Reporting Source: Is an ER patient who is diagnosed on peripheral smear with an acute leukemia coded as an outpatient if the patient died while in the process of being admitted for treatment or is the patient coded as a death certificate case?
Scope Regional LN Surgery--Melanoma: How is this field coded when there is no primary skin lesion and the only disease present is one axillary lymph node that reveals melanoma? See Discussion.
Surgery of Primary Site--Lung: Is this field coded to 30 [Resection of lobe or lobectomy] or 33 [Lobectomy with mediastinal lymph node dissection] when a lobectomy specimen includes 2 AP window lymph nodes? See Discussion.
Behavior--Lung: How is behavior to be coded for a diagnosis of adenocarcinoma of a lung tumor that is further classified per the CAP protocol as, "non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)" while the pathologist also classifies the tumor as pT1b, pN0? See Discussion.
Date of Diagnosis/Diagnostic Confirmation: How are these fields coded when a physician statement of diagnosis predates a positive biopsy? See Description.
Date of Diagnosis--Lung: Should the diagnosis date be coded to the date of the scan or the date of the resection when there is a negative biopsy that occurs between the two procedures? See Discussion.
Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"?
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