C65.2

🧬 ICD-10 CM C65.2 — Malignant Neoplasm of Left Renal Pelvis

Billable Code Confirmed

ICD-10 CM C65.2 is a valid, billable 4-character ICD-10-CM code for FY2026 . Characters 1-3 (C65) define the malignant neoplasm of the renal pelvis, and character 4 (2) specifies the left side . No additional characters are required.

Non-Billable Parent Codes — Never Submit These

• ❌ C65 — 3-character header — missing laterality

Always submit C65.2 (all 4 characters) when a malignant neoplasm of the left renal pelvis is documented.

Clinical Context: Renal Pelvis vs. Kidney Parenchyma

ICD-10-CM C65.2 captures malignancies originating specifically in the funnel-like dilated part of the ureter in the kidney (renal pelvis/calyces) . This is clinically distinct from renal cell carcinoma (RCC), which originates in the kidney’s lining/parenchyma and is coded to C64.- . The most common histology for C65.- is transitional cell carcinoma (TCC).

Code Classification

ICD-10-CM Diagnosis Code — wRVU, assistant payable, and global period fields are not applicable. See the commonly associated CPT and ICD-10-PCS Crosswalk sections for procedural billing.

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🔍 Code Description

ICD-10-CM C65.2 classifies malignant neoplasm of left renal pelvis. This code represents an active primary cancer located in the central collecting system of the left kidney, including the pelviureteric junction and renal calyces.

Cancer of the renal pelvis is relatively rare compared to general kidney cancer and frequently presents with painless hematuria and flank pain. Because the renal pelvis shares the same urothelial lining as the ureter and bladder, patients are often evaluated for synchronous tumors elsewhere in the urinary tract.

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🌳 Code Tree / Hierarchy

C65 Malignant neoplasm of renal pelvis ❌ Non-billable
│
├── C65.1 Malignant neoplasm of right renal pelvis ✅ Billable
├── C65.2 Malignant neoplasm of left renal pelvis ◀ THIS CODE ✅ Billable
└── C65.9 Malignant neoplasm of unspecified renal pelvis ✅ Billable

Overlapping Lesion Rule

If a primary malignant neoplasm overlaps two or more contiguous sites (e.g., overlapping the kidney parenchyma and the renal pelvis) and the exact point of origin cannot be determined, do not use C65.2. Instead, classify it to the overlapping lesion subcategory code C68.8 (Malignant neoplasm of overlapping sites of urinary organs) .

✅ Includes

The following clinical terms and scenarios map to C65.2 when documented :

• Primary malignant neoplasm of the left pelviureteric junction

• Primary malignant neoplasm of the left renal calyces

• Transitional cell carcinoma (TCC) of the left renal pelvis

• Urothelial carcinoma of the left renal pelvis

❌ Excludes

Excludes 1 — Cannot Be Coded Simultaneously with C65.2

Code	Description	Note
Z85.528	Personal history of other malignant neoplasm of urinary tract	Mutually exclusive. A condition cannot be coded as both a current, active malignancy and a historical, eradicated condition during the same encounter .

Excludes 1 Violation Risk

The most common error is coding a history of cancer code (Z85.-) when the patient is still receiving active, adjuvant treatment (e.g., chemotherapy or radiation) for the left renal pelvis tumor. If the patient is on active oncology management, the cancer is coded as active (C65.2), not historical .

Excludes 2 — May Be Coded in Addition if Separately Present

Code	Description	Note
C64.2	Malignant neoplasm of left kidney, except renal pelvis	Can be coded simultaneously if the patient has two distinct, separate primary tumors (e.g., an RCC in the cortex and a separate TCC in the pelvis) .
C67.-	Malignant neoplasm of bladder	Can be coded simultaneously if the patient has primary TCC of the renal pelvis and a separate primary TCC of the bladder .

📋 Clinical Overview

Anatomic Site Distinction

Understanding the anatomic origin ensures proper code selection within the genitourinary block.

