EOD 2018/Primary tumor--Melanoma: The code and level translations in the Note 4 of Extent of Disease (EOD) Primary Tumor for Melanoma Skin seem incorrect. Please advise.
* Code 000: In situ
* Code 100: Level I (should be level II) (< 0.75 mm Breslow's Depth)
* Code 200: Level II (should be level III) (0.76 mm to 1.50 mm Breslow's Depth)
* Code 300: Level III (should be level IV) (> 1.50 mm Breslow's Depth)
Please see the corrected levels below for the note. Note 4: If a Breslow's depth is given in the pathology report and there is no other indication of involvement, the following guidelines may be used (Note: If a physician documents a different Clark's Level than provided by these guidelines, go with the physician's Clark Level)
Code 000: Level I (In situ)
Code 100: Level II (< 0.75 mm Breslow's Depth)
Code 200: Level III (0.76 mm to 1.50 mm Breslow's Depth)
Multiple primaries--Heme & Lymphoid Neoplasms: Is this abstracted as one primary or two?
5/2/13 Bone Marrow biopsy: myelodysplastic syndrome with approaching to acute myeloid leukemia with del 5q and 7q deletions. FISH: deletion of chromosome 5q and deletion of chromosome 7q detected.
I checked the Heme DB manual and there is no term "With approaching to". I checked the Multiple Primary calculator and it says new primary. My interpretation is that the myelodysplastic syndrome is in the process of transforming to acute myeloid leukemia.
Abstract a single primary, myelodysplastic syndrome with del 5q and 7q deletions (9986/3). This neoplasm can transform to acute myeloid leukemia (AML); however, "with approaching to" cannot be used to report this AML.
CS Lymph Nodes--Colon: Are positive paracecal lymph nodes for cecal primaries coded to 10 [paracolic] or code 20 [cecal: anterior (prececal), posterior (retrocecal); NOS]?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Assign code 20 [Regional lymph node(s) for specific subsites]. Paracecal means near the cecum. Paracecal lymph nodes are regional nodes for the cecum and not for other colon subsites.
Histology (Pre-2007)--Breast: Is a "noninvasive papillary carcinoma, solid type, of the breast" coded to 8503/2 [noninfiltrating intraductal papillary carcinoma] or 8230/2 [Intraductal carcinoma, solid type]?
For tumors diagnosed prior to 2007:
Code histology to 8503/2 [Noninfiltrating intraductal papillary adenocarcinoma]. "Solid" is one of four subtypes of intraductal papillary carcinoma. The other subtypes are cribriform, micropapillary and spindle cell. ICD-O-3 does not provide codes for each intraductal papillary subtype, so code to intraductal papillary 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.
Primary site--Heme & Lymphoid Neoplasms: How do you code primary site for a case of "leukemia cutis" when the bone marrow exam is negative for involvement with leukemia?
Code the primary site to C421 [bone marrow] per Rule PH30 which states to use the to determine the primary site and histology when rules PH1-PH29 do apply. Leukemia cutis is the term for a leukemic infiltration of the epidermis, the dermis or the subcutis. This infiltration is easily identified as cutaneous lesions, but the primary site is still bone marrow. This is a type of "metastasis" or spread of the leukemia cells. The "conventional" definition for leukemia cutis is the infiltration of skin from a bone marrow primary. See the Hematopoietic & Lymphoid Neoplasm Coding Manual Glossary.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
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.
Surgery of Primary Site--Bladder: Should a TURB be coded to 27 [Excisional biopsy; SEER Note: Code TURB as 27] when there is obvious extravesicular extension demonstrated because the 2004 SEER Manual states "Do not code an excisional biopsy when there is macroscopic residual disease"?
Assign code 27 [excisional biopsy]. The site-specific instructions have priority over the general instructions. According to the instructions for coding surgery of the bladder, use code 27 for TURB.
First course treatment--Anus: Is the topical application of trichloroacetic acid to an anal condyloma with AIN III first course treatment coded to 10 [Local tumor destruction, NOS] in the Surgery of Primary Site field?
Code the trichloroacetic acid treatment of reportable AIN III in the "Other Therapy" field. Assign code 1 [Other].
Reportability/Histology--Testis: Is micropapillary serous borderline tumor reportable? Pathology states Testis (C621) radical orchiectomy: Micropapillary serous borderline tumor.
We consulted an expert genitourinary pathologist who advises that micropapillary serous borderline tumor of the testis is reportable. He states "it is the same neoplasm as in the ovary. It arises from tissue (tunica vaginalis) surrounding the testis so is a paratesticular neoplasm."
Please note: not all borderline tumors are reportable and this diagnosis is an exception because it is assigned /2 in ICD-O-3.2. It is reportable for cases diagnosed Jan 1, 2021 and later.
EOD-Extension/EOD-Lymph Nodes--Bladder: Are "perivesical nodules" coded in the EOD-Lymph Nodes field or are they discontinuous extension and coded in the EOD-Extension field?
For cases diagnosed 1998-2003:
Code "perivesical nodules" in the EOD-Lymph Nodes field as involvement of regional lymph nodes. Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node.
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