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Report Produced: 05/02/2025 00:15 AM

Report Question ID Question Discussion Answer Year
20140056

MP/H--Bladder: Are 8130 and rule H12 correct for this case? Bladder with papillary urothelial carcinoma with squamous cell differentiation.

Rule H8 applies, code the histology with the numerically higher ICD-O-3 code which is papillary transitional cell carcinoma, 8130.

Based on the information provided, there is a single bladder tumor, papillary urothelial carcinoma with squamous cell differentiation. Urinary sites rule H12 does not apply because this is a single tumor, not multiple tumors. In the single tumor H rules, H3 does not apply as this rule does not include papillary transitional cell carcinoma. Rule H4 is papillary carcinoma or papillary transitional cell carcinoma and refers you to Table 1. Table 1 does not list papillary urothelial carcinoma with squamous cell differentiation because there is no ICD-O-3 code for this histology. Table 1 does list transitional cell carcinoma with squamous differentiation as code 8120, however, the papillary transitional cell carcinoma is the higher code, 8130. We will review this situation for the next version of the rules.

2014
20150010

Multiple Primaries/Histology--Colon: What is the correct histology code and MP/H Rule when a colectomy final diagnosis is adenocarcinoma with colloid and signet ring cell features? See discussion.

The MP/H Equivalent Terms and Definitions for Colon indicate that type, subtype, predominantly, with features of, major, or with ___ differentiation are all equivalent in terms of coding histology. However, this is not indicated in the General Instructions (e.g., Histologic Type ICD-O-3 or General Instructions Histology Coding Rules). It also is not included as a Note under the Rules where one would expect to use these terms, for example, Rule H7. Is this an oversight or error in the Manual?

In this case, Rule H7 seems to be the first (and most appropriate) rule that applies to this mixed histology tumor. However, the specific histology terms that an invasive tumor may be identified as, are only listed under Rule H13. Can these same terms be used when applying rules for which they are not specifically noted? It would seem logical to use the equivalent histology terms to code a mixed histology tumor identified as a subtype or with features, etc., despite the fact that the specific terms are not listed under Rule H7.

 

Rule H7 applies. Assign code 8255. H13 does not apply as mucinous/colloid/signet are not NOS histologies. They are specific histologies. This will be addressed in the upcoming revisions to the rules.

2015
20140016 MP/H Rules/Histology--Bladder: What is the correct histology code for this situation? See discussion. Patient has 2 bladder tumors, both invasive -- one is transitional cell carcinoma (8120/3) and the other is papillary TCC (8130/3). They have the same extent of disease, both involve the lamina propria. Is this 8120, because of the Note under rule H11 or is this 8130 because under rule H12, it says 'papillary carcinoma and transitional cell carcinoma'? If so, what is the meaning of the note under rule H11?

Rule H12 applies, code to 8130.

The note under H11 is intended to explain the order of the rules; that is, why the rule to code papillary transitional/urothelial cell carcinoma (H12) follows the rule to code transitional/urothelial cell carcinoma (H11).

 2014
20150018

First course of treatment--Immunotherapy:  Should Rituxan be coded to immunotherapy?  See discussion.

Is the instruction under #4.b. on page 114 of the 2014 SEER Program Coding and Staging Manual incorrect? It says to code Rituxan as chemotherapy.  

Rituxan changed categories from chemotherapy to a biologic therapy/Immunotherapy agent effective with cases diagnosed January 1, 2013. See page 150 or page 164 in the 2015 SEER manual. The instruction in the 2014 SEER manual was incorrect regarding Rituxan.

2015
20100107 MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tumor described as "renal cell carcinoma, clear cell with rhabdoid features"? See Discussion.

Is the statement "with __ features" indicative of a specific type of renal cell carcinoma (that is not represented by a specific histology code) or a second histologic type? Per ICD-O, "malignant rhabdoid tumor" is coded 8963/3. "Rhabdoid" is not listed in Table 1 in the MP/H rules as a specific type of renal cell carcinoma.

Rhabdoid features occur in about 5% of all renal cell cancers and indicate a more aggressive tumor. Per WHO, these tumors comprise approximately 2% of all pediatric tumors with a median diagnosis age of 1-2 years old. This diagnosis is highly suspect in patients over age 3. Most previously reported rhabdoid tumors over age 5 have subsequently proven to be renal medullary carcinomas.

