SEER Inquiry System - View

Question: 20120075 Status
Final

References
Source 1:   Heme & Lymph Manual & DB
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Notes:  
Source 2:  
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Notes:  


Question
Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for chronic lymphocytic leukemia/small lymphocytic lymphoma when a lymph node biopsy was positive for CLL/SLL but no bone marrow biopsy was performed? See Discussion.

Discussion
A right neck lymph node biopsy and flow cytometry proved CLL/SLL. The PET scan showed multiple involved lymph nodes in the right cervical, mediastinal and para-aortic areas. No bone marrow biopsy was done. Per the Hematopoietic DB, Module 3, the histology should be coded 9823/3 [CLL/SLL], but how is primary site coded? The manual states to code the primary site to the involved lymph node region when there is no bone marrow involvement, but it does not specifically address how to code the primary site when no bone marrow biopsy or peripheral blood smear was done.



Answer
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C77.8 [multiple lymph node regions, NOS].

Per Rule PH6, code the primary site to the involved lymph node region(s) when there is no bone marrow involvement or when it is unknown whether the bone marrow is involved. To determine the more specific lymph node subsite to code, use Rule PH21. It indicates one is to code the primary site to C778 [multiple lymph node regions, NOS] when multiple lymph node regions, as defined by the ICD-O-3 (see Table C1: Lymph Node/Lymph Node Chain Reference Table in Appendix C), are involved and it is not possible to identify the lymph node region where the lymphoma originated.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

History
This SINQ question has been updated to the Hematopoietic & Lymphoid Neoplasm Manual & Database published January 2014. The original answer below was written based on the rules in 2012 For cases diagnosed 2012 and later, access the Hematopoietic Database at

http://seer.cancer.gov/tools/heme/.

Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. The 2012 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.

Code the primary site to C77.8 [multiple lymph node regions, NOS]. The steps used to arrive at this decision are:

Step 1: Enter chronic lymphocytic leukemia in the Heme DB. Click on the SEARCH button. Ensure that the term “chronic lymphocytic leukemia/small lymphocytic lymphoma” [9823/3] is highlighted on the screen.

Step 2: Scroll down to the MODULE RULE section. Per the Heme DB, refer to Module 3, rule PH8 in the manual.

Step 3: Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, go to the Primary Site and Histology Coding Rules. The rules are intended to be reviewed in consecutive order within the module. Stop at the first rule that applies to the case you are processing. Scroll to MODULE 3 and start at Rule PH8 in Module 3. Stop at Rule PH8. Per this rule code the primary site to the involved lymph node region(s) when there is no bone marrow involvement or when it is unknown whether the bone marrow is involved.

Step 4: Scroll down to Module 7 (Coding Primary Site for Lymphomas Only) for further instruction on coding the primary site. Rule PH8 indicates the lymph nodes will be coded as the primary site. The patient has multiple lymph node areas involved. Start at Rule PH25. Again, the rules are intended to be reviewed in consecutive order within the module. Stop at the first rule that applies to the case you are processing. Stop at Rule PH30. Code the primary site as multiple lymph node regions, NOS [C77.8] when multiple lymph node regions as defined by the ICD-O-3 are involved and it is not possible to identify the lymph node region where the lymphoma originated.



Last Updated
06/30/2014

Date Finalized
09/21/2012