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EOD-Clinical Extension--Prostate: For prostate cancer, can an elevated PSA be used to code metastasis? See discussion.
5/31/98 PE: 30 gm prostate with nodularity, suspicious for CA.
Final diagnosis: Stage D Ca of prostate with mets, NOS
PTA IVP: Normal collecting system
5/11/98 CXR: NED
PSA 86.3 Suggestive of prostate Ca per MD
5/13/98 TURP and bilat. orchiectomy: Plan was to perform orchiectomy as treatment of choice if biopsy was positive. Appears MD feels that the patient has mets, NOS based on the elevated PSA.
5/13/98 TURP Adenocarcinoma, PD
For cases diagnosed 1998-2003, do not code the EOD-Clinical Extension field based on elevated PSA alone. If a recognized practitioner states that there is metastasis, then metastasis should be coded.
In this case, code the EOD-Clinical Extension field to 85 [Metastasis] because it is Stage D. But if you had D1 or D2 staging based on the involvement of lymph nodes, then that involvement would be coded under EOD lymph nodes and not under the clinical extension field.
Histology (Pre-2007)--Colon: What code is used to represent the histology "adenocarcinoma arising in a papillary adenomatous polyp"? See discussion.
Is "adenocarcinoma arising in a papillary adenomatous polyp" equivalent to adenocarcinoma in a villous adenoma [8261/3] or adenocarcinoma in an adenomatous polyp [8210/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8261/3 [adenocarcinoma in a villous adenoma]. In describing colon polyps, papillary and villous are equivalent terms.
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.
Surgery of Primary Site--Cervix: How is this field coded for a cervix primary when a biopsy removes the entire tumor? See discussion.
Path from biopsy shows "severe dysplasia--CIN III" and the report from an endocervical curettage (ECC) is "chronic cervicitis"?
For cases diagnosed 1998 and later: Code the Surgery of Primary Site field to 25 [Dilatation and curettage; endocervical curettage (for in situ only)].
Multiple Primaries (Pre-2007): Is an in situ tumor followed by another in situ tumor in the same location a new primary? See discussion.
Example: Six months after an in situ lesion was excised from the buccal mucosa, another in situ lesion was excised from the same area of the buccal mucosa with no mention of it being recurrent.
For tumors diagnosed prior to 2007:
Code as a second primary if the second in situ tumor occurred more than 2 months after the first, and it is not referred to as recurrent by the clinician or pathologist. There are no special rules for determining the number of primaries when an in situ lesion follows an in situ.
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.
Histology (Pre-2007): What code is used to represent the histology for a "malignant invasive gastrointestinal stromal tumor (GIST)"?
For tumors diagnosed 2001-2006: Malignant GIST is coded 8936/3.
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.
CS Extension--Prostate: How do you code clinical extension for prostate primaries diagnosed at autopsy? See discussion.
A patient was not diagnosed prior to autopsy. The autopsy diagnosis states that this is adenocarcinoma of the prostate without capsular invasion.
Should clinical extension be coded to clinically inapparent, NOS (10) and pathologic extension be coded to no prostatectomy done within first course of treatment (97)?
Code CS Extension (clinical) to 99 [Unknown]. Code SSF 3 according to the amount of tumor found using the information from the autopsy.
Primary Site: What site code is used to classify a femur biopsy with pathologic diagnosis of "Ewing sarcoma/primitive neuroectodermal tumor (PNET)"? See discussion.
ICD-O-3 lists PNET as being site specific to C71._. The pathology report states "some authors consider both Ewing sarcoma and PNET to be the same histologic entity given that they share the same translocation between chromosomes 11 and 23."
Code the Primary Site field to C40.2 [femur] based on Rule H in the ICD-O-3 that states, "Use the topography code provided when a topographic site is not listed in the diagnosis. This topography code should be disregarded if the tumor is known to arise at another site."
EOD-Size of Primary Tumor--Prostate: Should the size of tumor be recorded as 001 (focus) or the actual size when both are stated? See Discussion.
The pathology report from a TURP identifies a 3-mm focus of adenocarcinoma.
For cases diagnosed 1998-2003, code the EOD-Size of Primary Tumor field to 003 [3 mm]. The rule that says to code a focus or foci of tumor as 001 was developed for use when no tumor size is given.
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