Surgery of Primary Site--Breast: What code is used to represent this field for a breast primary treated with a "bilateral mastectomy"? See discussion.
Pt diagnosed with rt breast primary opted to be treated with rt modified radical mastectomy and lt simple mastectomy. Path revealed invasive ductal carcinoma on the rt and ductal carcinoma in situ on the lt. Path reported 14 axillary lymph nodes were found in the mastectomy specimen.
There are two primaries. For cases diagnosed 1/1/2003 and after: For the rt breast, code Surgery of Primary Site to 51. The contralateral left breast malignancy is not involved with the right breast primary by either direct extension or metastasis. Codes 42 and 52 are used to capture prophylactic mastectomy of the opposite noncancerous breast. In this case, the opposite breast has cancer so these codes cannot be used. Code Scope of Regional Lymph Node Surgery to 5 and Surgical Procedure of Other Site to 0.
For the lt breast, code Surgery of Primary Site to 41, Scope of Reg LN Surgery to 0, and Surgical Procedure of Other Site to 0.
EOD-Lymph Nodes--Breast: Are lymph nodes described as being either "keratin positive" or "keratin positive for metastasis" to be coded as involved lymph nodes?
For cases diagnosed between 1998-2003:
Lymph nodes that are only "keratin positive" would not be coded as involved lymph nodes. The pathologist uses this expression to mean that the nodes stained positive for keratin that does not mean they are also involved with cancer.
However, if the pathologist uses these stains to make a definitive diagnosis of metastatic carcinoma (i.e., uses the expression "keratin positive for metastasis"), then code the nodes as involved.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field for a lymph node biopsy that reveals "well differentiated lymphocytic lymphoma" and a bone marrow biopsy that reveals "chronic lymphocytic leukemia/well differentiated lymphocytic lymphoma"?
For cases diagnosed prior to 1/1/2010:
Code the Grade, Differentiation field to 1 [Grade 1] for both of these cases because there is no mention of T-cell, B-cell, null cell, or NK cell involvement. Both cases have a pathologic description of well differentiated, not the descriptors "high grade," "low grade," or "intermediate grade" which must be ignored when coding grade for lymphomas.
For lymphomas, you cannot code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field because these terms refer to categories in the Working Formulation and not to histologic grade. However, you can code terms such as "well differentiated", "moderately differentiated" and "poorly differentiated" for lymphoma histologies.
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: Should we take the grade from a TNM staging form over a grade stated in a pathology report when the grade mentioned on the TNM staging form is a higher grade (e.g., Pathology report diagnosis is moderately differentiated adenocarcinoma, Gleason's 3+3=6, but the physician checked "poorly differentiated" on the TNM form)?
Code the Grade, Differentiation field to 2 [moderatley differentiated]. Code from the pathology report over the TNM staging form. If you do not have access to the path report, use the grade from the TNM form.
Histology (Pre-2007)--Kidney: What code is used to represent the histology "renal cell carcinoma with granular cell morphology"? Kidney primary with diagnosis of renal cell CA with granular cell morphology. Do we code as granular cell carcinoma? Is the term "morphology" synonymous with "type"? See discussion.
Do we code this type of tumor as a granular cell carcinoma [8580/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8320/3 [granular cell carcinoma]. Renal cell carcinoma is a non-specific term that has several specific cellular subtypes, one of which is granular cell [8320/3].
Note: Do not code to granular cell tumor [9580/3], which is not a histology related to renal cell 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.
Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries?
For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary.
Diagnostic Confirmation--Testis: How do you code this field when a testicular mass is confirmed to be cancer on physical exam and testicular antigen, but the orchiectomy specimen was negative and yet the final signout diagnosis on the medical record was "testicular cancer"?
Code the Diagnostic Confirmation field to 5 [Positive laboratory test/marker study] because the disease was confirmed both clinically and by a positive marker. Code 8 [Clinical diagnosis only] is used when the diagnosis is based on information other than that coded in 5, 6, or 7 [positive lab test/marker study, visualization, and radiography or other imaging techniques]. Code 8 is rarely used.
EOD-Extension--Cervix: How do you code tumor extension described as "the in situ lesion extends from the cervix to the mucosa of the vagina"? See discussion.
Example: Cone biopsy of cervix and vaginal vault both show ca in situ. The op report stated: "lesion extending from the left lateral portion of the cervix onto the left lateral portion of the vagina." The pathologist stated it "appeared to be an in situ lesion extending from the cervix to the mucosa of the vagina."
For cases diagnosed 1998-2003:
Code the Primary Site to C53.9 [Cervix uteri] and the EOD-Extension filed to 00 [in situ]. In situ is a measurement of invasion. Extension of the cervical in situ carcinoma via the mucosa to the vagina does not affect the EOD extension code.
EOD-Extension--Lung: Are "aortico-pulmonary window", "paratracheal space", and "subcarina" coded in the EOD extension field or in the EOD lymph node involvement field? See discussion.
Would a lung tumor that extends into the AP window be synonymous with extension into the mediastinum? If so, would this also apply to extension to subcarina, paratracheal space, and other such terms corresponding to areas listed in the mediastinal lymph node field under code 2?
For cases diagnosed between 1998-2003:
Extension into the aortico-pulmonary window, would be coded in the EOD-Extension field as 70 [mediastinal extension]. If the tumor extends into the paratracheal space, subcarina, or other areas listed under the code 2 in lymph nodes, code the EOD-Extension field to 70 to capture this type of involvement.
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