Histology (Pre-2007)--Breast: Are diagnoses of "infiltrating duct and mucinous carcinoma" and "duct carcinoma, mucinous type" both coded to the histology code of 8523/3?
For tumors diagnosed prior to 2007:
Code "Infiltrating duct and mucinous carcinoma" to 8523/3 [Infiltrating duct mixed with other types of carcinoma] according to the instructions for coding a single tumor with complex histology in Appendix C of the 2004 SEER manual. Assign code 8523/3 when the diagnosis is duct carcinoma mixed with another type of carcinoma. Look for "and" or "mixed" in the diagnosis.
Code the Histology field for a "ductal carcinoma, mucinous type" to 8480/3 [Mucinous carcinoma].
The instructions for coding a single tumor with complex histology are to code the specific type if the diagnosis is "Duct carcinoma, _____ type."
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.
Grade, Differentiation--All Sites: Can "Fuhrman nuclear grade" be coded if it is the only grade given for a kidney primary, or is breast the only site for which we can use a nuclear grade in coding the Grade, Differentiation field? See discussion.
Our pathologist consultant disagrees with coding nuclear grade for any site because it is only a component of the grade, in most cases, and is not adequate to use by itself.
If the Fuhrman nuclear grade system can be used by coders, will a conversion table for the system be added to the coding documentation by SEER in the future?
For cases diagnosed 2004 and later: Fuhrman grade can be used to code the Grade, Differentiation field.
Reason no treatment/Surgery of Primary Site: Does the "Reason for No Cancer-Directed Therapy" field only relate to the "Surgery of Primary Site" field? If so, for what diagnosis years is that effective? Have SEER's coding guidelines changed over time? See discussion.
Whenever a surgical procedure is performed that results in a non 0 or 9 code in any one of the Surgery fields, should the Reason for No Site-Specific Surgery field be coded to 0 [Cancer-directed surgery performed]?
For cases diagnosed 2003 and forward: The field "Reason for No Surgery of Primary Site" applies only to surgery of primary site. This is a change from the pre-2003 instructions.
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.
Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with abundant mucin production"? See discussion.
If the diagnosis is adenocarcinoma with a mucinous focus, we code as 8140/3. However, when there is abundant mucin production, do we use 8480/3?
See SINQ #20010075: "The tumor must contain at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology. "
For tumors diagnosed prior to 2007:
Code the Histology field to 8481/3 [mucin-producing adenocarcinoma] if the diagnosis states "adenoca with abundant mucin production". Assume that the term "abundant" represents a term that implies > 50% of the tumor is mucin producing.
When a pathologist makes a diagnosis of mucin-producing adenocarcinoma, the pathologist has determined that more than 50% of the tumor is mucin-producing, so it is unnecessary for the abstractor/coder to look for additional supporting documentation.
If the pathologist states adenocarcinoma "with mucin production," look for a statement about the percentage or amount of mucin production, such as "abundant" or other wording indicating extensive mucin production. If such a statement or wording is present, code 8481/3 [mucin-producing adenocarcinoma]. If not present, code 8140/3 [adenocarcinoma, NOS].
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.
Reason for No Cancer-Directed Surgery: Could you explain why this field would be coded to 1 [Cancer-directed surgery was not recommended] or 2 [Contraindicated due to other conditions] for a case that presents with distant metastasis at diagnosis?
For cases diagnosed 1998-2002:
Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-directed surgery was not recommended] for patients who present with either a primary site or histology for which surgery is not a standard treatment. Also use code 1 for those patients who present with distant disease for a primary site that is typically treated surgically. Patients with distant metastasis typically do not have surgery performed as part of first course of treatment.
Code 2 [Contraindicated due to other conditions] is used when surgery would normally be recommended for the site (given the current stage of the tumor) but other medical conditions pose too much of a risk for the patient to undergo surgery.
Histology (Pre-2007)--Breast: What code is used to represent histology for "invasive ductal carcinoma with squamous differentiation"? Is "squamous differentiation" synonymous with "squamous metaplasia"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8570/3 [Adenocarcinoma with squamous metaplasia]. Our pathology consultant agrees that squamous metaplasia is synonymous with squamous differentiation.
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: How do we code site when endometrioid carcinoma arises in "endometriosis"?
Code the Primary Site to where the endometriosis implanted, which may or may not be the endometrium. Endometrioid carcinoma can arise in the ovary, endometrium and other internal genital sites. The site/histology edit for endometrioid and ovary has been removed from the SEER edit set.
EOD-Size of Primary Tumor/EOD-Extension--Breast: How do you code extension when the tumor in the breast is in situ and the regional axillary lymph nodes are positive? See discussion.
For example, what extension code is used for a 4.5 cm DCIS (no invasive ca found in excisional biopsy or mastectomy specimen) with mets to 01/07 LNs?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 045 [4.5 cm]. Document how the size was determined in the EOD-Extension field.
Code the EOD-Extension field to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) AND proportions of in situ and invasive not known]. By virtue of the lymph node metastasis, this must be an invasive breast carcinoma. The size of the invasive component is unknown.
Grade, Differentiation--Lymphoma/Leukemia: Should the term "Pre-T" be added to code 5 [T-cell] in the ICD-O-3 Table 22, 6th Digit Code for Immunophenotype Designation for Lymphoma and Leukemia?
For cases diagnosed prior to 1/1/2010:Code the Grade, Differentiation field to 5 [T-cell] in the 6th digit of the ICD-O-3 morphology field when the terms "pre-T cell" or "T-precursor" are used. However, this is not an official change to ICD-O-3.
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.
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