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| Report | Question ID | Question | Discussion | Answer | Year |
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20200011 | Race: How should race information from linkages be incorporated into the coding of Race? See Discussion. |
Race information is provided in the Centers for Medicare and Medicaid Services (CMS) linkage results. Oftentimes it matches what is coded in the database, but other times it does not. In situations where the CMS (or other) linkage provides a race value that differs from the coded Patient set, are we to ignore the CMS stated race given the SEER Manual instructions indicating self-reported race has priority or should we add the different Race values from linkages as an additional race (ex. Race 02)? |
Use self-reported race as the priority when information on race is available. Use the associated text field to document why a particular race code was chosen when there are discrepancies in race information. Generally, race information is used from linkages when race data is missing or unknown, or to enhance data. We will add clarification on linkages in the next SEER Manual update. |
2020 |
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20130100 | Multiple primaries/Primary site--Heme & Lymphoid Neoplasms: How many primaries are there and how should I code the primary site(s)? See discussion. |
Patient had a hemicolectomy and a salpingo-oophorectomy and was found to have diffuse large B cell lymphoma in the colon (10 cm cecal mass), 3/16 regional lymph nodes involved with lymphoma. Fallopian tube showed involvement with diffuse large B Cell lymphoma.
Multiple primaries - Colon and fallopian tube?
One primary - Colon? Stage IV, or lymphoma from an unknown primary? Note: There were no other lymph nodes involved. |
Use Rule M2. Abstract as a single primary when there is a single histology.
When you have questions about how to code the primary site, start with the abstractor notes. If the answer isn't found there go to Module 7 (a specific module to help code primary site for lymphomas).
The abstractor notes for DLBCL in this case do not provide information you can use for this case. Go to Module 7 in the PH rules.
Use Rule PH25 Code the primary site to the organ when lymphoma is present in an organ and that organ’s regional lymph nodes. Code the primary site to colon (organ and regional lymph nodes involved). The fallopian tube is secondary involvement. As is common with lymphomas, there can be more than one organ involved. You can differentiate the primary site from the secondary site(s) because of the large colon mass with regional lymph node involvement. |
2013 |
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20200048 | Solid Tumor Rules/Multiple Primaries--Lung: How many primaries are accessioned when a patient is diagnosed with right lower lobe invasive acinar adenocarcinoma (8551/3) in 2018 and treated with lobectomy, followed by a 2019 right middle lobe cancer (NOS, 8000/3) diagnosed as new stage 1 primary by cancer conference? See Discussion. |
Lung Rule M14 appears to be the first rule that applies to this case and instructs the user to abstract a single primary. However, we were hoping for confirmation that a cancer (NOS) or malignancy (NOS) would not be a distinctly different histology that may qualify for Lung Rule M8. Currently, these histologic terms are not included in the Table 3 options or mentioned in the preceding notes. |
Use M14 and code a single primary. Per our SME, carcinoma or cancer, NOS is not an acceptable diagnosis which is why 8000 and 8010 were not included in the tables or rules. We assume there was no tissue diagnosis for the 2019 diagnosis. We recommend searching for more information or better documentation on this case. |
2020 |
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20140066 | First course treatment: When a patient has a Haplo bone marrow transplant, is this coded as an allogenic bone marrow transplant since part of his marrow was used in addition to a donor? |
Use code 12 in the Hematologic Transplant & Endocrine Procedures data field. Per the NCI, this procedure is an allogeneic transplant.
