C65, and dx of papillary urothelial carcinoma bladder C67 diagnosed June 2024

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Barbara Dearmon, BS, ODS-C, Ofelia Fernandez, ODS-C
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