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Produced: 10/19/2025 8:50 PM
Question 20130012
Inquiry Details
References:
2007 MP/H Rules
Question:
MP/H Rules/Multiple primaries--Urinary: If topography codes C681-C689 are not included in Urinary Multiple Primary Rule M8, would a subsequent renal pelvis papillary transitional cell carcinoma be a new primary? See Discussion.
Discussion:
The patient had a papillary transitional cell carcinoma of the bladder and ureter diagnosed in 2010. The primary site was coded to C689 [urinary system, NOS]. The patient was diagnosed with a transitional cell carcinoma of the renal pelvis [C659] in 2012. In applying the MP/H rules to the 2012 diagnosis, rule M8 would be ignored because the primary site of the 2010 primary was coded to C689. The result is that M9 or M10 would be applied which indicates a new primary for the 2012 diagnosis. Should the 2012 renal pelvis carcinoma be a new primary?
Answer:
For cases diagnosed 2007 or later, accession a single primary, papillary transitional cell carcinoma of the bladder and ureter [C689, urinary system, NOS] diagnosed in 2010. The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Urinary MP Rules because site specific rules exist for this primary.
Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. This patient has urothelial tumors in two or more of the listed sites (bladder, ureter and renal pelvis) diagnosed within 3 years.
When C689 is assigned because tumors of the bladder and tumors of the ureter were determined to be a single primary and the site of origin is not known (as in this example), rule M8 is applied when a subsequent tumor is diagnosed in one of the listed sites. However, if site C689 [urinary system, NOS] was assigned for other unknown urinary primary site situations, rule M8 would not be used.
Rule M8 was written specifically for urothelial tumors in the renal pelvis, ureter, bladder and urethra. Paraurethral gland [C681] and overlapping lesions of urinary organs [C688] do not belong in rule M8.
We will add this issue to the list of possible revisions for the next edition of the MP/H Rules.
History:
Rule M8 was written specifically for urothelial tumors in the renal pelvis, ureter, bladder, and urethra. Paraurethral gland (C681) and overlapping lesions of urinary organs (C688) do not belong in rule M8.
When C689 is assigned because tumors of the bladder and tumors of the ureter were determined to be a single primary and the site of origin is not known (as in your example), it makes sense to apply rule M8 when a subsequent tumor is diagnosed in one of the listed sites. However, if C689 is assigned for other unknown primary site situations, rule M8 should not be used.
We will add this issue to the list of possible revisions for the next edition of the MP/H rules.