Rather than wiping out a patient’s immune system before transplanting donor bone marrow, doctors administer just enough chemotherapy to suppress the immune system, which keeps patients from rejecting the donated marrow without harming their organs. The procedure requires just a half-match, meaning that a patient’s parents or children could be suitable donors. AKA: Half-match transplants. |
2014 | |
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20240054 | EOD 2018/Primary Tumor--Breast: We are having difficulty deciding when we can or cannot use physician-assigned TNM staging to code EOD data items if the medical record or hospital abstract documentation is unclear. As a central registry, we are unable to query physicians for clarification. Please advise what is a “discrepancy” in the EOD General Instructions to “Use the medical record documentation to assign EOD when there is a discrepancy between the T, N, M information and the documentation in the medical record.” See Discussion. |
We know that physician TNM staging is not always accurate, and we also know that doctors sometimes use information in assigning their TNM which may not be available to registrars. Is it a discrepancy when the documentation in the chart is unclear or not definitive, yet the physician assigns a TNM that seems to incorporate that documentation? Or is a discrepancy an obvious conflict between chart documentation and the doctor’s staging – such as a mis-assignment of TNM category that doesn’t at all match with clear and complete medical record documentation, or the physician’s use of criteria that should be excluded from the TNM assignment per AJCC guidelines? A real case example is a patient with breast carcinoma, imaging states 12 cm tumor with thickening of dermis, and thickening of morphologically suspicious internal mammary and level 1-2 axillary lymph nodes. Medical oncologist states locally advanced breast cancer with extensive changes involving skin thickening associated with the mass, at least stage IIIC based on imaging and exam findings, cT4 N3b. Only axillary nodes were sampled and found to be positive. Post-neoadjuvant therapy resection showed only focal DCIS. Per EOD guidelines, would the oncologist’s staging be a discrepancy with the chart documentation and therefore ignored, with EOD-Primary Tumor coded 200 for skin thickening, and EOD-Lymph Nodes 200 for involvement of axillary nodes only? Or would the doctor’s TNM be a clarification/confirmation of documentation terms that we otherwise would not code, with EOD-PT coded 400 for extensive skin involvement and EOD-LNs 600 for internal mammary + axillary nodes? |
Use all information available in the medical record. EOD is a combination of the most precise clinical and pathological documentation of the extent of disease as instructed in the EOD 2018 General Instructions, Extent of Disease section. EOD 2018 General Instructions, General Coding Instructions section advises to use the medical record documentation to assign EOD when there is a discrepancy between the T, N, M information and the documentation in the medical record. When there is doubt that the documentation in the medical record is complete, code the EOD corresponding to the physician staging. A discrepancy can exist within the medical record when the information in the chart is unclear, incomplete, or conflicting, for example, the TNM staging from pathology differs from the medical oncologist’s TNM staging. In the scenario provided, use the medical oncologist stage information that takes into account imaging and exam findings. Based on the stage cT4 N3b, assign EOD Primary Tumor: 400 Extensive skin involvement WITHOUT a stated diagnosis of inflammatory carcinoma WITH or WITHOUT dermal lymphatic filtration EOD Regional Nodes: 600 Internal mammary node(s), ipsilateral, clinically apparent (On imaging or clinical exam) WITH axillary (level I, II, or III) lymph node(s), ipsilateral including infraclavicular |
2024 |
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20120079 | Reportability: Is positive urine cytology (ex: malignant cells interpreted as carcinoma) by itself reportable? If so, is the case coded to bladder by default or is is coded to C689, urinary system, NOS? | Urine cytology positive for malignancy is reportable. Code the primary site to C689 in the absence of any other information.
However, if a subsequent biopsy of a urinary site is negative, do not report the case.
For 2013 diagnoses and forward, report these cases when they are encountered. Do not implement new/additional casefinding methods to capture these cases. As always, do not report cytology cases with ambiguous terminology. |
2012 | |
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20110143 | Multiple primaries--Heme & Lymphoid Neoplasms: How many and what primary site(s) are to be accessioned when biopsies of clavicular and neck skin lesions are both consistent with mycosis fungoides? See Discussion. |
Per the Heme DB and Manual, this is a single primary; however, per the MP/H Rules, this would be multiple primaries. Which rules apply to this case? |
