Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"?
Code the Date of Diagnosis field to the date of the scan. This is the earliest date that a recognized medical practitioner said the patient had cancer. The diagnosis on the CT scan was a malignancy. The only question was whether the mass on the scan was metastatic or a primary.
Surgery of Primary Site--Prostate: What treatment code is used to represent prostate carcinoma treated with "high intensity focused ultrasound" (HIFU)?
For cases diagnosed 1998 and later:
Code the Surgery of Primary Site field to 17 [Other method of local tumor destruction]. HIFU uses focused energy to destroy tissue. It is classified as a surgical procedure.
Grade, Differentiation--All Sites: What code is used to represent this field when there are invasive and in situ components in a tumor, but only the in situ component is graded (e.g., Invasive ductal carcinoma with high grade ductal carcinoma in situ)?
Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. The grade is taken from the invasive component only.
Histology (Pre-2007)--Breast: What code is used to represent the histology "duct carcinoma, colloid type"? See discussion.
Do we use 8480/3 [colloid carcinoma] or 8523/3 [duct carcinoma] mixed with other types of carcinomas?
For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [colloid carcinoma] per Rule 4. The lesion is colloid type of ductal carcinoma, not ductal carcinoma mixed with colloid carcinoma.
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--Pancreas: How do you code extension when CT scan shows a mass in the head of the pancreas "encompassing" the hepatic branch of the celiac artery? See discussion.
We do not code the term "encompasses" as involvement. However, should we code this case as extension to the peripancreatic tissue, NOS or as unknown?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [Extension to peripancreatic tissue, NOS]. There has to be extension to peripancreatic tissue if the mass encompasses the celiac artery.
Grade, Differentiation--Bone Marrow: Can we use the AJCC Cancer Staging Manual, which lists myeloma as a B cell neoplasm under non-Hodgkin lymphomas, to code Grade, Differentiation field for myeloma to B-cell (code 6)?
For cases diagnosed prior to 1/1/2010:
No. Myeloma is a malignancy of plasma cells. Plasma cells are the daughters of B cells. So technically it would be correct to call them B cell, but that is not common usage.
Cell marker (phenotype) should be coded in the Grade, Differentiation field for only leukemias and lymphomas, as classified in the ICD-O-3. In the ICD-O-3, myeloma is listed under Plasma Cell Tumors, not Lymphomas. When a cell marker is coded for a leukemia/lymphoma it should be coded only from pathology and/or cytology reports.
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.
Grade, Differentiation--All Sites: If the grade given for the primary site is from a provisional diagnosis and the grade given for a metastatic site is from a final diagnosis, should we follow the SEER rule that says to code the grade as stated in the final diagnosis (e.g., Provisional diagnosis: High grade papillary serous carcinoma of ovary. Final dx: poorly differentiated adenocarcinoma in a caval lymph node)?
Code the Grade, Differentiation field to 4 [High grade] from the examination of the ovary (primary site). Do not code grade from a metastatic site.
Scope of Regional Lymph Node Surgery/EOD-Lymph Node fields: How do you code these fields if a pt has multiple lymph nodes surgeries at different times? See discussion.
Example: 1/01/03 Biopsy of 1 sentinel lymph node: positive for metastasis. 1/10/03 Modified radical mastectomy and axillary lymph node dissection: ductal carcinoma with 8 neg lymph nodes.
For cases diagnosed 1/1/2003 and later: Code Scope of Reg LN Surgery to 7. Code EOD Lymph Nodes field to 6. Code EOD Pathologic Number of Reg LN Positive and Examined fields to 01 and 09 respectively.
For the Scope of Reg LN Surgery use the highest applicable code number if more than one Scope of Reg LN Surgery was performed. The EOD lymph node fields are cumulative and count all lymph nodes removed during the diagnostic and first course treatment procedures.
Reportability/Ambiguous Terminology/Date of Diagnosis: If a "suspicious" cytology is reportable only when a later positive biopsy or a physician's clinical impression of cancer supports the cytology findings, is the Date of Diagnosis field coded to the later confirmation date rather than to the date of the suspicious cytology? Is a suspicious "biopsy" handled the same way?
Cytology reported as "suspicious" is not reportable. If the physician confirms the suspicious cytology by making a clinical diagnosis of malignancy, the Date of Diagnosis field is coded to the date of the clinical diagnosis, which may or may not be same date the cytology was performed.
Without supporting clinical documentation, the case will remain non-reportable and will not be submitted to SEER. The supporting documentation can be a physician's statement that the patient has cancer, a scan or procedure that identifies cancer, or a positive biopsy.
Suspicious "biopsies" are reportable according to SEER's list of ambiguous terms. Suspicious "cytologies" without supporting clinical statements are not.
Primary Site/EOD-Extension/EOD-Lymph Nodes--All Sites: What codes are used to represent these fields for an "extramedullary myeloid tumor (granulocytic sarcoma)" of the colon with positive or negative lymph nodes?
For cases diagnosed 1998-2003:
If only the extramedullary site is involved, such as colon, code the Primary Site field to the site of origin. Granulocytic or myeloid sarcoma is an exception to the rule that all leukemias should be coded to bone marrow as the primary site. Granulocytic sarcoma is a deposit of malignant myeloid cells in a site other than bone marrow (extramedullary). For EOD staging, granulocytic sarcoma [9930/3] is included in the Hematopoietic, Reticuloendothelial, Immunoproliferative and Myeloproliferative Neoplasms scheme and the Extension field is coded to 10 when the lymph nodes are negative, since it (like solitary plasmacytoma) is a localized deposit of tumor.
However, if the regional lymph nodes associated with the extramedullary primary site are involved, code the EOD-Extension field to 80 [Systemic disease] because the disease is no longer an isolated deposit of malignant granulocytes (in other words, it is not localized).
The EOD-Lymph Nodes field is coded to 9 regardless of whether or not the lymph nodes are involved because that is the only allowable code for that field.
An official website of the United States government
Home