Type of Multiple Tumors--Lung: Is this field coded to 40 [Multiple invasive] or 80 [Unk in situ or invasive] when only one nodule is biopsied of multiple existing nodules for a reported single lung primary? See Discussion.
The right lung has 4 tumor nodules in the upper lobe. Biopsy of one tumor is positive for moderately differentiated adenocarcinoma. No other work up performed.
Should code 40 be used because we dont know the behavior of the other nodules?
The best code to use in this case is 40 [multiple invasive]. For lung only, it is assumed that all of the tumors are the same histology and that all are invasive.
MP/H Rules/Histology: In the absence of a tissue diagnosis, should the histology field be coded based on the findings of a suspicious cytology or a CT scan that clinically confirmed the diagnosis? See Discussion.
Cytology (brushings at ERCP) which are highly suspicious of adenocarcinoma. A CT of the abdomen performed the next day shows a mass, most likely Klatskin tumor. Can the histology be coded to Klatskin tumor [8162/3] based on the CT findings?
For cases diagnosed 2007 or later, code the histology to 8162/3 [Klatskin tumor] using the histology from the CT. This case is confirmed clinically based on the CT. It cannot be accessioned based on suspicious cytology.
Rule H8 in the 2007 Histology Coding Rules for Other Sites provides instructions for coding histology when the pathology report and cytology report are not available.
CS Extension--Breast: Is the term "erosion" the same as "ulceration"?
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.
"Erosion" is not synonymous with "ulceration" when coding CS extension for breast.
MP/H Rules/Recurrence--Breast: Do we use a pathologists comment of "recurrent ductal carcinoma" found in the pathology report for a new specimen to determine whether the new specimen actually represents a new primary or recurrent disease? See Discussion.
The patient had a left breast cancer LIQ, ductal with DCIS. Nodes (-) diagnosed in 1998
Treatment: Lumpectomy-clear margins
Refused radiation
Hormone therapy: Tamoxifen
Present: June 2007
Left breast-invasive ductal ca, UOQ
Pathology report comments: Recurrent ductal ca.
Left axillary nodes (+)
For cases diagnosed 2007 or later, apply the 2007 MP/H breast rules. Go to the multiple tumors module and begin with rule M4. Stop at rule M5: tumors diagnosed more than 5 years apart are multiple primaries.
The only time you can accept a pathologist's statement of recurrence is when the statement is made based on a review of the slides from the previous diagnosis compared to the slides from the current diagnosis.
Multiple Primaries/Histology--Lymphoma/Leukemia: How many primaries and what histologies are coded when a path diagnosis for a cervical/neck mass demonstrates classical Hodgkin's lymphoma on a background of chronic lymphocytic leukemia?
For cases diagnosed prior to 1/1/2010:Hodgkin disease and chronic lymphocytic leukemia are separate primaries according to our current instructions. Abstract and code them separately.
For cases diagnosed 1/1/10 and later, 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.
CS Lymph Nodes--Kidney, renal pelvis: Under what circumstances would code 80 [Lymph nodes, NOS] be used to document the presence of positive lymph nodes? See Discussion.
The CS Schema for Kidney (Renal Parenchyma) states to use code 70 for Regional Lymph Nodes, NOS. The schema for for Renal Pelvis states to use code 50 for Regional Lymph Nodes, NOS. Both schemas have a Code 80, for Lymph Nodes, NOS that maps to N1 in both schemas.
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.Code 80 can be used for positive lymph nodes when you are unable to determine if they are regional or distant. CS Lymph Nodes code 80 is provided for this situation in accordance with the downstaging rule.
Code 80 should be used very infrequently and only when there is no indication whether the involved lymph nodes are regional or distant.
Multiplicity Counter-Breast: The general instructions say to ignore separate microscopic foci when determining when to use the single tumor or multiple tumor modules. Do these instructions apply if sizes are given for the foci? See Discussion.
For instance, would a 1.2 cm breast tumor with 3 scattered microscopic foci ranging from 2-4 mm be treated as multiple tumors (4), or as a single tumor?
If the microscopic foci are measured and listed as part of the diagnosis, they should be counted as multiple tumors.
Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast?
Code the primary site as skin of breast when skin of breast is documented as the site of origin.
According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass."
Histology--Melanoma: How is a "malignant melanoma arising in a melanocytic nevus" coded?
The histology code is 8720/3 [malignant melanoma, NOS].
There is no specific code for melanoma arising in melanocytic nevus. According to our pathologist consultant, this is likely because nevi are so common, melanoma arising in association with them is common and appears to have no bearing on prognosis or treatment. Most pathologists do not include the nevus in the diagnosis of melanoma, even when they see it.
Code melanomas arising in melanocytic nevi to the appropriate melanoma code, probably 8720, 8721, or 8743 in most cases.
CS Extension--Prostate: Can the phrase "hard, fixed prostate" be interpreted as clinical extracapsular extension and coded to 50 [extension or fixation to other structures]? See Discussion.
Patient had a "hard, fixed prostate" with needle core bx positive for Gleason grade 4+5=9 adenocarcinoma extensively involving gland. PSA was 87.5. Lymphadenectomy showed 3 positive pelvic/obturator lymph nodes. No prostatectomy was done and no physician TNM staging documented.
Do we need a specific clinical description of other organs to which the prostate is fixed in order to code CS Clinical Extension 50, or does the statement "hard, fixed prostate" qualify? If not, how would we code extension for this seemingly advanced cancer?
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 extension code 50 [extension or fixation to adjacent structures] based on the term "fixed." Fixation to a particular structure(s) does not have to be specified in order to use code 50.
Do not use the statement "hard" to determine CS extension.
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