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SEER Inquiry System - Report
Produced: 10/19/2025 9:41 PM
Question 20210061
Inquiry Details
References:
2021 SEER Manual, 151-154. First Course of Therapy
Question:
First course treatment/Update to current manual: Should the instruction regarding expectant management in the 2021 (and 2022) SEER Manual include how to code for the patient’s decision to proceed with expectant management? See Discussion.
Discussion:
Currently, First Course Therapy instruction for expectant management (also referred to as active surveillance, watchful waiting, etc.) instructs one to code 0 or 00 (not done) for all data items when the physician opts for expectant management.
We find that the treatment decisions can be driven by the patient, physician, or combination of both patient and physician depending on the options presented.
Answer:
Instructions for First Course of Therapy include using the documented first course of therapy (treatment plan) from the medical record. While a patient may weigh in on the treatment decision, the physician is responsible for developing and managing the treatment plan including closely watching a patient’s condition but not giving treatment unless symptoms appear or change.
We can add language to a future manual to clarify.
