Primary Site--Skin: Should cutaneous leiomyosarcoma be coded to primary skin of site (C44_) or soft tissue (C49_)?
Code cutanteous leiomyosarcoma to skin. Leiomyosarcoma can originate in the smooth muscle of the dermis. The WHO classification designates this as cutaneous leiomyosarcoma. The major portion of the tumor is in the dermis, although subcutaneous extension is present in some cases.
Update to the Current Manual/SEER*RSA--SEER Site-specific Factor 1: The 2024 SEER Manual and SEER*RSA say that Codes 10-51 are hierarchical; use the highest code that applies (10 is highest, 51 is lowest). Should the guidance say that 51 is highest, 10 is lowest since code 10 is a HPV negative p16 test?
Assign the highest code with 51 as the highest and 10 the lowest when there is more than one test performed with differing results.
The SEER Manual will be updated in the 2025 release. SEER*RSA will be updated in a future release, version 3.3 in 2026, as version 3.2 has been updated for 2025.
All Surgical Fields/Radiation Sequence with Surgery--Unknown Primaries: What codes are used to represent these fields for an unknown primary treated with a radical neck dissection followed by radiation therapy?
For unknown primaries treated with a lymph node dissection and diagnosed 1/1/2003 and after, code:
1) Surgery to Primary Site: 98 [All unknown and ill-defined disease sites, WITH or WITHOUT surgical treatment].
2) Scope of Regional Lymph Node Surgery: 9 [Unknown or not applicable].
3) Surgical Procedure of Other Site: 1 [Surgery to other site(s) or node(s), NOS; unknown if regional or distant].
4) Radiation Sequence with Surgery: 3 [Radiation after surgery]. Any planned surgical treatment is used to code radiation/surgery sequence (per CoC I&R).
First course of treatment: What is the correct code to use for allogenic stem cell transplant?
Code an allogenic stem cell transplant as 20 (Stem cell harvest (stem cell transplant) and infusion) in Hematologic Transplant and Endocrine Procedures in the 2016 SEER Manual.
Reportability--Hematopoietic, NOS: Is a "refractory cytopenia with excess blasts" discovered on a bone marrow biopsy reportable?
For cases diagnosed prior to 1/1/2010:
Refractory cytopenia with excess blasts (RCEB) is reportable. RCEB is the same disease process as refractory anemia with excess blasts, except there is more than one type of blood cell that is low (red, white, platelets).
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Update to Current Manual/Neoadjuvant Treatment: What codes should be used for Neoadjuvant Therapy--Clinical Response and Neoadjuvant Therapy--Treatment Effect when the neoadjuvant therapy is still in progress at the time the case is initially abstracted as with rapid reporting. There is no code for neoadjuvant therapy still in progress and code 9 generates an edit for Neoadjuvant Therapy--Clinical Response.
Assign code 8 for Neoadjuvant Therapy--Clinical Response and assign a code 9 for Neoadjuvant Therapy--Treatment Effect when the treatment is still in progress. Revise these codes after the treatment has been completed.
We will update the manual to include these instructions.
EOD-Extension--Colon: How should this field be coded for "adenocarcinoma penetrating through bowel wall into adjacent adipose tissue?
For cases diagnosed 1998-2003: The difference between EOD-extension codes 40 and 45 is the level of the fat involved. Code 40 is subserosal fat immediately adjacent to the muscular wall of the colon inside the serosa/visceral peritoneum. Code 45 is pericolic fat in areas where there is a serosal surface or in the retroperitoneal areas of the ascending and descending colon where there is no serosa. Code 42 was added for use when it is not possible to determine whether subserosal fat or pericolic fat is involved. Code 42 should be used only when there is a reference to 'fat' (NOS) The answer for the case example above depends on the location of the primary and whether the fat referred to is within or outside the entire thickness of the colon wall. If no additional information is available, use code 42 [Fat, NOS].
Reportability/Behavior--Hematopoietic, NOS: Is a "myelodysplastic/myeloproliferative disease, unclassifiable" coded to 9975 with a behavior code of 3 as indicated in the WHO blue book on "Tumours of Haematopoietic and Lymphoid Tissues" or is it not abstracted because it has a behavior code of 1 which means the case is not reportable?
For cases diagnosed prior to 1/1/2010:Code MDS/MPD U to 9975/3 [Myelodysplastic/myeloproliferative disease, unclassifiable]. Change the behavior code to /3 according to ICD-O-3 Rule F. The case is reportable.
The WHO book is more recent and gives a specific code for this new hybrid category of the WHO/REAL classification.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Reportability--Pancreas: Is this reportable? Is this benign? If reportable, what histology code and behavior code should be used? A final pathology diagnosis reads: "Cystic pancreatic endocrine neoplasm (CPEN)".
"Cystic pancreatic endocrine neoplasm (CPEN)" is reportable. Assign 8150/3 based on the information provided. We consulted our expert pathologist and he states "Since metastases have been reported in a few, and all the rest of the pancreatic endocrine tumors are now designated malignant, …we are safe considering them /3 until proven otherwise. Since most of them are non-functioning, [assign code] 8150/3 unless specified as to G1 (8240/3) or G2 (8249/3)."
Date of Diagnosis: When doing follow-back at nursing homes on DCO cases, we find it difficult to code diagnosis date because the nursing home records are often vague or incomplete. Should the diagnosis date be coded as unknown (excluded from SEER database), the date of death, or the approximate date of diagnosis as reported on the death certificate?
If the nursing home record indicates that the patient had cancer, use the best approximation for date of diagnosis.
If the record says the patient had cancer when admitted, but it does not provide a date of diagnosis, use the date of admission as the date of diagnosis.
If there is no mention of cancer in the nursing home record and/or all work-up in the record is negative, assume the cancer was discovered at autopsy. Use the date of death as the date of diagnosis, and leave as a Death Certificate Only case.
An official website of the United States government
Home