Systemic/Surgery Sequence: Does the Systemic/Surgery Sequence field apply to only the first surgery performed (Date of First Surgical Procedure) or does it apply to the most definitive surgery (Date Most Definitive Surgery) as well? See Discussion.
Example: Bladder primary with transurethral resection of the bladder tumor (TURBT) on 2/17/2017 (Date of First Surgical Proc) followed by a second TURBT on 3/24/2017 (Date Most Definitive Surgery) with mitomycin C instilled on the second, most definitive TURB procedure.
There is an edit failure (IFX166) when Systemic/Surgery Sequence is coded 5 (intra-operative systemic) and Systemic Date does not match Date of First Surgical Procedure. How should we capture the intra-operative systemic treatment during the second, most definitive TURB? Is the correct Surgery/Systemic Sequence code 3 (systemic after surgery) for this case because (intra-operative) chemo was technically given after the first surgery?
Assign code 3 to Systemic/Surgery Sequence and document the intraoperative treatment in the text field. Surgery is defined as a Surgical Procedure to the Primary Site (codes 10-90), Scope of RLN Surgery (codes 1-7), or Surgical Procedure of Other Site (codes 1-5) in the 2018 SEER Manual. In this case, the treatment was after the first surgical procedure.
Flag: For cases diagnosed prior to 2001, how is the ICD-O-3 Conversion Flag set if the ICD-O-2 and ICD-O-3 histology and behavior fields are both directly coded, as registrars in this region are instructed to do when submitting late cases, and as a result no conversion is necessary? Is it to 0 [Morphology (Morph--Type&Behav ICD-O-3 originally coded in ICD-O-3)] or Blank [Not converted]?
Assign code 3 [converted with review].
In your scenario above, ICD-O-2 and ICD-O-3 are being independently coded which should yield the same result as converting the case and then reviewing it.
Otherwise, if there is an ICD-O-3 code which differs from the ICD-O-3 code based on the conversion criteria, it will trigger an edit.
First Course Therapy/Neoadjuvant Treatment: How are Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect coded when the neoadjuvant therapy was not completed? Does the entire course of neoadjuvant therapy need to be completed before we can code these fields? See Discussion.
Example: The neoadjuvant therapy was started, the patient progressed, the treatment plan was altered, and a new course of systemic therapy was started; surgery was cancelled.
01/25/21 Bile duct brushing: Malignant cells present, adenocarcinoma
01/26/21 Surgical oncology consult: Currently unresectable; recommend neoadjuvant chemo
02/22/21-3/29/21 Neoadjuvant Gemzar & Abraxane, two cycles, discontinued due to disease progression
04/17/21 Surgical oncology re-eval: CT positive for disease progression, need to change Rx
04/26/21 Second change of treatment due to progression: Irinotecan, Oxaliplatin, and 5FU
07/16/21 Surgical oncology re-eval: Unresectable, advise 4-6 months of chemo followed by radiation
Assign code 3 (Progressive disease (PD)(per managing/treating physician statement) for Neoadjuvant Treatment--Clinical Response and code 7 (Neoadjuvant therapy completed and planned surgical resection not performed) for Neoadjuvant Treatment--Treatment Effect. These are the best choices under the circumstances. Use text fields to record the details.
Surgery of Primary Site--Bladder: Is any mention of cautery in the gross description of pathology for a TURBT specimen sufficient to code 22 (excisional biopsy with electrocautery), or does there need to be a statement in the operative report that electrocautery was performed? See discussion.
Often, pathology for TURBT with non-invasive papillary TCC includes a gross description with a variety of cautery descriptions. For example, "received are three cautery roughened gray-pale pink tissue fragments.” However, the operative report is documented as a "TURBT" with no further description of the procedure.
Assign code 22 when cautery is mentioned n the gross description of pathology for a TURBT specimen.
2021 SEER Manual/Surgery of Primary Site--Lung: What is the correct surgery code for a left upper lobe (LUL) wedge resection (confirming adenocarcinoma) followed by a lingular-sparing LUL lobectomy and mediastinal lymph node dissection? Is the correct Surgery Code 22 since the lingula was not resected (not the whole LUL Lung)? Or should the appropriate surgery code be 33 (this surgery suffices to code to a lobectomy with the mediastinal lymph node dissection)?
Assign code 22 for LUL wedge resection followed by a lingular-sparing LUL lobectomy and mediastinal lymph node dissection. Code the lymph node surgery in Scope of Regional Lymph Node Surgery. We obtained input from an expert who agrees with this code. He states a lingula-sparing lobectomy is best coded as a segmentectomy because it is the same as an apical trisegmentectomy.
Surgery of Primary Site--Corpus uteri: What is the correct surgery code to assign for dilation and curettage (D&C) for an in-situ endometrium (C541) primary? The code to use for the cervix uteri (C530-C539) is specified, but not for the corpus uteri (C540-C549).
Assign code 20 for endometrial D&C for in situ cancer of endometrium.
First Course Treatment/Reason for No Surgery of Primary Site: How should we be coding Reason For No Surgery of Primary Site for cases where surgery was planned but ultimately cancelled due to progression? See Discussion.
There is a discrepancy in the SEER and STORE manual definition of code 2 for Reason for No Surgery of Primary Site. STORE includes progression of tumor prior to planned surgery as part of the definition for code 2, but the SEER Manual does not. The progression statement is included in the SEER Manual (2018 and 2021) for Reason for No Radiation, but not for Reason for No Surgery.
Assign code 2 for cases where surgery was planned but ultimately cancelled due to progression in the data item Reason For No Surgery of Primary Site. Code 2 description contains examples and is not exhaustive of reasons for no surgery.
We will add the example for consistency in the next version of the SEER manual.
First Course Therapy/Surgery of Primary Site--Prostate: What is the correct surgical code for irreversible electroporation ablation of the prostate diagnosed in 2021?
Assign code 17 for irreversible electroporation ablation of the prostate when there is no tissue submitted to pathology for a 2021 or 2022 case.
EOD 2018/Heme & Lymphoid Neoplasms--Myeloid Sarcoma: How is Extent of Disease (EOD) Primary Tumor coded for a myeloid sarcoma with multifocal skin involvement? See Discussion.
Patient has a diagnosis of myeloid sarcoma presenting as multiple erythematous papules and nodules on back, chest, right arm & shoulder. Oncologist did not mention any evidence or suspicion of an associated AML diagnosis.
HemeRetic schema EOD Primary Tumor Note 1 states that myeloid sarcoma can be coded as localized (code 100) or systemic (code 700). It is not clear what would qualify as systemic disease for myeloid sarcoma.
Assign code 100, localized, using the 2018 EOD Primary Tumor, HemeRetic schema, for the myeloid sarcoma with skin involvement since only the skin is involved. Use code 700, distant or disseminated, when multiple organs are involved.
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