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).
Seq no-central--Brain and CNS: How should subsequent tumors be sequenced when the patient has a history of a brain tumor, with no information on the behavior of the brain tumor? According to the sequencing rules, it appears some assumption must be made regarding the behavior of the brain tumor.
Sequence the brain tumor in the 60-87 series when you do not know the behavior. If you have reason to believe the brain tumor was malignant, sequence it in the 00-59 series.
Reportability/Breast: Is lobular carcinoma in situ (LCIS) reportable? The eighth edition, American Joint Commission on Cancer (AJCC) Cancer Staging Manual does not stage LCIS.
Yes, LCIS is reportable. Staging does not determine reportability. Follow the reportability requirements of your state and national standard setter. SEER reportability requirements are found in the SEER manual starting on page 5, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf
Laterality--Head and Neck: Were the topography codes C090 and C091 intentionally left off of the Sites for Which Laterality Codes Must Be Recorded table in the 2018 SEER Manual? The codes were also removed from Table 10 in the 2018 Solid Tumor Rules for Head and Neck but appear under coding instructions 1b. and 6b. in the manual.
Thank you for bringing this to our attention. C090 and C091 were intentionally removed from the list of sites for which laterality must be coded. They should have also been removed from coding instructions 1b and 6b. We will make that correction in the next version of the manual.
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.
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.
CS Mets at Dx/CS Mets Eval--Colon: Would the metastasis field be coded to 00 [No; none] and the evaluation field be coded to 1 [No path exam of metastatic tissue performed.] when the source of information is from the operative findings for the following 6 different cases? 1) Liver normal; 2) No evidence of metastatic disease; mesentery normal, 3) Small ascites; no liver metastasis, mass adherent to duodenum without obvious invasion, 4) No mets or local invasion, 5) No evidence of carcinomatosis, peritoneal studding or malignant effusion and 6) Tumor adherent to lateral sidewall (path negative); no evidence of metastatic implants.
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.
The CS Mets Eval code refers to the method used to evaluate the site farthest from the primary site. The correct code may not be the highest eval code. For example 1 above, if the liver is the site farthest from the colon primary that was evaluated for distant mets, code the CS Mets Eval code to the method used to evaluate liver. Code surgical evaluation as 1.
Assuming this is all of the information about possible distant metastatic sites for the examples above, code CS Mets at DX as 00, and CS Mets Eval as 1 for each.
Please note: imaging of farther sites should also be included when CS Mets at DX is coded. For example, if there was also a negative chest X-ray, the CS Mets at DX field would be 00 but the CS Mets Eval field would be 0 because the CXR documents that there are no mets beyond the immediate area of the tumor.
Surgery of Primary Site--Melanoma: Please further explain the SEER Note under Melanoma surgery codes 30-36 for these two examples. Are both examples coded 31?
1. Shave bx: +melanoma in situ, +microscopic margins Wide excision: no residual melanoma in situ
2. Shave bx: melanoma, +microscopic margin Wide excision: Melanoma, margins negative (margin status negative but distance not stated)
Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30.
Reportability/Histology--Testis: Is micropapillary serous borderline tumor reportable? Pathology states Testis (C621) radical orchiectomy: Micropapillary serous borderline tumor.
We consulted an expert genitourinary pathologist who advises that micropapillary serous borderline tumor of the testis is reportable. He states "it is the same neoplasm as in the ovary. It arises from tissue (tunica vaginalis) surrounding the testis so is a paratesticular neoplasm."
Please note: not all borderline tumors are reportable and this diagnosis is an exception because it is assigned /2 in ICD-O-3.2. It is reportable for cases diagnosed Jan 1, 2021 and later.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Prostate: Radical prostatectomy reveals two distinct tumors. One is "adenocarcinoma with ductal differentiation" and the other is "adenocarcinoma with acinar differentiation." What code is used to represent the histology and how many primaries does the patient have?
For tumors diagnosed 2001-2006:
This is one primary. Code the Histology field to 8255/3 [adenocarcinoma with mixed subtypes] based on rule A of the Coding Complex Morphologic Diagnoses. This is code was added in the ICD-O-3.
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.
An official website of the United States government
Home