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Report Produced: 05/21/2026 12:59 PM

Report Question ID Question Discussion Answer Year
20071020 Histology--CLL/SLL: What is the correct histology code for a lymph node described in the pathology report comment section as "phenotypically consistent with chronic lymphocytic leukemia"? See Discussion. Current rules instruct us to select the lymphoma code for lymph node and/or tissue with the dual diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma. We have a cervical lymph node biopsy with that dual diagnosis, however, the pathology comment states that after immunohistochemistry testing, the lymph node is "phenotypically consistent with chronic lymphocytic leukemia." No bone marrow or blood work-up is performed.

For cases diagnosed prior to 1/1/2010:Code Small Lymphocytic Lymphoma. The current rules have not changed. Code to lymphoma because the diagnosis was made on a lymph node.

"Phenotypically consistent" means the lymph node contains CLL/SLL, not some other hematopoietic or metastatic disease.

For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2007
20021090 Primary Site--Ovary/Peritoneum: How should the Primary Site field be coded when no resection is done and it is uncertain whether the primary site is in the ovary or the peritoneum? See discussion. CT: ascites, omental cake and peritoneal studding. H&P impression: probable ovarian or peritoneal primary. Repeat CT: no enlarged adnexal mass seen to suggest ca of ovary, but possibility couldn't be ruled out. Omental bx: Metastatic ca. Comment: "IHC stains have been performed and are not typical of ovarian ca, although do not exclude an ovarian primary." After the bx, there were two clinical diagnoses written a month apart with no evidence of further work-up between those dates. The first diagnosis was "ovarian ca". The second was "Peritoneal carcinomatosis 2 month ago; Primary is unknown, possibly ovarian."

Use the best information available to identify the primary site. In this case, it is the physician's clinical assessment. Code the Primary Site to C56.9 [Ovary] for this example because the ovary is indicated to be the primary site according to the physicians involved.

When there is no surgical procedure involving the removal of the ovaries, code the Primary Site based on the clinical assessment of the disease location. If the disease is only noted to be in the peritoneum, code site to peritoneum, NOS. If the disease is seen clinically in both the ovary and the peritoneum, code site to ovary.

 2002
20000485 EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion. CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]?

For cases diagnosed 1998-2003:

Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present.

 2000
20091048 Surgery of Primary Site--Lymphoma/Soft Tissue: How is this field coded for an excision of a neck mass that found lymphoma in soft tissue (C49.0)? See Discussion. CT scan showed soft tissue mass in the retropharynx. 9/23/2008 Laryngoscopy with biopsy taken of left tonsil and left base of tongue and random biopsies of nasopharynx; FNA of left neck. Path stated left tonsil, squamous papilloma. Left base of tongue, no significant histopathology. Nasopharynx biopsies, compatible with tonsillar tissue. Pretracheal lymph node biopsies, mild reactive lymphoid hyperplasia. 9/30/2008 Excision of left neck mass with limited deep jugular chain lymph node dissection. Path stated lymph node left jugular biopsy, no tumor seen. Soft tissue, left neck biopsy, malignant B cell lymphoma with plasmacytoid differentiation. Addendum from consult: favor a diagnosis of a marginal zone lymphoma. Per the gross description, the specimen was fibrofatty connective tissue in which there is a tumor infiltrate.

Updated May 2026

For cases diagnosed prior to 2023:

Assign code 26 [partial resection]. Use the surgery codes that apply to the primary site, C490-C499.

For cases diagnosed 2023+, see code A260.

 2009
20010075 Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with a mucinous focus"? See discussion. Could 8480/3 [mucinous adenocarcinoma] be used to code histology?

For tumors diagnosed prior to 2007:

Code the Histology field to 8140/3 [adenocarcinoma, NOS]. "Focus" does not indicate the majority of tumor per rule C2 on page 2 of the Coding Complex Morph Dx's. The tumor must be at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology.

We code to the more specific term if there are no qualifying or modifying terms such as: focally, focus, predominantly. If any qualifying words are used, the C1 rule applies, which is to code to the majority of tumor.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2001
20041099 First Course Treatment: If a patient makes a blanket refusal of all recommended therapy or refuses all treatment before any therapy was recommended, are only immunotherapy and hematologic/endocrine therapies to be coded as refused (code 87)? Or should all treatment modalities be coded as refused if a patient makes a blanket refusal? Or should none of the treatment modalities be coded as refused because we do not know what would have been recommended? See Discussion. Coding instructions for immunotherapy and for hematologic/endocrine procedures state that Code 87 is to be assigned if either of the following circumstances apply: 1) If the patient made a blanket refusal of all recommended treatment. 2) If the patient refused all treatment before any was recommended. These instructions are not included for other treatment modalities. When the patient refuses treatment, the first course of therapy is no treatment. Code all treatments as refused. 2004
20081047 Reason no surgery of primary site/First course treatment: If the Reason no Surgery of Primary Site field is coded as 7 (refused), must the other treatment options (radiation, chemo, hormone) also be coded as 7? See Discussion. Coding instruction #5 in the SEER manual states: "Assign code 7 (refused) if the patient refused recommended surgery or made a blanket statement that he/she refused all treatment."

Refused [code 7] means this modality was specifically recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was refused, code Reason no surgery of primary site 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment].

Refusal of surgery does not necessarily mean that all treatment was refused. Coding Surgery of Primary Site as "refused" does not affect the coding of Radiation, Chemotherapy, Hormone Therapy, etc.

 2008
20021190 Histology (Pre-2007)--Bladder: What code is used to represent the histology "transitional cell and small cell carcinoma" of the bladder? See discussion. Code 8045/3 is used for combination codes that represent a mixture of small cell carcinoma and any other carcinoma. When we use this histology code for bladder primaries with mixed transitional cell and small cell carcinoma, we encounter a problem with the SEER edits (site and morphology conflict).

For tumors diagnosed prior to 2007:

Please see SEER Inquiry question ID number 20041104.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20071100 Type of Multiple Tumors--Colon: How is this field coded for a case in which the patient is found to have two in situ polyps and an adenocarcinoma arising in a polyp all in the same segment of the colon? See Discussion. Code 30 would not count the fact that these are polyps. Code 31 states "AND a frank adenocarcinoma." What would be the correct code? Assign code 30 [In situ and invasive] in this case. Code 31 does not apply here because frank adenocarcinoma is not present. 2007
20071025 Radiation Therapy: How is radiation coded when it is "recommended" but the patient dies before radiation is started? See Discussion. Code 0 seems appropriate but then we would lose the fact that it had been recommended. All of the other modalities give an option for 'recommended but patient died prior to treatment.' Is there a reason this option is not given for radiation?

Code Radiation (Rx Summ--Radiation) to 0 [None; diagnosed at autopsy].

SEER does not collect the Reason For No Radiation field. However, those who abstract using software that captures this data item can identify these cases. Code 5 [radiation not administered because patient died] reflects this situation.

Radiation (Rx Summ-Radiation) is a SEER field. This field is derived from the data collected in Rad-Boost Rx Modality and Rad-Regional TX Modality. These fields do not include a choice for "radiation not given because the patient died prior to treatment." Therefore, this information cannot be coded in the Radiation field.

 2007