Updated May 2026 When there is a question of whether the SEER MP/H Rules (2007-2017), Solid Tumor Rules (2018+) or Hematopoietic and Lymphoid Neoplasm Rules (2010+) apply, check the histology and refer to the Case Reportability Instructions in the Hematopoietic and Lymphoid Neoplasm Manual. All ICD-O-3 morphology codes in the range 9590 - 9992 are included in the Hematopoietic Rules. Mycosis Fungoides [9700/3] is included in this range. Therefore, the SEER MP/H Rules do not apply to mycosis fungoides. This case should be accessioned as a single primary: mycosis fungoides [9700/3] of the skin, NOS [C449]. Per Rule M2 abstract a single primary when there is a single histology. Note that in the Primary Site(s) section of the Heme DB, it states the primary site must always be coded to skin (C440 - C449) for mycosis fungoides. Because the primary site is stated in this section of the Heme DB, it is not necessary to use the Primary Site Rules to determine the primary site. Code the primary site to C449 [skin, NOS] because the patient has multiple sites of skin involvement and there is no documentation indicating which subsite of skin was the origin of the mycosis fungoides. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2011 |
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20110142 | Reportability--Heme & Lymphoid Neoplasms: Is the pathologic final diagnosis of "follicular lymphoma, WHO grade 1-2, findings may represent in situ follicular lymphoma" reportable if the clinician also states this may be an "in situ follicular lymphoma"? See Discussion. |
2/16/11 mesentery biopsy showed "follicular lymphoma, WHO grade 1-2, findings may represent an "in situ" follicular lymphoma." 3/7/11 clinician note stated, "nodularity of the mesentery which upon biopsy may be in situ follicular lymphoma. No treatment is necessary. This is not a proven malignancy. It may evolve into one. Plan 6 month follow-up and CT scans. Do the notes from the oncologist and pathologist stating that this "may be" or "may represent" an in situ lymphoma make this case non-reportable? |
Updated May 2026 This case should not be accessioned. In situ lymphoma is not reportable for any of the standard setters (CoC, NPCR, or SEER) for any diagnosis year. In the Case Reportability Instructions, it states "Do report in situ (/2) lymphomas." |
2011 |
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20130031 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a plasmacytoma of the intervertebral disc is diagnosed in 2010 followed by a diagnosis of immature plasma cell myeloma by a right hip biopsy in 2011? See Discussion. |
The patient was diagnosed with intervertebral disc plasmacytoma and had radiation therapy to the pelvic bones in 2010. In 2011 (more than 21 days later) a right hip biopsy revealed immature plasma cell myeloma. There is clinical documentation that this is progression into myeloma. Per the Heme DB (Primary Site(s) and Definition sections) and Rule PH30, in the Heme Manual, the primary site is coded to C421 [bone marrow] and the histology is coded 9732/3 [plasma cell myeloma] when there is a clinical diagnosis of multiple myeloma and/or there is no documentation of a bone marrow biopsy or the results are unknown. This patient did have a bone marrow biopsy that indicates there are an increased plasma cells present; plasma cells represent less than 10%. The skeletal survey and bone scan did not reveal any further lesions. Is this progression of disease because there is only one lesion in the right hip 8 months after the diagnosis of plasmacytoma? Or is this a second primary based on the right hip biopsy that showed plasma cell myeloma and the physician's documentation of disease progression? Plasmacytomas are usually single lesions. Would this disease process have multiple lesions if they are diagnosed at different times? |
Updated May 2026 This case is accessioned as two primaries: Plasmacytoma diagnosed in 2010 and plasma cell myeloma diagnosed in 2011 per Rule M10. The patient has a diagnosis of a solitary plasmacytoma (chronic neoplasm) followed by a diagnosis of plasma cell myeloma (acute neoplasm) diagnosed after the initial clinical workup was completed for the chronic (plasmacytoma) neoplasm. The physician is calling this a progression to plasma cell myeloma even though the bone marrow has less than 10% plasma cells, take this statement as progression or a clinical diagnosis of plasma cell myeloma. |
2013 |
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20110017 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported if a patient originally diagnosed with CLL is subsequently diagnosed several months later on a bone marrow biopsy with Richter's syndrome that transformed into a large cell lymphoma? See Discussion. |
Per reviewed resources, the described condition is rare. Should the histology remain CLL or be changed to large cell lymphoma? |
Updated May 2026 This case is accessioned as two primaries per Rule M10 which states to abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm and there is a second diagnosis of an acute neoplasm more after the initial clinical workup of the chronic disease is completed. The first primary is CLL [9823/3] and it is a chronic neoplasm. The second primary is diffuse large B-cell lymphoma (DLBCL) [9680/3] and it is an acute neoplasm. Richter syndrome (RS) is a complication of B cell chronic lymphocytic leukemia (CLL) or hairy cell leukemia (HCL) in which the leukemia changes into DLBCL. There is also a less common variant in which the CLL changes into a Hodgkin lymphoma. Richter's transformation affects about 5% of CLL patients. Richter syndrome is listed under the Alternate Names section in the Heme DB for diffuse large B-cell lymphoma [9680/3]. |
2011 |
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