EOD-Extension--Lung: How do you code extension for a lung tumor described on bronchoscopy as "obstructing the RUL and intruding into the right bronchus intermedius. Small tumor nodules distally in midline of anterior trachea wall"?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] because the tumor nodules are discontinuous from the primary tumor.
EOD-Lymph Nodes--Breast: How do you code this field when the gross description on the pathology report states "nodal tissue is matted" but only 1/18 lymph nodes is found to contain micrometastatsis per the microscopic description of the report?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 1 [Micrometastasis] because the matted nodal tissue was found to contain only one node with micrometastasis when examined microscopically. Coding priority is given to the microscopic description over the gross description.
Histology (Pre-2007)/Behavior Code: What code is used to represent the histology "foci of well differentiated intramucosal carcinoma [carcinoma in situ] arising on the surface of a tubular adenoma"? The pathologist referred to this colon biopsy as "in situ".
For tumors diagnosed prior to 2007:
Assign histology code 8210 [adenocarcinoma in a tubular adenoma] and behavior code 2 [in situ]. "In situ" is specified by the pathologist.
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.
EOD-Extension--Lymphoma: What code is used to represent this field for a lymphoma that involves the spleen and lymph nodes above the diaphragm (e.g., involvement of only the spleen below the diaphragm and cervical lymph nodes above the diaphragm)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 32 [30 + involvement of the spleen; III S]. The spleen is counted twice (once as the spleen and a second time as a lymph node region below the diaphragm). As a result, the EOD-Extension field is coded to reflect involvement of lymph node regions on both sides of the diaphragm plus involvement of the spleen. See Note 1 on the EOD scheme that states "Any lymphatic structure is to be coded the same as a lymph node region."
Surgery of Primary Site--Skin: Should Mohs surgery be code to 27 [Excisional biopsy] or 31 [Shave biopsy followed by a gross excision of the lesion]? See discussion.
Under surgery coding in the 5/22/01 SEER Abstractor/Coder Workshop book, page 20, it states that Mohs surgery should be coded as an excisional biopsy. The ACoS I&R dated 6/6/2001 states that it should be coded to 31.
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 34 [Mohs surgery, NOS], 35 [Mohs with 1-cm margin or less] or 36 [Mohs with more than 1-cm margin].
Grade, Differentiation--Breast: Does SEER agree with our pathologist who contends that "by convention lobular carcinoma is considered to be grade 2"?
No. SEER does not have a default grade code for lobular carcinoma. Code the grade as stated in the pathology report. If no grade is stated, code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable].
Reportability: Is "Castleman's Disease" reportable?
For cases diagnosed prior to 1/1/2010:Castleman's Disease is not reportable to SEER. Synonyms for this disease process include: Castleman-Iverson Disease, benign giant lymph node hyperplasia, and angiofollicular mediastinal lymph node hyperplasia. Castleman's Disease is a rare disorder characterized by non-cancerous growths that may develop in the lymph node tissue throughout the body. The plasmacellular form of this disease may progress to lymphoma or plasmacytoma.
For cases diagnosed 2010 forward, 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.
Primary Site--Head & Neck: What site code is used to represent the following head and neck primary where there is not a clear statement of primary site? See discussion.
6/29/02: PE: 2-3 cm mass in the posterior pharynx that seems to arise from the right side of back of tongue.
6/29/02 CT soft tissue of neck: 3 cm right sided oropharyngeal mass, possibly arising from right tongue mass. There is near occlusion of airway at this level.
7/3/02 Excision of oropharyngeal tumor: Palpated mass could clearly be felt coming off the right lateral tongue in approximately the mid portion of the tongue near the tonsillar base.
Code the Primary Site field to C02.9 [tongue, NOS], based on the information provided.
EOD-Extension--Lymphoma: What code is used to represent this field for an extranodal lymphoma that has more than one tumor in the primary site OR has intraluminal extension from the primary site to an adjacent organ? See discussion.
1. Small lymphocytic lymphoma with 2 tumors in the stomach.
2. Lymphoma involving the cecum and ileum.
3. Lymphoma of the fundus of stomach with extension into the esophagus.
For cases diagnosed 1998-2003:
Using the EOD scheme for lymphoma, code the Extension field to 11 [Localized involvement of a single extralymphatic organ or site; Stage IE] for all 3 of these cases.
For the stomach lymphoma: There are 2 areas of lymphoma, but it is still confined to one site.
For the other 2 lymphomas: Intraluminal (mucosal) spread of the lymphoma never equals extension. The same phrase that was added to code 21, "Direct extension to adjacent organs or tissues", will be added to code 11 in the Collaborative Stage System. Neither "mucosal spread to a contiguous organ" or "direct extension into a nearby organ" affect staging. Both are still coded to 11 as long as there are no other sites of lymphoma involvement.
EOD code 80 is poorly written. It does not mean diffuse invovement or multiple tumors in a single organ but rather "diffuse disease in two or more organs."
Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: Is the prostatic urethra a new primary for a case with a history of recurrent noninvasive bladder cancer that was subsequently diagnosed with transitional cell carcinoma in situ of the prostatic urethra and had a subsequent clinical diagnosis of "refractory bladder carcinoma"?
For tumors diagnosed prior to 2007:
If the histology of the bladder primary is "transitional cell carcinoma" or "papillary transitional cell carcinoma," do not code the prostatic urethra as a new primary. This is probably a case of intraluminal (mucosal) spread of the original tumor, rather than separate primaries. The clinical diagnosis supports this view.
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.
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