Surgery of Primary Site--Skin: Should Mohs surgery be code to 27 [Excisional biopsy] or 31 [Shave biopsy followed by a gross excision of the lesion]? See discussion.
Under surgery coding in the 5/22/01 SEER Abstractor/Coder Workshop book, page 20, it states that Mohs surgery should be coded as an excisional biopsy. The ACoS I&R dated 6/6/2001 states that it should be coded to 31.
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 34 [Mohs surgery, NOS], 35 [Mohs with 1-cm margin or less] or 36 [Mohs with more than 1-cm margin].
Histology: What code is used to represent the histology "endometrioid adenocarcinoma, villoglandular type"?
Assign code 8262/3 [Villous adenocarcinoma].
According to the WHO Classification of Tumours, Breast and Female Genital Organs (2003), villoglandular is one of four variants of endometroid adenocarcinoma. The corresponding ICD-O-3 code according to WHO is 8262/3.
EOD-Size of Primary Tumor/EOD-Extension--Breast: How do you code extension when the tumor in the breast is in situ and the regional axillary lymph nodes are positive? See discussion.
For example, what extension code is used for a 4.5 cm DCIS (no invasive ca found in excisional biopsy or mastectomy specimen) with mets to 01/07 LNs?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 045 [4.5 cm]. Document how the size was determined in the EOD-Extension field.
Code the EOD-Extension field to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) AND proportions of in situ and invasive not known]. By virtue of the lymph node metastasis, this must be an invasive breast carcinoma. The size of the invasive component is unknown.
Histology (Pre-2007): What code is used to represent the histology "non oat cell carcinoma"?
For tumors diagnosed 2001-2006:
Code the Histology field to 8046/3 [non-small cell carcinoma] if the pathologist does not provide a more specific histologic type. "Non oat cell" is a synonym for "non-small cell."
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.
Reportability--Hematopoietic, NOS: Should we add the missing terms listed in the Abstracting and Coding Guide for the Hematopoietic Diseases to ICD-O-3 because these absent synonyms would not be identified during hematology casefinding? See discussion.
The Abstracting and Coding Guide for the Hematopoietic Diseases gives a preferred term for each code followed by a list of synonyms, not all of which are listed in the ICD-O-3. Two examples are: 1) 9962/3 [Essential Thrombocythemia] has 6 synonymous terms listed, but the last three of them are not in ICD-O-3. 2) 9930/3 [Myeloid Sarcoma] has the synonym "extramedullary myeloid tumor" which is not in ICD-O-3.
For cases diagnosed prior to 1/1/2010:Do not add these synonyms to ICD-O-3. The Abstracting and Coding Guide for the Hematopoietic Diseases lists synonyms for the preferred terms to assist in the classification of these other terms. In the absence of a specific code for the synonym, code to the preferred term. For casefinding, these terms would be grouped in a broader category of hematologic diseases under an ICD-9-CM or ICD-10 code and, therefore, will be identified during casefinding procedures using the disease index.
For cases diagnosed 2010 forward, 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.
First Course Treatment: 1) When is Decadron (Dexamethasone) coded as cancer treatment? 2) When Decadron is given to a patient with multiple myeloma, is it coded as treatment only if given in combination with chemotherapy? See discussion.
SEER Book 8 states that Decadron is an important therapeutic agent for treatment of multiple myeloma. In the Abstracting and Coding Guide for the Hematopoietic Diseases, Decadron is a hormonal treatment for multiple myeloma "when given as part of a chemotherapy regimen".
For cases diagnosed 1/1/2003 and after:
1. Code hormone therapy to 01. Code any therapy administered to treat cancer tissue that achieves its effect on cancer tissue through a change in the hormone balance in the hormone therapy field. Decadron is coded for leukemias, lymphomas and multiple myelomas primaries. It is coded for other sites only when stated to be cancer-directed treatment.
2. Code hormone therapy to 01. Decadron should be coded as hormone therapy for multiple myeloma when given alone or as part of a first course of treatment chemotherapy regimen.
Measured Thickness--Melanoma: Can in situ melanoma cases have "depth of invasion" coded to something other than 999? See discussion.
Biopsy of the left arm: Melanoma, 0.2mm in thickness. The in situ component extends to a peripheral margin.
For cases diagnosed 1998-2003:
Code the Measured Thickness (depth) field to 020 [0.2 mm] for this case.
In situ disease can have a depth of invasion because the surface epithelium can be of varying depths without the melanoma breaking through the basement membrane.
Histology (Pre-2007)/Behavior Code: What code is used to represent the histology "foci of well differentiated intramucosal carcinoma [carcinoma in situ] arising on the surface of a tubular adenoma"? The pathologist referred to this colon biopsy as "in situ".
For tumors diagnosed prior to 2007:
Assign histology code 8210 [adenocarcinoma in a tubular adenoma] and behavior code 2 [in situ]. "In situ" is specified by the pathologist.
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.
Ambiguous Terminology/Reportability: How should the expressions "suspicious for but not diagnostic of" and "suspicious for the possibility of early invasive adenocarcinoma" be interpreted for reportability? Would the interpretation be different depending on the primary site?
For reportability, interpret "suspicious for but not diagnostic of" as NOT diagnostic of cancer.
The phrase "suspicious for the possibility of early invasive adenocarcinoma" may indicate that the case is in situ. If no further information is available, this is not reportable.
The site of the cancer diagnosis does not change the interpretation.
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