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20190088 | Surgery of Primary Site/Surgical Procedure of Other Site--Breast: When bilateral nipple/skin sparing mastectomies are performed for a single primary confined to one breast, we should code 30 for surgery and 0 for Surgery of Other Site or follow the CAnswer Forum and code 1 in Surgery of Other Site? See Discussion. |
Registrars are confused because the STORE manual dropped "involved" from the description of contralateral breast removal in the Appendix B surgical codes. In April, 2019, CAnswer Forum instructed registrars to code both the surgery with uninvolved breast to the proper code, plus code Surgery of Other Site to 1. In October, they stepped back and instructed registrars not to code Surgery of Other Site to 1 if a code for uninvolved breast removal is included in the breast surgery code. However, they insist that if the surgery code is 30, subcutaneous mastectomy, and the uninvolved contralateral breast is also removed, then continue to code Surgery of Other Site to 1. This contradicts the specific instructions for Surgery of Other Sites. |
For single primaries only, code removal of involved contralateral breast under the data item Surgical Procedure/Other Site (NAACCR Item # 1294), this is, code 1, according to the 2018 SEER Manual: Assign code 1 When the involved contralateral breast is removed for a single primary breast cancer This would also apply when Surgery of the Primary Site code is 30 (subcutaneous mastectomy) for breast. If uninvolved, assign code 0 to Surgical Procedure of Other Site SEER registries should follow the instructions according to the SEER Manual. |
2019 |
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20200013 | Solid Tumor Rules (2018)/Multiple primaries--Colon: Solid Tumor Rules 2018, Colon Rule M7, bullet 3 indicates that (if neither bullet 1 or 2 apply) a new tumor at the anastomotic site must be stated to arise in the mucosa (confirmed in SINQ 20190096) to qualify as a new primary. However, there is often no clear statement of tumor arising from or involving mucosa (unless the new tumor is limited to the mucosa) noted by pathologists in our region. Do any of the following examples imply a new tumor arising in mucosa per Rule M7, bullet 3? See Discussion. |
Examples: 1) New tumor at the ileocolic anastomosis, described as a, Circumferential centrally ulcerated mass with raised borders. Tumor extension: Tumor invades through muscularis propria into subserosal adipose tissue, no involvement of the serosal surface identified. The only mention of mucosa on the resection is the uninvolved enteric mucosa or uninvolved colonic mucosa in the otherwise uninvolved portions of the ileum/colon. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? 2) Right colon with anastomosis site. Tumor site: Anastomosis. Tumor extension: Tumor invades through the muscularis propria. Gross description does not describe mucosa, only noting, at the central area of anastomosis is an ill-defined, slightly raised, tan-brown to purple mass measuring 2.2 x 2 cm, which is nearly circumferential, causing obstruction at the site of anastomosis. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? 3) Polyp at ileocolonic anastomosis, polyp biopsy final diagnosis was, Invasive moderately differentiated colonic adenocarcinoma in association with adenoma. No mention of mucosa on the biopsy final diagnosis or gross description. Clinical info indicates, There is an ulcerated 5 cm mass at the ileo-colonic anastomosis that was biopsied. If neither bullet 1 or 2 apply, is this a new primary per M7 bullet 3? |
Following the 2018 Colon Solid Tumor Rules M7 and M8: Example 1: Assuming the first and second tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 Bullets 1 and 2 do not apply), abstract a single primary as the pathology states uninvolved enteric mucosa or uninvolved colonic mucosa (no involvement noted). Example 2: Assuming the first and second tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 bullets 1 and 2 do not apply), abstract a single primary as there is no mention of mucosal involvement. Example 3: Assuming the first and second polyps/tumors are not different histologies or they occurred less than or equal to 24 months apart (M7 bullets 1 and 2 do not apply), abstract a single primary as there is no mention of mucosal involvement. Of note in the case of the polyp, tumors coded as adenocarcinoma in a polyp, should be treated as adenocarcinoma (8140) for cases prior to 2018. Also, if the pathologist states the new tumor/polyp originated in the mucosa, it is a new primary. The rules which address "recurrence or new tumor at the anastomosis were created with the input of several gastrointestinal expert pathologists (CAP, AJCC, and WHO). Pathologists should be following CAP reporting guidelines and include information such as mucosal involvement in the final diagnosis and/or synoptic report. We can revisit this question that all polyps start in the mucosa and if needed, revise the rules to state this. |
2020 |
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20150062 | Grade--Bladder: How is Grade coded for the following cases diagnosed 1/1/2014 and later? See Discussion.