Feature	C65.2 — Renal Pelvis (Left)	C64.2 — Kidney Except Pelvis (Left)	C66.2 — Ureter (Left)
Anatomy	Central funnel/collecting system	Renal cortex, medulla, parenchyma	Tube connecting kidney to bladder
Common Histology	Urothelial / Transitional Cell (TCC)	Renal Cell Carcinoma (RCC)	Urothelial / Transitional Cell (TCC)
Surgical Tx	Nephroureterectomy often required	Partial/Radical Nephrectomy	Ureterectomy

CDI Query Trigger — Vague Pathology

If a pathology report indicates “malignant neoplasm of left kidney” but the operative note describes an “excision of a left renal pelvis mass,” query the provider to clarify the specific anatomic origin, as C65.2 and C64.2 map to different DRG/HCC sub-groupings.

Common Diagnoses / Clinical Indications

Patients presenting with this malignancy often exhibit the following symptoms :

• R31.0 / R31.9: Gross or unspecified hematuria (painless hematuria is a hallmark sign).

• R10.481: Left flank pain.

• N13.30: Unspecified hydronephrosis (if the tumor obstructs urinary outflow).

Coding Manifestations

While you should code the malignancy as the primary diagnosis when it is the focus of care, always code documented secondary manifestations (like hydronephrosis) to fully capture patient complexity.

💰 HCC Risk Adjustment (CMS-HCC v28)

Field	Detail
CMS-HCC Model Version	v28 (2024-2025 Implementation)
HCC Assignment	✅ Mapped — HCC 22
HCC Category	HCC 22 — Colorectal, Bladder, and Other Cancers
RAF Coefficient	~0.15 - 0.25 (varies by demographic/status)

C65.2 maps directly to a Neoplasm Disease Group HCC and contributes to the RAF score .

Capture Annually

As an active oncology code, C65.2 should be evaluated and documented at least once annually if the patient is undergoing active surveillance, chemotherapy, radiation, or if the provider is actively managing complications related to the tumor. Once the provider documents the patient is unequivocally “in remission” or “cured,” transition to the appropriate history code (Z85.528) .

🏥 DRG Assignment

MDC 11 — Diseases and Disorders of the Kidney and Urinary Tract

DRG	Title	Est. Relative Weight*
DRG 686	Kidney and Urinary Tract Neoplasms with MCC	~1.45 - 1.65
DRG 687	Kidney and Urinary Tract Neoplasms with CC	~0.95 - 1.10
DRG 688	Kidney and Urinary Tract Neoplasms without CC/MCC	~0.70 - 0.85

Approximate. Verify against IPPS FY2026 Final Rule tables .

Sequencing and Complications

If the patient is admitted for surgical removal of the neoplasm (e.g., nephrectomy), the surgical procedure will shift the encounter to DRG 656-658 (Kidney and ureter procedures for neoplasm). If the admission is for chemotherapy administration, code Z51.11 as the principal diagnosis and sequence C65.2 secondarily.

🔗 Related ICD-10-CM Codes

Laterality Variants

Code	Description
C65.1	Malignant neoplasm of right renal pelvis
C65.2	Malignant neoplasm of left renal pelvis ← This Code
C65.9	Malignant neoplasm of unspecified renal pelvis

Adjacent Genitourinary Variants

Code	Description
C64.2	Malignant neoplasm of left kidney, except renal pelvis
C66.2	Malignant neoplasm of left ureter
C68.8	Malignant neoplasm of overlapping sites of urinary organs

🛠️ Commonly Associated CPT Codes (Urology / Profee)

Inpatient and Profee Setting Context

These codes are frequently utilized by urologists and uro-oncologists when evaluating or surgically treating left renal pelvis tumors.

CPT Code	Description	Profee Coding Notes (Modifier 26)
50220	Nephrectomy, including partial ureterectomy, any open approach	Primary surgical treatment. Append -LT modifier.
50546	Laparoscopy, surgical; nephrectomy, including partial ureterectomy	Minimally invasive approach. Append -LT modifier.
50240	Nephrectomy, partial	Used if tumor is localized and nephron-sparing surgery is viable.
52204	Cystourethroscopy, with biopsy(s)	Commonly performed to rule out synchronous bladder/ureteral TCC.

NCCI Bundling Considerations

• Cystourethroscopy (52000) is generally bundled into more extensive surgical procedures like nephrectomy (50220) if performed by the same provider at the same session, unless performed for a distinctly separate indication (requiring modifier -59 or -XU).

🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)

When C65.2 is an inpatient diagnosis, these PCS codes are relevant for associated inpatient surgical procedures.

PCS Section	Body System	Root Operation	Clinical Application
0 (Medical and Surgical)	T (Urinary System)	T (Resection)	Total surgical removal of the left renal pelvis. Example: 0TT40ZZ (Open approach).
0 (Medical and Surgical)	T (Urinary System)	B (Excision)	Partial removal or biopsy of the left renal pelvis. Example: 0TB44ZX (Percutaneous Endoscopic approach, Diagnostic).

💊 Coding Scenarios and Examples

Scenario 1 — Inpatient: Surgical Intervention

Clinical Vignette: A 62-year-old male is admitted for a scheduled laparoscopic left nephroureterectomy. Recent outpatient CT urogram and cystoscopy demonstrated a 3 cm mass isolated to the left renal pelvis. Pathology confirms high-grade urothelial carcinoma of the left renal pelvis. The patient tolerates the procedure well and is discharged on post-op day 3.

Principal Diagnosis:

• C65.2 — Malignant neoplasm of left renal pelvis (Reason for admission/surgery)

Procedure Codes (PCS):

• 0TT44ZZ — Resection of Left Kidney Pelvis, Percutaneous Endoscopic Approach

• 0TTB4ZZ — Resection of Left Ureter, Percutaneous Endoscopic Approach

MS-DRG Assignment: Groups to DRG 658 (Kidney and ureter procedures for neoplasm without CC/MCC).

Scenario 2 — Outpatient / Infusion: Chemotherapy

Clinical Vignette: A 58-year-old female presents to the outpatient oncology infusion center for her first cycle of Gemcitabine and Cisplatin. She was diagnosed last month with an advanced malignant neoplasm of the left renal pelvis. She complains of mild nausea prior to the infusion.

CPT / HCPCS (Profee):

• 96413 — Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

• J9201 — Injection, gemcitabine hydrochloride, 200 mg

• J9060 — Injection, cisplatin, powder or solution, 10 mg

ICD-10-CM Diagnoses:

• Z51.11 — Encounter for antineoplastic chemotherapy (Must be principal for the infusion encounter)

• C65.2 — Malignant neoplasm of left renal pelvis (Secondary to show the reason for chemo)

• R11.0 — Nausea (Treated symptom)

Scenario 3 — CDI Query: Vague Tumor Location

Clinical Vignette: A urology consult note states: “Patient has a mass in the left kidney. Biopsy shows transitional cell carcinoma. Will schedule for nephrectomy next week.”

Action / Outcome:

While “left kidney mass” usually defaults to C64.2 (renal parenchyma), the histology “transitional cell carcinoma (TCC)” is highly indicative of a renal pelvis or ureteral origin. C64.2 (Renal cell carcinoma) and C65.2 (TCC) require distinct codes. A query should be sent to clarify the anatomic origin of the mass.

Query Response: Provider updates documentation to state: “Transitional cell carcinoma originating in the left renal pelvis.”

Corrected ICD-10-CM Coding:

• C65.2 — Malignant neoplasm of left renal pelvis

⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Misidentifying the site. Coding C64.2 (kidney, except renal pelvis) when the tumor specifically originates in the renal pelvis. Always verify the histology and operative report.
❌	Coding both Active and History codes. Assigning C65.2 simultaneously with Z85.528 for the exact same cancer. If the cancer has been excised and no active treatment is occurring, only use the history code .
✅	Sequence Z51.11 first for chemo. If the sole purpose of the admission or encounter is chemotherapy administration, sequence Z51.11 as primary and C65.2 as secondary.
✅	Look for secondary sites. Renal pelvis cancers frequently metastasize or have synchronous tumors in the bladder. Ensure you capture secondary malignant neoplasm codes (C77.- to C79.-) if metastasis is documented.
✅	Annual HCC Capture. C65.2 maps to V28 Neoplasm disease groups. Ensure this diagnosis is documented and submitted on a claim at least once per calendar year while active to maintain the patient’s risk profile.