EOD-Lymph Nodes--Head & Neck: When a physician provides only "Stage IV" (i.e., an abbreviated stage) for a right posterior tongue primary with lateral extension into the oropharynx and hypopharynx, can you assume "palpable" level 2, 3 and 5 lymph nodes are involved?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 9 [Unknown], based on the information provided.
The physician's statement of an N category from a TNM may be used to determine lymph node involvement in the absence of other information. However, you cannot assume nodal involvement based on the incomplete staging information of "Stage IV" for a base of tongue primary. For this primary site, extension into the hypopharynx from this primary is equivalent to T4/Stage IV. Therefore you cannot assume the clinician's assessment of the case as Stage IV represents his assessment of lymph node involvement.
Chemotherapy: How is treatment with Iressa (Gefitinib) coded?
Code treatment with Iressa as chemotherapy.
Iressa is an epidermal growth factor inhibitor. While it doesn't kill cells directly, it damages the cell reproduction process. We classify it as a chemotherapy agent.
Histology (Pre-2007): What code is used to represent the histology adenocarcinoma with "areas of" papillary architecture and "foci of" squamous differentiation? Even though "areas of" and "foci" are non-majority terms, should histology be coded to the combination code of adenocarcinoma with mixed subtypes [8255/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to the majority of the tumor, which is 8140/3 [adenocarcinoma, NOS]. The terms "areas of" and "foci of" should be ignored because they are not terms that reflect the majority of the tumor. Therefore, we cannot use rule A on page 2 of Coding Complex Morphologic Diagnoses because this diagnosis does not represent a complex morphology.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Histology (Pre-2007)--Cervix: Is 8384/3 [adenocarcinoma, endocervical type] a specific histology type that must be stated or does it apply to any adenocarcinoma arising in the endocervical? Should the ICD-O-3 histology code of 8384/3 [Adenocarcinoma, endocervical type] be used for final diagnoses of "adenocarcinoma of the endocervix" or "adenocarcinoma of the cervix"?
For tumors diagnosed prior to 2007:
Histology code 8384 is for adenocarcinoma of endocervical type. This specific type (endocervical) must be part of the diagnosis in order to assign code 8384. This histology code is not to be used for Adenocarcinoma, NOS of the endocervix or cervix.
Adenocarcinoma of endocervical type can be diagnosed in other tissues and if so it will be stated as endocervical type. Adenoca of the endocervix would be coded to plain Adenoca.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
EOD-Size of Primary Tumor: Can you code the tumor size if you have the aggregate size given for two or more tumor masses?
For cases diagnosed 1998-2003:
No. Never code the aggregate size in the Size of Primary Tumor field when the pieces removed come from TWO OR MORE tumors. If there is a clinical statement regarding the size of two or more tumors, code this field to the size of the largest tumor.
The aggregate size can only be used to code the Size of Primary Tumor field when the PATHOLOGIST estimates the size of the tumor from the pieces of ONE tumor removed by the surgeon.
EOD-Extension--Lymphoma/Brain and CNS: How is this field coded for a primary brain lymphoma that is described as multi-focal?
For cases diagnosed 1998-2003: Since brain is the only site involved in this example, assign code 11 [Localized involvement of a single extralymphatic organ or site].
EOD-Extension--Colon: How is this field coded for an appendical primary when the appendix has ruptured and intrapentoneal fluid is positive?
For cases diagnosed 1998-2003: Code EOD extension as 85 [Metastasis]. Positive intraperitoneal fluid is equivalent to distant metastasis (implantation) for colon, including appendix, primaries.
Histology (Pre-2007)--Melanoma: How is histology coded for a final pathology diagnosis of "malignant melanoma, NOS" that is clinically described as a nevus?
For tumors diagnosed prior to 2007:
Code 8720 [malignant melanoma]. Assign the histology code based on the histology stated in the final diagnosis on the pathology report. The pathology report must say melanoma arising in junctional nevus to use the code 8740/3 [Malignant melanoma in junctional nevus].
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Histology (Pre-2007)--Breast: What code is used to represent the histology of "invasive ductal carcinoma and in situ ductal carcinoma, cribriform type"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/3 [ductal carcinoma] unless the combination is ductal and lobular.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Primary Site--Breast: What subsite code should be used for a diagnosis of "inflammatory carcinoma"?
Code the Primary Site field to C50.9 [Breast, NOS] for a breast primary presenting with inflammatory cancer unless there is a palpable mass within the breast. If there is a palpable mass, code the primary site to the position of the mass.
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