EOD-Extension--Lymphoma: What code is used to represent a non-Hodgkin lymphoma presenting with involvement of an extralymphatic organ and lymph nodes on the opposite side of the diaphragm?
For cases diagnosed 1998-2003: Code the EOD-Extension field to 31 [30 + localized involvement of an extralymphatic organ or site; Stage III E].
EOD-Clinical Extension/EOD-Lymph Nodes--Prostate: How do you code clinical extension and lymph nodes for path only prostate cases treated with a TURP? Would clinical extension be coded to unknown or localized, NOS?
For cases diagnosed 1998-2003: Code the EOD-Clinical Extension field to 30 [localized, NOS] and the EOD-Lymph Nodes field to 0 [no lymph node involvement]. Per Note 7: Use code 30 when there is insufficient information as to whether the tumor is clinically apparent or inapparent but the tumor is confined to the prostate. This is an example of a case where there is insufficient information as to whether the tumor is clinically apparent or inapparent. Assume the tumor is confined to the prostate.
Surgery of Primary Site--Skin: Explain the difference between code 30 and code 45.
Code 30 [Biopsy of primary tumor followed by a gross excision of the lesion]
Code 45 [Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm, NOS. Margins MUST be microscopically negative.]
For cases diagnosed 1/1/2003 and after: Code 30 represents a biopsy or excision in which the margins of excision are less than 1 cm or the margins are unknown. Code 45 represents a wide excision in which it is known that the margins of excision are greater than 1 cm.
EOD-Clinical Extension--Prostate: In the SEER EOD manual, there is a list of terms to distinguish apparent from inapparent tumor for prostate primaries. Are terms in the "maybe" category and are terms not on the list clinically inapparent or clinically apparent when there is no physician staging of the case? See discussion.
The rectal examination states that there is "asymmetrical enlargement of the prostate, firmness over the right lobe" and the physical exam impression is extensive carcinoma of right lobe. A needle biopsy of the right lobe was positive. "Enlarged" is on SEER's list of clinically inapparent terms; "asymmetrical" and "firm, NOS" are on the "maybe" list.
For cases diagnosed 1998-2003:
On the basis of the physical exam impression, code the EOD-Clinical Extension field to 20 [involvement of one lobe, NOS] for this case. Although the medical record did not provide a physician's staging of the case as clinically apparent, the physician did suspect carcinoma prior to the biopsy.
If clarifying stage information is missing and the term is in the "maybe" category or the term is not on the list, then code extension as 30 [localized, NOS] for cases that appear localized.
EOD-Extension--Lung: Is bilateral pleural effusion coded as 72 [malignant pleural effusion] or 85 [metastasis]? See discussion.
Example:
10/30/98 CXR: Widespread malignancy, hilar, superior mediastinal masses, bilateral pleural effusions, fullness in soft tissue right neck.
11/01/98 CT chest/ABD: Extensive infiltrate mediastinum by radiolucent tumor mass that engulfs esophagus/trachea. Pleural effusion extends so low it apes ascites. Normal ABS/pelvis.
11/01/98 Pathology: FNA right supraclavicular lymph node: metastic oat cell ca. Sputum cytology reported to be negative.
For cases diagnosed 1998-2003, code the EOD-Extension field to 72 [malignant pleural effusion; pleural effusion, NOS].
Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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.
Hematologic Transplant and Endocrine Procedures--Breast: Is a bone marrow transplant first course of cancer-directed therapy for breast cancer? If yes, are time guidelines relating to the first "remission" the same as for those used in leukemia primaries?
For cases diagnosed 1/1/2003 and after: A bone marrow transplant can be first course of therapy for cases in which there has been no progression of disease between the initial therapy (e.g., surgery, radiation, chemotherapy) and the bone marrow transplant. Code Hematologic Transplant and Endocrine Procedures field to 10-12 or 40 (depending on the type of bone marrow transplant performed).
Do not use leukemia treatment time guidelines when coding breast cancer treatment.
Surgery of Primary Site/Reconstruction-First Course--Breast: If the plan is to "reconstruct" the breast 6 months after an ipsilateral modified radical mastectomy, is the time span a problem or should it be coded in the Surgery of Primary Site field because it was planned?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 55 [Modified radical mastectomy WITHOUT removal of uninvolved contralateral breast, Implant]. The time span is not a problem as long as the reconstruction was planned as first course, which is indicated by tissue expander insertion at the time of the original surgery.
Grade, Differentiation: Are anaplastic tumors always coded to grade 4, even for anaplastic brain primaries?
Yes. Always code the Grade, Differentiation field to for 4 [Grade IV] for "anaplastic" tumors. Anaplastic is synonymous with undifferentiated. Refer to the example in the SEER Program Code Manual, 3rd Ed.
Surgery of Primary Site--Lung: What code is used to represent "photodynamic therapy" (PDT) for lung primaries? See Discussion.
PDT is not listed in the Surgery to Primary Site field codes for lung.
For cases diagnosed 2003 and later, code the Surgery of Primary Site field to 19 [Local destruction or excision, NOS] for lung primaries. Photodynamic therapy is a surgical procedure that results in the local destruction of tumor.
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