MEDICAL CODING TRAINING IN CALICUT

 N42.31

 (PROSTATIC INTRAEPITHELIAL

NEOPLASIA)

                       A premalignant change arising in the prostatic epithelium, regarded as the most important and most likely precursor of prostatic adenocarcinoma. The neoplasia takes the form of an intra-acinar or ductal proliferation of secretory cells with unequivocal nuclear anaplasia, which corresponds to nuclear grade 2 and 3 invasive prostate cancer. 

 

• N42.31  is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2021 edition of ICD-10-CM N42.31 became effective on October 1, 2020.
• This is the American ICD-10-CM version of N42.31 - other international versions of ICD-10 N42.31 may differ.

Introduction: High-grade prostatic intraepithelial neoplasia (HGPIN) is generally accepted to be a precursor lesion of prostate cancer. The likely outcome of isolated low-grade PIN (LGPIN) lesions in prostate biopsies remains unclear. A follow-up study of 106 patients with LGPIN- and HGPIN lesions was performed.

                                  High-grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic carcinoma. The only method of detection is biopsy; prostatic intraepithelial neoplasia (PIN) does not significantly elevate serum prostate-specific antigen concentration and cannot be detected by ultra-sonography. The incidence of PIN in prostate biopsies averages 9% (range, 4%–16%), representing 115,000 new cases of PIN diagnosed each year in United States. PIN has a high predictive value as a marker for adenocarcinoma, and its identification warrants repeated biopsy for concurrent or subsequent invasive carcinoma. Carcinoma will develop in most patients with PIN within 10 years. PIN is associated with progressive abnormalities of phenotype and genotype that are intermediate between normal prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. Androgen deprivation therapy decreases the prevalence and extent of PIN, suggesting that this form of treatment may play a role in chemoprevention.

                              Prostatic intraepithelial neoplasia (PIN) represents the preinvasive end of the continuum of cellular proliferations within the lining of prostatic ducts and acini. The term “PIN” is usually used today as a synonym for high-grade PIN (HGPIN) (formerly PIN grades 2 and 3 on a 1–3 scale). The high level of interobserver variability with low-grade PIN limits its clinical utility, and pathologists do not routinely report this finding except in research studies.¹ Interobserver agreement for HGPIN is “good to excellent.”² Other terms, such as “dysplasia,” “carcinoma in situ,” and “intraductal carcinoma,” are discouraged.

DIAGNOSTIC CRITERIA FOR PIN

PIN is characterized by cellular proliferations within preexisting ducts and acini with cytologic changes mimicking cancer, including nuclear and nucleolar enlargement. There is inversion of the normal orientation of epithelial proliferation with PIN from the basal cell compartment to the luminal surface, similar to adenomas in the colon and other sites. Four main patterns of HGPIN have been described: tufting, micropapillary, cribriform, and flat7 . There are no known clinically important differences between the architectural patterns, and their recognition appears to be only of diagnostic utility. Other unusual patterns of PIN include the signet ring cell pattern, small cell neuroendocrine pattern, mucinous pattern, and microvacuolated (foamy gland) pattern, and inverted (hobnail) pattern.

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