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SEER Inquiry System - Report
Produced: 12/28/2024 12:22 PM
Question 20210065
Inquiry Details
References:
Solid Tumor Rules. Lung, September 2021 Update
Question:
Solid Tumor Rules (2018/2021)/Histology--Lung: Should there be an exception to the Solid Tumor Rules for Lung to allow coding a more specific histology described by ambiguous terminology, when the only pathologic workup done is a cytology report? Due to the unique nature of lung cases which are often diagnosed on imaging and cytology without more definitive pathology, we are seeing many cases where the existing Solid Tumor guidelines result in very generic NOS histology codes. For example, lung mass found on imaging with a fine needle aspirate of a lymph node, final diagnosis "positive for malignancy" and comment "consistent with squamous cell carcinoma." See Discussion.
Discussion:
The Solid Tumor histology coding guideline #3 for Lung states that an ambiguous histology can only be coded over an NOS when a physician clinically confirms it or the patient receives treatment based on the ambiguous histology; similar instructions exist in rules H3 and H12. We are in a central registry and don't typically have access to physician notes or treatment plans; unfortunately our hospital abstracts rarely document physician confirmation of ambiguous histology and we are uncertain if we should accept their coding of the more specific histology, assuming they did find clinical confirmation that was not documented. If not, our understanding of the Solid Tumor rules is that the histology in such a case would have to be coded as malignancy NOS (8000/3) per the non-ambiguous final diagnosis, and that we cannot use the more specific but ambiguous squamous cell carcinoma since we don't have definite clinical confirmation. We also have a fair number of cytology-only lung cases without any hospital information to clinically confirm an ambiguous histology.
Answer:
Code histology as squamous cell carcinoma, NOS (8070/3) using Lung Solid Tumor Rules, Rule H3 if no other information is available. Rule H3 states: If the case is accessioned (added to your database) based on a single histology described by ambiguous terminology and no other histology information is available/documented, code that histology.
