Tumor Tip of the week 10-24-2025 Invasion Beyond Capsule

10-24-2025

Scenario: 2025

• Laparoscopic Radical Left Nephrectomy:
• Poorly differentiated renal cell carcinoma with clear cell features, grade 4.
• Largest measurable dimension of carcinoma 4.5 cm.
• Carcinoma invades renal sinus fat and perinephric fat
• Soft tissue adipose tissue margin involved with carcinoma.
• Lymphovascular space invasion is present.
• Necrosis is present.
• Adrenal gland no neoplasia identified.

Question: How would you code the SSDI Invasion Beyond Capsule

• 0, Invasion beyond capsule not identified
• 1, Perinephric (beyond renal capsule) fat or tissue
• 2, Renal sinus
• 3, Gerota’s fascia
• 4, Any combination of codes 1-3
• 5, Invasion beyond capsule, NOS

Answer: 4, Any combination of codes 1-3

The Tumor invaded perinephric fat (code 1) and renal sinus fat (code2) thus assigned combination code 4