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Report Produced: 05/27/2025 16:05 PM

Report Question ID Question Discussion Answer Year
20230034

Update to Current Manual/Surgery of Primary Site 2023--Melanoma:  Considering the 2023 melanoma surgery codes for punch biopsy NOS (B220) and shave biopsy NOS (B230), how is Date of First Surgical Procedure coded when the punch or shave biopsy is not excisional? See Discussion.

Now that there are specific surgery codes for shave and punch biopsies, are these biopsies always the Date of First Surgical Procedure (NAACCR Item #1200)? Or should we still be applying the Surgery of Primary Site 2023 instruction in the SEER Manual that states shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed?

Example: On 01/01/2023, patient has a frontal scalp shave biopsy showing melanoma, margins involved. On 02/01/2023, frontal scalp excision shows residual melanoma. Surgery code is assigned B520 (shave followed by wide excision). How is Date of First Surgical Procedure coded now that there is an additional surgery code for the shave biopsy?

Code the Date of First Surgical Procedure as 01/01/2023 in the example provided where the shave biopsy is followed by wide excision. Beginning in 2023, significant changes were made in that shave, punch, and elliptical biopsies are coded as surgical procedure regardless of margin status. Appendix C Skin Surgery Codes state that an incisional biopsy would be a needle or core biopsy of the primary tumor.

Please see Appendix M: Case Studies for Coding Melanoma in STORE v23, Case study 2: Shave Biopsy followed by WLE (page 412), for an explicit example of how to code your example case.

We will clarify this in the upcoming release of the SEER manual,

 2023
20230028

Histology--Vulva:  How is the histology coded for vulvar intraepithelial neoplasia III (VIN III)/Squamous cell carcinoma in situ from a pathology report of the vulva, 8070/2 for squamous cell carcinoma in situ or 8077/2 for VIN III?  The rules do not discuss this particular situation. 

Assign 8077/2 for high-grade squamous intraepithelial lesion, VIN 3 in this case.  The WHO Classification of Female Genital Tumors, 5th edition, states that squamous intraepithelial lesions (SILs) of the vulva are also known as vulvar intraepithelial neoplasia, HPV-associated.  The term squamous cell carcinoma in situ is not recommended.

 2023
20230032

Reportability/Histology--Thyroid: Is a diagnosis of papillary carcinoma, follicular variant, encapsulated/well demarcated, non-invasive reportable? See Discussion.

The final diagnosis for a left thyroid lobectomy was Papillary thyroid microcarcinoma, further stated to be Histologic Type: Papillary carcinoma, follicular variant, encapsulated/well demarcated, non-invasive. The diagnosis comment states there is a small follicular pattern papillary microcarcinoma.

Is the designation of “non-invasive” for this papillary follicular tumor equivalent to a non-reportable diagnosis of Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 8349/1? Or should this be accessioned as either a reportable in situ (non-invasive) papillary follicular thyroid carcinoma or a papillary microcarcinoma per the diagnosis comment?

Your case is equivalent to encapsulated follicular variant of papillary thyroid carcinoma, non-invasive (non-invasive EFVPTC) and is not reportable for cases diagnosed in 2021 or later even though it says "carcinoma." That is because the WHO assigned a behavior code of /1 to this entity (8349/1). NIFTP is assigned to the same histology and behavior code.

 2023
20230042

First Course Treatment/Surgery of Primary Site--Rectum:  What surgery code should be used for laparoscopic C/T open low anterior resection with colorectal anastomosis, loop ileostomy in diagnosis year 2020, code 30 or 40?  See Discussion.

Can you provide clarification on Rectum primary surgical code 40 Pull through WITH sphincter preservation (colo-anal anastomosis)? Would this be code 30 or 40 due to the colorectal anastomosis? 

Assign code 40, Pull through WITH sphincter preservation (colo-anal anastomosis).  The National Cancer Institute Dictionary of Cancer Terms defines coloanal anastomosis as a surgical procedure in which the colon is attached to the anus after the rectum has been removed. It is also called coloanal pull-through.

 2023
20230075

EOD/Summary Stage--Eye: How is stage coded for a patient with extranodal non-Hodgkin lymphoma involving bilateral choroids (single focus, both sites) and no lymph node involvement? Since the eyes are a paired site, is this two separate extranodal sites? If so, there are no Summary Stage or EOD tumor codes that best fit this scenario.

Assign as Stage IV as recommended by our expert hematological oncologist. This is a rare occurrence and this type of presentation does not fit the definition of intraocular extension. Stage IV is probably the best stage for this type of presentation, since there are two extranodal organs involved, even though they involve a bilateral site.

