Reportability/AmbiguousTerminology: Because there is a caveat in the SEER PCM, 3rd edition to ignore adverbs such as "strongly" when assessing reportability, should a term such as "likely" cancerous be reportable given than the expression "most likely" cancerous is reportable?
"Likely cancerous" is NOT reportable.
The CoC, NPCR and SEER have agreed to a strict interpretation of the ambiguous terms list. Terms that do not appear on the list are not diagnostic of cancer.
Primary Site/EOD Fields--Head & Neck: In the absence of an actual resection and a pathologic evaluation of the affected area, would a laryngoscopy or CT scan provide a better assessment of the EOD and the primary site?
For cases diagnosed 1998-2003:
For Primary Site and EOD, CT information has higher priority than laryngoscopy. The CT scan gives a better picture of the involvement of the deeper tissues. A laryngoscopy falls into the "physical exam" category more than the "operative" category. The laryngoscopy report is not an "operative" report like those generated from a surgical procedure.
Solid Tumor Rules (2018)/Histology--Lung: The Histology coding guidelines for lung cancer state to code histology when stated as type or subtype but not to code when described as pattern. How should the histology be coded (Adeno, NOS or Adeno, Mixed subtypes) if the College of Americal Pathologists Protocol of the pathology report lists the following: Histologic type: Adenocarcinoma, papillary (90%), lepidic (8%), and solid (2%) patterns?
The term/modifier "patterns" is no longer allowed to code a specific histology according to the Lung Solid Tumor H rules. Disregard the papillary, lepidic, and solid patterns and code histology to adenocarcinoma, NOS (8140/3).
Multiple Primaries (Pre-2007)--Melanoma: Many melanoma patients have multiple occurrences over time that are not called recurrent and often are even in the same skin subsite, some in situ only and others alternating between in situ and invasive. Should these multiple occurrences really be new primaries?
For tumors diagnosed prior to 2007:
Unless it is stated to be a RECURRENT or METASTATIC melanoma, record each melanoma as a separate primary when:
1. The occurrences are more than two months apart.
2. The fourth digit of the ICD-O topography code for skin [C44._] is different .
3. The first three digits of ICD-O-3 morphology code are different.
4. An in situ melanoma is followed by an invasive melanoma.
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.
MP/H Rules/Histology--Thyroid: Regarding rule H15, is the mixed code 8340 [Papillary carcinoma, follicular variant] used when there are subtypes of these histologies described, such as a tumor diagnosed with follicular and papillary microcarcinoma or should 8341 [Papillary microcarcinoma] be used?
For cases diagnosed 2007 or later:
For coding purposes, this is a papillary and follicular combination that would be coded to the combination code 8340/3 [Papillary carcinoma, follicular variant].
For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.
Histology (Pre-2007)--Breast: Is histology coded from the more representative specimen or should the combination code 8522/3 [Infiltrating duct and lobular carcinoma] be used for a case in which a right breast mass needle core biopsy revealed infiltrating ductal ca, grade III and the subsequent right mastectomy revealed a 2.3 cm lobular carcinoma?
For tumors diagnosed prior to 2007:
Code the histology using the final diagnosis on the pathology report of the procedure that resected the majority of the primary tumor. In this case, the mastectomy removed more of the tumor than the needle biopsy. The final diagnosis from the mastectomy is infiltrating lobular carcinoma. Code histology to 8520/3 [lobular 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.
EOD-Size of Primary Tumor--Colon: When an adenocarcinoma is stated to be arising in an adenoma and the "tumor size" stated in the final pathologic diagnosis is the same size as the mass described in the gross description, should we assume that the entire polyp has been totally/near totally replaced by tumor and code the tumor size stated in the final path diagnosis?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field as stated by the pathologist in the final pathologic diagnosis. If the size of the tumor is the same as the size of the polyp, assume the polyp was completely replaced by tumor.
Primary site/Histology--Heme & Lymphoid Neoplasms: How are these field coded when a biopsy of a substernal mass and the pericardium show T-cell lymphoblastic lymphoma/leukemia, the CT scan showed mediastinal and hilar adenopathy and no bone marrow biopsy was done?
Code the histology to 9837/3 [T lymphoblastic leukemia/lymphoma].
To determine the primary site for leukemia/lymphoma histologies, first go to Module 4. Per Rule PH8, code the primary site to the site of origin when lymph nodes, tissue or organs are involved. To determine a more specific histology, go to Module 7, rules for coding primary site for lymphomas. Per Rule PH20, code the lymph node region when multiple lymph node chains within the same region are involved. Mediastinal and hilar lymph nodes are intrathoracic lymph nodes. The substernal mass is also intrathoracic and is presumed to be a lymph node mass which involved the pericardium. For this case, code the primary site to C771 [Intrathoracic lymph nodes].
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.
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.
An official website of the United States government
Home