SEER Inquiry System - Question 20100068 Details

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Question 20100068

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Inquiry Details

References:

Heme & Lymph Manual & DB

Question:

Histology--Heme & Lymphoid Neoplasms: How is this field coded for a JAK-2 positive myeloproliferative disorder, NOS, that is never specified as acute or chronic but was treated with Hydrea? See Discussion.

Discussion:

The hematology oncologist referred to the case as a JAK-2 positive myeloproliferative disorder. It is never called acute or chronic. JAK-2 test was positive for mutation, and the bone marrow report indicates, "Morphological features can be seen in myeloproliferative neoplasm." Flow cytometry report indicates, "The flow data demonstrate neutrophilia with left shift. Lymphocytes are composed of a mixed population of T and B-cells with some atypical B-cells." The patient is subsequently treated with Hydrea.

Answer:

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

Code the histology to 9975/3 [myeloproliferative/myelodysplastic neoplasm, unclassifiable] which is a new code implemented in 2010. Myeloproliferative disorder NOS is equivalent to myeloproliferative disease which is listed as a synonym for code 9975/3.

When the disease is diagnosed very early, it may manifest symptoms of two or more specific myeloproliferative neoplasms. As the disease progresses, it will manifest the symptoms of one of the specific MPN subtypes. When a more specific diagnosis becomes available, change the histology code to the more specific MPN code as directed in the PH rules. That is the scenario you describe. JAK-2 is positive, but the physician does not designate PV or ET. Hydrea is treatment for both PV and ET. In the future, the specific type of MPN may be diagnosed. In the interim, code the only diagnosis you have, MPN, NOS.

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 2010

For cases diagnosed 2010-2011, code the histology to 9975/3 [myeloproliferative/myelodysplastic neoplasm, unclassifiable] which is a new code implemented in 2010.

The process used to determine the histology is:

Enter MPN into the search mechanism in the 2010 Hematopoietic Database.

Click on the term "myeloproliferative disease, NOS, and see that the preferred term is Myelodysplastic/myeloproliferative neoplasm, unclassified.

Click on Display Abstractor Notes button to see that this code is now used for MPN NOS, and MPN unclassifiable. The third paragraph explains when the disease is diagnosed very early, it may manifest symptoms of two or more specific myeloproliferative neoplasms. That is the scenario you describe. JAK-2 is positive, but the physician does not designate PV or ET. Hydrea is treatment for both PV and ET. In the future, the specific type of MPN may be diagnosed. In the interim, code the only diagnosis you have, MPN, NOS.

The answers for SINQ questions with 2010 ID numbers were written using the 2010 Heme & Lymph Manual & DB. The instructions for using the 2010 Hematopoietic Database were written for the version of the software in use as of 5/24/2011. The user interface of the web-based 2010 Hematopoietic Database available from the SEER website varies slightly from the 5/24/2011 version in that the web-based version provides all the disease information in one scrollable window.

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 2010

For cases diagnosed 2010-2011, access the 2010 Hematopoietic Database at http://seer.cancer.gov/tools/heme/. Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. For 2010-2011 diagnoses, click on the "use the 2010 database" label in the upper right corner of the screen. The 2010 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.

Cancer Site Category:

Heme & Lymphoid Neoplasms

Data Item Category:

Histology

Other Category:

N/A

Year:

2010