Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block?
Yes, assign diagnostic confirmation code 2 for diagnosis based on smears and cell block from CT guided FNA. This reply pertains to solid tumors.
First Course Cancer-Directed Treatment--Bladder: How should Mitomycin-C instillation for bladder cancer be coded?
Code the instillation of Mitomycin-C into the bladder for a bladder primary in both the Chemotherapy and Surgery to Primary Site fields. Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. Mitomycin-C is listed in SEER book 8 as a chemotherapeutic drug, specifically an alkylating agent.
Also, code the Surgery of Primary Site field to 15 [intravesical therapy]. Code the surgical procedure as well as the type of drug (chemotherapy in this case).
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?
This question was answered by the CoC:
Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.
Multiplicity Counter/Ambiguous terminology: How should these fields be coded for cases with an unknown date of diagnosis?
If the date of diagnosis is unknown, it is likely that you have little information for this case. Both multiplicity counter and ambiguous terminology fields would probably be coded as unknown. However, if information on the number of tumors and the diagnostic confirmation are available, code these fields as specified in the manual.
First Course Treatment: What code is used to represent each treatment modality field when there is no indication that a particular modality of treatment was recommended or started?
Code the individual treatment fields to 0 or 00 [None] when the modality is not addressed in the treatment plan (or when a treatment plan is lacking) and there is no indication that a particular modality of treatment was recommended or started.
MP/H/Multiple primaries--Stomach: How should I report this case? I reviwed both the MP/H and the Heme Rules and could not determine whether or not this case is multiple primaries in a single site but two histologies and therefore needing two separate abstracts.
Path Diagnosis: Gastric Mass Biopsy: 1) Signet Ring Cell Carcinoma. 2) Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT Lymphoma). 3) Mild Intestinal Metaplasia and Marked Fundic Gland Atrophy, Negative for H Pylori. Comments: Biopsy shows presence of both signet ring carcinoma and MALT Lymphoma.
Report two primaries: MALT lymphoma and signet ring carcinoma. Use the 2007 MP/H rules and the Heme rules for this case.
This case could be an example of a "collision tumor" - two separate tumors that grow together into one mass. Collision tumors are a rare exception to rule M2 in the MP/H rules.
MP/H Rules--Ovary: How do you code histology for a diagnosis of "clear cell CA, predominately cystic."
For cases diagnosed 2007 or later, assign histology code 8310 [Clear cell carcinoma]. Cystic describes the appearance of the tumor. Clear cell is the histologic type. Code clear cell carcinoma 8310/3. Rule H11 applies.
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.
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