1) Low grade urothelial carcinoma, invasive carcinoma not identified (8120/2)
2) Papillary urothelial carcinoma, high grade, no evidence of invasion (8130/2) |
The rules for coding Bladder Grade appear to have changed over time. SPCM 2013 Appendix C instructions state that Grade should be coded to 9 for urothelial carcinoma in situ (8120/2) and to 1 or 3 for non-invasive papillary urothelial carcinoma (8130/2).
When the grade instructions were removed from Appendix C in 2014, these site specific instructions for in situ bladder cases were no longer included. Thus the two grade system, found in SPCSM 2014+ Grade/Differentiation Coding Instructions for Solid Tumors, is being used to code grade for both the in situ and invasive urothelial malignancies stated to be "low grade" (code 2) or "high grade" (code 4). See also, SINQ 20150022. Please clarify the current grade instructions for in situ and invasive urothelial carcinomas of the bladder. |
Follow the instructions in the 2014+ Grade Coding Instructions to code grade for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/ Instruction #4.a. states to code grade for in situ tumors when grade is specified. This instruction applies to bladder cases, as well as other in situ tumors.
1. Assign grade code 2
2. Assign grade code 4
See the note below the table in instruction #7. |
2015 |
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20160024 | Reportability--Melanoma: Please explain how a CTR is to interpret the guideline in the MP/H rules (Cutaneous Melanoma): Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. Is this to mean that evolving melanoma in situ is not reportable? Or should we follow the guidelines in SEER Question 20130022 that states the reportability terms for melanoma and melanoma in situ. |
Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.
See also SINQ 200120078 and 20110069. |
2016 | |
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20200088 | Histology--Heme & Lymphoid Neoplasms: Is there an inconsistency between the histologies listed as deleted in the ICD-O-3.2 Implementation Guidelines and the obsolete histologies in the Hematopoietic and Lymphoid Neoplasms Database (Heme DB)? See Discussion. |
While we recognize the Heme DB has been the correct source for histology coding for heme and lymphoid neoplasms dating back to 2010, the ICD-O-3.2 Implementation Guidelines appear to provide incorrect coding instructions. Histologies 9670/3, 9728/3, 9729/3 and 9836/3 are listed in Table 3 - Deleted ICD-O codes in ICD-O-3.2. While we recognize these histologies have been included in this Table because they have now been deleted, it is unclear whether the Comments regarding their use listed in the 4th column of the Table is correct. For each of these histologies, the comment states the histology listed in the 1st column (ICD-O-3/3.1) should be used prior to 2021. For example, for histology 9670/3, the comment states: Cases diagnosed prior to 1/1/2021 use code 9670/3. Cases diagnosed 1/1/2021 forward use code 9823/3. However, each of these histology codes have been obsolete for cases diagnosed 1/1/2010 and later. If registrars were following the Heme DB and Heme Manual instructions (the appropriate coding source for these neoplasms), these histologies would not have been used in a decade. Should the Comments column in Table 3 be updated? Or should a Note follow the Table indicating registrars should not use these histology codes for cases diagnosed after 1/1/2010, and these histology codes have been deleted for cases diagnosed 1/1/2021? It seems misleading to indicate any of these are valid histology codes for a 2010-2020 diagnosis when the Heme DB confirms these histology codes only apply to cases diagnosed prior to 2010. |
Follow the Heme DB to determine which codes are obsolete as of 2010. These histologies were made obsolete based on the 2010 WHO Hematopoietic book and confirmation with physicians. The official changes from ICD-O-3 were not implemented until ICD-O-3.2 Also, edits will not allow these histologies to be used for cases diagnosed 2010 and later. The ICD-O tables were based on documentation from IARC ICD-O committee and may differ from practices in North America. |
2020 |
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20150028 | MP/H Rules/Histology--Head & Neck: Please clarify rule H3. The first statement is "Do not code terms that do not appear in the histology description". The second statement is "Do not code...unless the words...appear in the final diagnosis"
One of our pathology labs frequently will state "keratinizing squamous cell" in the microscopic description (histologic description), but only state "squamous cell carcinoma" in the final diagnosis. May we code from the histologic description if it's not in the final diagnosis? |
Follow rule H3 and code squamous cell carcinoma for these cases unless you can obtain confirmation that these cases should be coded keratinizing squamous cell carcinoma from the lab and/or pathologist. Document this confirmation in your policies and procedures.
