**Note 1:** Pathological grade must not be blank.
**Note 2:** Assign the highest grade from the primary tumor. If the clinical grade is higher than the grade determined during the pathological time frame, use the grade that was identified during the clinical time frame for both the clinical grade and the pathological grade.
**Note 3:** Codes 1-4 take priority over codes A-D.
**Note 4:** The Fuhrman grade is no longer used for coding grade for Kidney cancers. The WHO/ISUP grade is now used. If the Fuhrman grade is documented, code 9.
**Note 5:** Code 9 when
* Grade from primary site is not documented
* No resection of the primary site
* Neo-adjuvant therapy is followed by a resection (see post-therapy grade)
* Clinical case only (see clinical grade)
* There is only one grade available and it cannot be determined if it is clinical, pathological, or after neo-adjuvant therapy
* Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available