Report | Question ID | Question | Discussion | Answer | Year |
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20051020 | CS Extension/CS Site Specific Factor--Breast: How is extension (localized or unknown) and SSF6 (entire tumor in situ or 888) coded for an in situ breast primary in which bone metastasis is diagnosed 4 months following the mastectomy? See Discussion. | In situ breast primary with bone mets. No mets work up prior to mastectomy done 2/04. Path: 2.5 cm mass: ductal carcinoma in situ, solid type, with comedonecrosis (no invasive carcinoma found in mastectomy specimen). Bone scan done 4/04 showed compression fractures. MRI 6/04 showed diffuse metastatic disease of the bones. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. First, determine whether the bone mets in this case are progression of disease. If the patient was asymptomatic at the time of the mastectomy, the bone mets are disease progression, not initial stage. If the initial stage includes the bone mets and they are not disease progression, extension must be coded to at least 10. Code site-Specific Factor 6 to 040 [Size of entire tumor coded, size of invasive component not stated]. |
2005 |
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20061036 | CS Extension--Lymphoma: For lymphoma cases, can extension be coded to 80 [Nodular involvement of lungs] based on imaging or operative findings when there is no positive statement of involvement? See Discussion. | Specifically, CS Ext code 80 includes nodular involvement of the lungs. The CT report for this patient states that the lungs are nodular. Is that enough to use code 80? Can the liver be coded as involved based on the operative findings? Scenario: The patient was diagnosed with lymphoma. The CT showed pulmonary nodules. The pt had an exploratory laparotomy with a positive mesenteric LN bx and a positive ileocecectomy. The operative findings included a nodular liver. No staging was done by the oncologist and he has the pt on CHOP-R. |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Extension code 80 can be assigned based on imaging or operative findings as in the lymphoma case described above. The fact that this extension was not based on pathological evidence is captured in the evaluation code. Assign CS/TS Ext-Eval code 0 [No staging laparotomy done. No autopsy evidence used (clinical)]. |
2006 |
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20061031 | CS Extension--Head & Neck: If a 2 cm left tonsil primary extends to the lateral aspect of the soft palate, should extension be coded to 40 [Soft palate, inferior surface including uvula or soft palate NOS] or 42 [Soft palate, superior (nasopharyngeal) surface] for a tonsil primary? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Extension code 40 is for extension from the tonsil to the back (lower) part of the soft palate, or soft palate, NOS. Code 42 is for extension to the front (higher, nasopharyngeal surface) part of the soft palate. Inferior soft palate is the back (lower) part of the soft palate (C051). Superior soft palate is the front, (nasopharyngeal surface) of the soft palate (C113). Assign CS extension code 40 to the case above. |
2006 | |
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20061016 | CS Extension--Head & Neck (Larynx): If a patient with cancer of the larynx is described as experiencing hoarseness, is that sufficient information to code "vocal cord fixation" or does that phrase need to be used? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Do not code vocal cord fixation when the only information available is "hoarseness." Vocal cord fixation must be documented on endoscopy. Hoarseness is a common presenting symptom of laryngeal malignancy. |
2006 | |
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20061139 | CS Lymph Nodes--Lung: Do modifying terms such as "borderline" affect whether lymph nodes are coded as involved when they are used in conjunction with the descriptors listed in Note 2 (i.e., mass, adenopathy or enlargement) for lung primaries? See Discussion. | Lung primary: CT states "borderline" enlarged hilar lymph nodes. Note 2 in the Lung schema under CS Lymph Nodes does not address qualifiers. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Do not code the hilar lymph nodes as involved in this case. "Borderline" enlarged hilar lymph nodes do not meet the clinical criteria for enlargement. |
2006 |
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20061071 | CS Extension--Lymphoma: In the absence of physician staging, is an "enlarged" spleen seen on CT coded as involvement of the spleen for lymphoma cases? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Do not code spleen involvement when the only evidence is an enlarged spleen. When imaging is the only diagnostic tool (no biopsy or splenectomy), spleen involvement is based on the presence of nodules and not on enlargement. Splenic enlargement alone (by physical exam or imaging) is insufficient to support involvement of spleen. |
2006 | |
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20051092 | CS Extension--Kidney: When an incidentally found 5 cm mass discovered on a CT scan during a work-up for colon carcinoma is stated to be consistent with renal cell ca, should the case be staged as localized or unknown when no other information is available related to a work-up for the kidney primary? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Code what is known. In the example above, the tumor size and the extension are known and can be coded. The information is limited, but not completely missing. Code what you DO know rather than coding nothing. Any metastases from the kidney would have been discovered during the workup of the rectal cancer. |
2005 | |
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20061048 | CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Code vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability. |
2006 | |
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20051002 | CS Tumor Size/CS Site Specific Factor 6--Breast: How are these fields coded for a tumor stated to have only in situ disease in the breast with bone metastasis identified on scan? See Discussion. | 4/20/04 Quadrantectomy: "Tumor involves a significant portion of the biopsy and is estimated at 10 cm in greatest dimension." The only other mention of size is from imaging studies which is 3.5 cm. The histology is "high grade ductal carcinoma with comedo necrosis. No invasive carcinoma identified." Bone scan on 4/20/04 shows "widespread metastatic disease to bone." By rule the behavior code for this case is changed to malignant. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Code tumor size as 100 [10 cm]. Size from pathology or operative report is preferred over size from imaging.
Code SSF6 as 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and proportions of in situ and invasive not known.]
There is invasive tumor present (as proven by the bone metastasis), but the size and proportion of the invasive component is unknown.
Please note: Extension must be coded at least to 10 [Confined to the breast tissue and fat including nipple and areola; Localized, NOS] in this case. Do not assign extension code 00 [in situ]. |
2005 |
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20051118 | CS Tumor Size--Rectum: Should the tumor size be coded to 080 from the colonoscopy size or 075 from the CT scan size? See Discussion. | 6/29/04 Colonoscopy with biopsy: near obstructing circumferential friable mass extending from 8 to 16cm above anal verge. 6/30/04 CT Scan Abdomen/Pelvis: 7.5X7.2cm large rectal mass. The patient had radiation with concurrent 5-FU. Surgery is done after treatment. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Code tumor size as 080 (8cm). Code the largest pretreatment size recorded when there is preoperative systemic treatment. |
2005 |