EOD Primary Tumor: 700

SS: 7 (Distant)

 2023
20230055

Reportability/Histology--Heme and Lymphoid Neoplasms: Is "the differential diagnoses include, but not limited to, mantle cell lymphoma, atypical chronic lymphocytic leukemia/small lymphocytic lymphoma and a variant of marginal zone lymphoma" reportable? In the Heme manual, they use differential diagnosis that include reportable conditions as reportable. This can be found under Code 1: positive histology in the Diagnostic Confirmation Coding Instruction section page 18. The phrase "include, but not limited to" makes this not clear. 

This is reportable as 9591/3, B-cell lymphoma, NOS.All diagnoses in the differential are all B-cell lymphomas. The pathologist knows it a B-cell lymphoma but has not determined the subtype. If at a later time a specific lymphoma is determined, update the histology code accordingly. 

 2023
20230074

Extent of Disease/EOD Regional Nodes--Small Intestine: For an ileal/jejunal neuroendocrine primary, how should mesenteric soft tissue deposits (less than 2 cm) be collected in Extent of Disease (EOD) Staging? See Discussion.

Example: Patient is diagnosed with grade 1 well-differentiated neuroendocrine tumor of the ileum, confirmed on ileocolic resection in 2023. The final diagnosis is a 2.8 cm ileal mass, with focal lymph-vascular invasion and a single 0.6 cm tumor deposit within mesenteric fat; primary tumor completely resected with widely negative margins and 10 regional nodes negative for malignancy.

According to AJCC, mesenteric masses less than 2 cm should be stated in the pathology report as being present and collected by registrars but do not affect stage. EOD Regional Nodes has a code for large mesenteric masses greater than 2 cm only. How should we record these smaller tumor deposits if they are not supposed to affect stage?

Do not code 500 for involvement of the mesentery unless the mesentery is specifically stated to be involved (and we don't have that information). We need more information on this case to assign EOD primary tumor. 

EOD Regional Nodes would be 000 per AJCC. 

 2023
20230003

SEER Manual/Reportability--Ambiguous Terminology:  Please clarify the reportability and relevant date ranges of the following ambiguous terminology: almost certainly, most certainly, and malignant until proven otherwise.  See Discussion.

SINQ 20180104 indicates, in the absence of further info, the terms “almost certainly” and “until proven otherwise” are NOT reportable. There is no date range provided for this answer.

SINQ 20200027 indicates, in the absence of further info, the term “most certainly” IS reportable. There is no date range provided for this answer.

SEER Program Coding and Staging Manual 2022 indicates, in the absence of further info, the terms “until proven otherwise” and “most certainly” ARE reportable.

Essentially, we are hoping for an update of SINQ 20180104 due to 2022 reportability change. Clarification to the equivalence of “almost certainly” and “most certainly” would also be helpful.

Use the ambiguous terminology list as a guide in the absence of additional information after reviewing all available information and consulting the physician who diagnosed and/or staged the tumor. 

Equivalent to "Diagnostic for" malignancy or reportable diagnosis

  • most certainly carcinoma
  • malignant until proven otherwise

Not Equivalent to "Diagnostic for" malignancy or reportable diagnosis

  • almost certainly ("almost" conveys uncertainty in comparison to "most" as in "most certainly")

We will update SINQ 20180104.

 2023
20230045

Reportability/Histology--Thyroid:  Is a diagnosis of “angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma” reportable if the diagnosis comment states, additional immunostains were performed which demonstrate the carcinoma cells are positive for thyroglobulin and negative for calcitonin?  See Discussion.

Patient had a right thyroid lobectomy on 12/2022, with initial diagnosis of “thyroid carcinoma pending expert consultation for definitive classification.”  The slide review documented in the addendum shows a final diagnosis of “Angioinvasive oncocytic thyroid neoplasm, see comment.”  The subsequent comment states, “I would classify this lesion as an angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma.”  The comment goes on to state, “Additional immunostains were performed which demonstrate the carcinoma cells are positive for thyroglobulin and negative for calcitonin. The diagnosis remains unchanged.”

Do not report angioinvasive oncocytic thyroid neoplasm with features worrisome for a poorly differentiated oncocytic carcinoma based on the final, unchanged diagnosis.  Worrisome is not a reportable ambiguous terminology.

 2023
20230005

SEER Manual/First Course Treatment--Radiation Treatment Modality: How is Peptide Receptor Radionuclide Therapy (PRRT), a form of molecular therapy, coded when used to treat neuroendocrine tumors? See Discussion.

The 2023 SEER Manual indicates PRRT should be coded in the Other Therapy field per coding instruction 2.d.  Likewise, SINQ 20180106 instructs to code PRRT as Other Therapy, while the discussion portion clearly outlines the radioactive nature of this modality.

Would PRRT be best coded as a radioisotope in the Radiation Treatment Modality--Phase I, II, III field rather than in the Other Therapy field?

For cases diagnosed in 2023 and later, Update to the current manual: Assign code 13 (Radioisotopes, NOS) in Radiation Treatment Modality--Phase I, II, III for PRRT.

We will make this change in the next version of the SEER Manual.

 2023