Primary Site--Esophagus: What is the difference between C15.5 [Lower third of esophagus] and C15.2 [Abdominal esophagus]?
These descriptions represent the use of two different ways the esophagus can be divided anatomically. The two different systems used are illustrated in the SEER Self Instruction Manual for Tumor Registrars: Book 4. Assign the primary site code that describes the location of the tumor in the same way the tumor's location is described in the medical record.
Behavior Code--Bladder/Lymphoma: Should the "in situ" designation on a bladder primary's pathology report be ignored that states a diagnosis of "in situ lymphoma"?
Ignore the in situ designation. You cannot assign an in situ behavior code to a lymphoma primary. The term or designation of "in situ" is limited to solid tumors; carcinoma and/or cancer.
Date of Diagnosis: If a clinician states his current diagnosis of malignancy is based on a CT scan done at an early date that contained a diagnosis of only "neoplasm" or "worrisome for carcinoma" should the date of diagnosis be the date of the scan?
Yes. Code the Date of Diagnosis field to the date of the scan. The physician's clinical impression upon reviewing the earlier scan, is that the malignancy was confirmed by the scan. If there is a medical review of a previous scan that indicates the patient had a malignancy at an earlier date, then the earlier date is the date of diagnosis, i.e., the date is back-dated.
Place of Birth: When there is conflicting information, which record takes precedence in coding this field, the medical record or the death certificate?
If there is a discrepancy, use the information from the medical record to code the Place of Birth field. The information from the medical record is provided by the patient, the information on the death certificate is provided by others. If the medical record does not contain birth information, use the information from the death certificate.
Ambiguous Terminology: Should SEER's lists of ambiguous terminology be modified to reflect how pathologists and radiologists actually use these terms? See discussion.
Pathologists and radiologists say the term "suggestive" is used to describe a lesion that may be malignant, and the term "suspicious" is not used to describe lesions that may be malignant. According to the physician director of our Breast Center the FDA governs the use of terminology, and the term "highly suggestive" instead of "highly suspicious" must be used if there is a greater chance that a mass is malignant.
We recognize that the way clinicians and registrars speak is often different, and that the differences vary from region to region.
Our Medical Advisory Board reviewed the lists of ambiguous terminology before they were included in the third edition of the SEER EOD and the SEER Program Coding and Staging Manual 2004. Since that time, specific terminology has been mandated for describing mammography results. We know some of these terms are discrepant with our ambiguous terminology list.
As of 2007, the standard setters (CoC, NPCR, SEER and CCCR) all use the same ambiguous terminology list. Changes to the list must be approved by the NAACCR Uniform Data Standards Committee.
EOD-Extension: General instructions, page 7, note 3 states: " Extent of disease information obtained after treatment with neoadjuvant chemotherapy, hormone or immunotherapy has begun may be included." Because the SEER manual does not mention radiation treatment, can we use information from a lobectomy to code EOD if a patient has neoadjuvant radiation therapy?
Radiation therapy was inadvertently omitted from the list. Please see SINQ 20031012 answer as to when the surgical information can be used to stage the case.
EOD-Clinical Extension--Prostate: How do you distinguish between clinical extension codes of 10, 13, 14, and 20 for cases with a benign prostate per digital rectal exam that appear localized after TURP/prostatectomy? Can the clinical extension code of 10 be used if the term "microscopic carcinoma" is noted in the pathology report without also mentioning "foci" or "Stage A" for clinically inapparent tumors?
For cases diagnosed 1998-2003:
When the prostate feels benign and the cancer is found incidentally at the time of the microscopic exam, code the EOD-Extension field to 10 [number of foci or % of involved tissue not specified]. Code as 13 (less than or equal to 5%) or 14 (greater than 5%) if percentage involved is given in the tissue resected. If the path report states "solitary focus of carcinoma" without mentioning the total amount of tissue resected, code extension to 13. If there is more than one focus, code extension to 10. Don't assign a code of 20 unless the tumor is clinically apparent.
EOD-Extension/SEER Summary Stage 2000--Kidney/Eye: What codes are used to represent these fields for simultaneous bilateral Wilms tumor or simultaneous bilateral retinoblastoma?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.
Histology (Pre-2007)--Skin: Are "atypical melanocytic hyperplasia" and "severe melanotic dysplasia" synonyms for melanoma in situ?
For tumors diagnosed prior to 2007:
No. SEER determines its reportable list from the ICD-O-3. The above terms are listed as tumor-like lesions and conditions, but are not in situ or malignant.
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--Breast: If the patient has inflammatory carcinoma of the breast, is the tumor size coded as 998 even though we have a tumor size?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary tumor field to 998 [Diffuse; widespread; 3/4 or more of breast; inflammatory carcinoma] for all inflammatory breast carcinomas.
These cases have a worse prognosis because of the dermal lymphatic invasion. Half of the inflammatory breast carcinomas will have no palpable mass.
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