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SEER Inquiry System - Report
Produced: 11/25/2024 12:18 AM
Question 20120002
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Histology/Diagnostic confirmation--Heme & Lymphoid Neoplasms: How are histology and diagnostic confirmation coded when a patient has a clinical diagnosis of lymphoma but a pathologic diagnosis of malignant neoplasm, NOS? See Discussion.
Discussion:
This patient had CT scans showing extensive bilateral retroperitoneal lymphadenopathy suspicious for lymphoma and left axillary lymphadenopathy. Thin core biopsies were done of the left axillary lymph nodes and immunohistology pathology was read as malignant neoplasm with extensive necrosis. Flow cytometry analysis of the sample shows no definitive or sufficient CD45+ events for informative analysis. Karyotype analysis could not be performed on this specimen due to inadequate sample. FISH analysis using IGH break apart probe showed no evidence of clonal rearrangement in limited number of cells available for analysis. The physician's diagnosis is probable lymphoma, no further workup felt necessary because patient would not tolerate chemotherapy anyway and hospice was felt most appropriate care for patient.
The definitive diagnostic method for lymphoma, NOS is histologic confirmation, but the only histologic confirmation was of "malignant neoplasm with extensive necrosis." Should the histology and diagnostic confirmation be coded as lymphoma, NOS [9590/3] and imaging without microscopic confirmation [7] or malignancy, NOS [8000/3] and positive histology [1]?
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9590/3 [malignant lymphoma, NOS] and the diagnostic confirmation to 7 [radiology and other imaging techniques without microscopic confirmation]. Per the Diagnostic Confirmation Coding Instructions for Heme and Lymphatic Neoplasms, use code 1 when ONLY the biopsy was used to diagnose the specific histology. The biopsy only confirmed a malignancy; the scan confirmed the specific diagnosis of lymphoma.
Note that a clinical diagnosis can be a definitive diagnostic method for malignant lymphoma, NOS. In this case, the biopsy was inadequate and a more specific diagnosis could not be made by histology. Because no further work-up was pursued, this NOS diagnosis of malignant lymphoma was a clinical diagnosis only.
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) will appear which indicates the correct version of the program is available now for query.
Code the histology as malignant lymphoma, NOS [9590/3] and the diagnostic confirmation as radiology and other imaging techniques without microscopic confirmation [7]. The steps used to arrive at this decision are:
Per the Case Reportability Instructions, instruction 4, report the case when the diagnosis of a hematopoietic neoplasm is preceded by an ambiguous term. The ambiguous terms "suspicious" and "probable" should be used to accession cases. Instruction 6 states to report a clinical diagnosis, "Report the case even if the diagnostic tests are equivocal...and the physician makes the clinical diagnosis based on the equivocal tests and the clinical picture."
Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Ensure that the term "Malignant lymphoma, NOS" [9590/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Scroll down to the DEFINITIVE DIAGNOSTIC METHODS section. Note that a clinical diagnosis can be a definitive diagnostic method for malignant lymphoma, NOS. In this case, the biopsy was inadequate and a more specific diagnosis could not be made by histology. As no further work-up was pursued, this NOS diagnosis of malignant lymphoma was a clinical diagnosis only. Code the histology as 9590/3. Code the diagnostic confirmation as 7 [imaging] because the CT scan was "suspicious for lymphoma."
