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Report Produced: 11/27/2024 05:35 AM

Report Question ID Question Discussion Answer Year
20230008

SEER Manual/Surgery of Primary Site 2023--Breast:  What instructions should be followed when the 2023 SEER Manual Appendix C 2023 Breast Surgery Codes advise to code 1 in Surgical Procedure of Other Site for a simple bilateral mastectomy but the 2023 STORE Manual does not.  See Discussion.

The 2023 SEER Manual, Appendix C 2023 Breast Surgery Codes, note reads: 

SEER Note: Assign code A760 for a more extensive bilateral mastectomy. Assign code 0 in Surgical Procedure of Other Site (NAACCR #1294). For a simple bilateral mastectomy, assign code A410 with code 1 in Surgical Procedure of Other Site (NAACCR #1294).

In the 2023 STORE Manual, these notes are not mentioned and we are instructed not to code surgery to other site. Other education related to 2023 breast coding provided by NAACCR states to not code surgery to other site. 

Assign code 1 in Surgical Procedure of Other Site (NAACCR #1294) when a simple bilateral mastectomy is performed for a single tumor involving both breasts. This statement was inadvertently omitted from the STORE manual and will be added back in: For single primaries only, code removal of contralateral breast under the data item Surgical Procedure/Other Site (NAACCR Item #1294) or Surgical Procedure/Other Site at This Facility (NAACCR Item #674).

The information presented by NAACCR was intended to be consistent with what is in the SEER manual. It may have been misuderstood.

 2023
20061052 Diagnostic Confirmation--Leukemia: How is this field coded when the clinician confirms that the diagnosis of CML is based on a combination of the clinical picture and positive cytogenetic studies?

Assign code 1 [Positive histology]. For leukemia only, assign code 1 for positive hematologic findings including peripheral blood smears, CBCs and WBCs.

Cytogenetics studies would have been done on blood. Therefore, histology provided diagnostic confirmation as it would with smear, bone marrow, or other special study of blood cells.

 2006
20031052

Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description.

Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?

Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias.

 2003
20240036

Update to Current Manual/Race: How is Race coded when stated as Hispanic and there is no other information? See Discussion.

There appears to be discrepant information in the 2024 (and prior) SEER manual regarding race coding when the patient is described only as Hispanic/Latina. Page 78 tells us to Code as 01 (White) when: b. There is a statement that the patient is Hispanic or Latino(a) and no further information is available

  1. A person of Spanish origin may be any race; however, for coding race when there is no further information other than “Hispanic” or “Latino(a),” assign race as White as a last resort instead of coding unknown.

However, in Appendix D, under "Other Race descriptions", there is a statement that "If no further information is available, code as 99 Unknown." The list includes "Hispanic."

Assign code 01 (White) for Hispanic when there is no additional information. It is listed in the 2024 SEER Manual, Race Coding Instruction 6.b.i. and in Appendix D for code 01. We will remove Hispanic from the list in Appendix D under code 99 in the next version of the manual.

 2024
20210054

Tumor Size--Clinical/EOD 2018--Prostate: How is Tumor Size--Clinical coded when there is an incidental finding of prostate cancer on prostatectomy for another reason? See Discussion.

SEER*RSA states EOD Primary Tumor should be coded to 800 for an incidental finding of prostate cancer on prostatectomy for other reasons.

The SEER Manual states to assign code 000 for Tumor Size--Clinical when EOD Primary Tumor is coded to 800; however, the definition for Tumor Size--Clinical indicates clinical classification is composed only of diagnostic workup prior to treatment.

If there is no clinical workup for an incidental finding of prostate cancer, code 000 does not seem appropriate (does not meet criteria for clinical classification). Code 999 seems more appropriate for incidental findings during surgery for other reasons. The SEER Manual does not provide this exception in the current instruction.