For cases diagnosed 2007 or later, if the patient in this case is a child, apply Kidney Rule H7 and code histology to 8963/3 [malignant rhaboid tumor]. Otherwise, we strongly suggest you consult with the pathologist to determine if this is truly a rhabdoid rather than a medullary tumor.

 2010
20160017

Surgery of Primary Site--Melanoma: Please further explain the SEER Note under Melanoma surgery codes 30-36 for these two examples. Are both examples coded 31?

1. Shave bx: +melanoma in situ, +microscopic margins  Wide excision: no residual melanoma in situ

2. Shave bx: melanoma, +microscopic margin   Wide excision: Melanoma, margins negative (margin status negative but distance not stated)

Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30.

 2016
20140049

Reportability--Brain and CNS: Is Tuberculum sellae meningioma reportable? Is it same as sphenoidale meningioma?

Path: Brain tuberculum tumor resection: Meningioma, WHO grade I.

Revised answer based on ST rules

Yes, a Tuberculum sella meningioma is reportable if diagnosed 2004 or later. Code the primary site C700, cerebral meninges. It is a meningioma originating from the meninges of the Tuberculum sellae, which is part of the sphenoid bone.

 2014
20190074

First course treatment/Scope of Reg LN Surgery--Breast: How is Scope of Regional Lymph Node Surgery coded when there is a sentinel lymph node biopsy (SLNBx) and intra-mammary nodes removed for a single primary? See Discussion.

Example: Operative report documents a left breast skin sparing mastectomy and sentinel node biopsy procedure. Pathology report lists left axillary sentinel nodes in specimen A) with 0/2 nodes positive, and left breast mastectomy without axilla in specimen B) yielding an additional 0/2 intramammary nodes positive. Would the Scope of Regional Node Surgery be coded as 2 (SLN biopsy) to capture the intent of the sentinel node procedure only, or 6 (code 2 + 4) to capture the actual type and number of nodes removed?

SEER Coding and Staging Manual includes Scope of Regional Lymph Node Surgery instruction 4.b. which mentions assigning code 4 to intra-organ node removal. Similarly, there is instruction for coding SLN biopsy as code 2 and SLN biopsy with axillary dissection at the same time (code 6) or during separate procedures (code 7). However, it is not clear this combination code is how we should also capture an incidental intra-organ node removal.

Revised answer 07/11/2023

Assign code 6, Sentinel node biopsy and code 3, 4, or 5 at same time or timing not noted. There were two sentinel lymph nodes removed (code 2) plus two intramammary nodes removed in a separate specimen from the mastectomy (code 4). Assign code 6 when nodes are removed from a sentinel lymph node procedure at the same time as removal of intra-organ lymph nodes which were not part of the sentinel lymph node procedure.

 2019
20081059

Reportability/Histology--Head and Neck: Is a right cerebellopontine (CP) angle endolymphatic sac papillary tumor (ELST) reportable? If so, what is the histology code?

Revised December 2015

ELST is reportable. Code histology to adenocarcinoma (8140/3). Code primary site to inner ear (C301).

Endolymphatic sac tumors are rare non-metastasizing adenocarcinomas that originate in the endolymphatic sac of the inner ear (C301). They are slow growing and widely invade, and in later stages often destroy, the petrous bone. The WHO Classification assigns ICD-O-3 code 8140/3.

2008
20150024

Surgery of Primary Site--Breast: How should the Surgery of Primary Site field be coded when a patient has a lumpectomy and an additional margin excision during the same procedure? See discussion.

Operative report indicates a wire localized lumpectomy was performed. The pathology report includes a final diagnosis for two specimens as follows:

A) LEFT BREAST, EXCISION: INFILTRATING DUCTAL CARCINOMA

B) LEFT BREAST, NEW DEEP MARGIN, EXCISION: BENIGN BREAST TISSUES AND BENIGN FIBROFATTY SOFT TISSUES; NO EVIDENCE OF NEOPLASIA.

The definition for Breast surgery code 23 is "Reexcision of the biopsy site for gross or microscopic residual disease". There is no indication whether the re-excision has to be a separate procedure or can be during the same procedure as the excisional biopsy (lumpectomy). Some hospital registrars in our region believe code 22 is more appropriate.

Revised Answer

Assign code 22 when a patient has a lumpectomy and an additional margin excision during the same procedure.

According to the CoC, "Re-excision of the margins intraoperatively during same surgical event does not require additional resources; it is still 22. Subsequent re-excision of lumpectomy margins during separate surgical event requires additional resources: anesthesia, op room, and surgical staff; it qualifies for code 23."

 2015