The MP/H rules were written with input from leading pathologists in each specialty area. Based on their expert opinion, we instruct registrars to code histology based on the information in the final diagnosis. The microscopic description may contain other terms, but the pathologist lists only the pertinent terms in the final diagnosis. |
2015 | |
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20000491 | Terminology: Do focus, focal, foci and chips mean the same thing? | Focus, focal, and foci are variations of the same word. Focus (noun) describes an area or point of disease, either grossly or microscopically. Focal (adjective) relates to the area/focus of disease; an example is a prostate with focal adenocarcinoma. This means that the majority of the prostate is benign and the adenocarcinoma is confined to one small area/point. Foci (plural) describe more than one area/focus of disease. A prostate with foci of adenocarcinoma means the disease is multifocal (several areas/points of disease).
Chips are microscopic amounts of either tissue or tumor. A pathologist might examine several chips of prostate tissue, one of which contains a focus of adenocarcinoma. |
2000 | |
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20120019 | Surgery of Primary Site/Scope Regional LN Surgery--Breast: How are these fields coded for breast cases diagnosed 2011 and later when the patient has a simple mastectomy with removal of seven sentinel lymph nodes? See Discussion. | Per SINQ 20091076, the correct codes would be 41 [simple mastectomy] and 2 [sentinel lymph node biopsy only] when the patient has any number of sentinel nodes removed, as long as they are designated as sentinel nodes. Under the mastectomy codes in the 2011 SEER Manual, Appendix C, Breast Surgery Codes, the SEER Note states that code 41 [simple mastectomy] includes the removal of one to three axillary lymph nodes. A simple mastectomy with four or more axillary lymph nodes is coded to 51. Does the lymph node count for code 51 include both sentinel and axillary lymph nodes? Or does code 51 refer to strictly the count of axillary lymph nodes, separate from the count of sentinel lymph node(s) biopsied? | First, make sure that the seven lymph nodes removed were actually designated to be sentinel nodes and not a combination of sentinel nodes and other regional nodes. Code sentinel nodes only when the nodes are stated to be sentinel nodes or when the surgical procedure includes the injection of dye to identify sentinel nodes. If all seven nodes removed are sentinel nodes, follow the instructions in SINQ 20091076 and assign codes 41 [simple mastectomy] and 2 [sentinel lymph node biopsy only]. The SEER Note does not pertain to nodes designated as sentinel nodes. |
2012 |
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20100039 | Casefinding--Heme & Lymphoid Neoplasms: Is the 2010 casefinding code of 289.6 (Familial Polycythemia) addressed anywhere in the Hematopoietic Database? See Discussion. |
When you enter "familial polycythemia" into the Heme DM, polycythemia vera (PV) appears; however, the term "familial polycythemia" is not listed as one of the synonyms for PV. |
Familial polycythemia by itself is not reportable. This is a benign condition which occurs within families. Familial polycythemia can progress to polycythemia vera (9950/3), which would then be reportable. The code, 289.6, which is the ICD-9-CM code for Familial polycythemia is not included on the reportable list for casefinding. There is only one ICD-9-CM code for Polycythemia vera, 238.4. "Familial polycythemia" is listed in Appendix F: Non-Reportable List for Hematopoietic Diseases. |
2010 |
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20010162 | EOD-Size of Primary Tumor: Should the code 001 in tumor size be used for tumors described as having "focal" involvement? See discussion. | Is tumor size coded to 001 for the following examples:
Example 1: Focal adenoca in left lobe on prostatectomy. Example 2: Multifocal ductal carcinoma of breast on mastectomy. |
Example 1 and 2: There is insufficient information in the examples to determine whether EOD-Size of Primary Tumor should be coded to 001.
The instructions are that code 001 is used for a microscopic focus or foci of tumor only. That means that the tumor is small enough that it could not be seen by the naked eye, nor would it be palpable. Be careful with the term "focal" because it is most often used to describe tumor cells grouped or concentrated in one area as in example 1. There is no implication that this focus was microscopic only. Was it mentioned in the gross or macroscopic portion of the pathology report? If so, it is not coded to 001. Was it palpable? If so, it is not coded to 001.
Example 2 cites a multifocal breast cancer. Again, did the pathologist visualize the cancer (was it reported on the gross or macroscopic portion of the pathology?) If so, do not use code 001. Was the lesion palpable? If so, do not use code 001. |
2001 |
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