Assign code 000 for Tumor Size--Clinical when EOD Primary Tumor is coded 800 (No evidence of primary tumor). Code 000 indicates no tumor was found since there was no clinical workup to identify this incidentally found cancer. This is a special instruction for cases coded 800 in EOD Primary Tumor. Text fields can be used to record details.

 2021
20220043

First Course Treatment/Neoadjuvant Therapy--Melanoma:  How are the three Neoadjuvant Therapy data items (Neoadjuvant Therapy, Neoadjuvant Therapy--Clinical Response, Neoadjuvant Therapy--Treatment  Effect) coded when a patient is diagnosed with melanoma in the lymph nodes with no primary skin site identified? The physician gives immunotherapy as neoadjuvant therapy with planned and carried out surgical resection of involved lymph nodes following completion of immunotherapy. There is no "planned definitive surgical resection of the primary site" as no primary site was found,

Assign code 0 to each of the three Neoadjuvant Therapy data items in this situation.

We will add an example to the coding instructions for these data items in the next release of the manual.

 2022
20081097 DCO/Systemic Treatment, Surgery Sequence: How does SEER want systemic treatment/surgery sequence coded for a DCO case?

Assign code 0 [No systemic therapy and/or surgical

treatment] as a default for DCO cases.

 2008
20071116 Behavior--Bladder: What behavior code is used for a TURB path specimen diagnosis of "non-invasive urothelial carcinoma, no muscle found, depth of invasion cannot be assessed" when the clinician stages the case as Ta? See Discussion. The SEER site specific coding module for bladder says, "If the only surgery performed is a TURB and if it is documented that depth of invasion cannot be measured because there is no muscle in the specimen, code the behavior as malignant and not in situ."

Assign behavior code 2 [in situ] based on the physician's stage Ta.

When no other information is available and the TNM designation is not available, use the instructions on page C-844 in Appendix C of the 2007 SEER manual as a default.

 2007
20230075

EOD/Summary Stage--Eye: How is stage coded for a patient with extranodal non-Hodgkin lymphoma involving bilateral choroids (single focus, both sites) and no lymph node involvement? Since the eyes are a paired site, is this two separate extranodal sites? If so, there are no Summary Stage or EOD tumor codes that best fit this scenario.

Assign as Stage IV as recommended by our expert hematological oncologist. This is a rare occurrence and this type of presentation does not fit the definition of intraocular extension. Stage IV is probably the best stage for this type of presentation, since there are two extranodal organs involved, even though they involve a bilateral site.

EOD Primary Tumor: 700

SS: 7 (Distant)

 2023
20160052

Summary Stage 2000--Lymphoma: How is SEER SS2000 coded for an ocular adnexal lymphoma when it extends from the primary site to adjacent sites that are still orbital structures? See Discussion.

In this case, the lymphoma arose in the posterior orbit and the primary site was coded as C696 (orbit, NOS). The mass directly extended to at least one "adjacent" site, the lacrimal gland. Should SS2000 be coded to 1 (localized) or 5 (regional, NOS) when an ocular adnexal lymphoma arises in the posterior orbit and extends to involve the lacrimal gland? Although both the posterior orbit and the lacrimal gland are parts of the orbit, they have separate ICD-O-3 topography codes. Should extension to multiple sites within the orbit be classified as localized disease?

The issue is what constitutes "adjacent" structures for a tumor that arises in the orbit. In an article published by the Indian Journal of Opthamology it states, "According to the Ann-Arbor staging system, lymphoma confined to the orbit is designated as Stage I, involvement of adjacent structures (sinuses, tonsil and nose) makes it Stage II." Does SEER agree with this definition of "adjacent" structures? Or are the lacrimal gland, ciliary body, retina, conjunctiva and/or choroid "adjacent" structures for a lymphoma stated to arise in the posterior orbit?

Assign SEER SS2000 code 5 (Regional, NOS) for a lymphoma of orbit extending to lacrimal gland. In SEER SS2000, this is Stage IIE: Direct extension to adjacent organs or tissues.

2016