Other Therapy: Can herbal therapy be coded when used as a single therapy or when used in combination with conventional therapy as a complimentary treatment? See Discussion.
Page 201 of the SPCM 2004, item #5, states "Assign code 6 for unconventional methods whether they are single therapy or given in combination with conventional therapy." This statement itself is ok but there is no guideline on the use of complementary therapy when it is given as the only treatment. The SPCM, 3rd editon, page 140 states: "Use code '6' for alternative and complementary therapies ONLY IF the patient receives no other type of treatment." There is no such statement in the SPCM 2004.
Assign code 6 for unconventional methods whether they are single therapy (alternative medicine is the only treatment) or given in combination with conventional therapy (complementary medicine plus conventional).
Surgery of Primary Site--Lung: What code is used to represent "photodynamic therapy" (PDT) for lung primaries? See Discussion.
PDT is not listed in the Surgery to Primary Site field codes for lung.
For cases diagnosed 2003 and later, code the Surgery of Primary Site field to 19 [Local destruction or excision, NOS] for lung primaries. Photodynamic therapy is a surgical procedure that results in the local destruction of tumor.
Reportability--Melanoma: Is the following reportable? See Discussion.
PATH: Skin, Lt back exc bx: compound nevus with severe cytoarchitectural atypia and regression. Comment: due to overlap of morphology between MM and nevi with severe atypia, and since there's evidence of regression, consideration for re-excision may be considered if clinically indicated.
The final diagnosis, compound nevus with severe atypia, is not reportable. This diagnosis is not listed in ICD-O-3.
CS Tumor Size--Ovary: Can the size of a tumor mass shadow seen on a CT scan be used to code CS Tumor Size? See Discussion.
Ovarian primary: No surgery performed. CT abd/pelvis states "Bilateral pleural effusions, ascites. Right appendix region with tumor mass shadow 3 x 8 x 3.9cm"
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 CS tumor size 999 [Unknown; size not stated]. The size of the tumor is not known in this case.
Note that tumor size is not used for AJCC staging for ovary.
Grade, Differentiation--All Sites: Why was the decision made not to code all "3-component differentiation systems" the same way that Bloom-Richardson is coded? For example, SEER codes a low grade BR to 1 for the Differentiation field and a low grade for other grading systems to 2. See discussion.
Our Pathologist Consultant agrees with SEER's guideline to code the Bloom-Richardson and B&R modifications of low, intermediate and high to 1, 2 and 3 respectively and thinks all 3-component systems should be coded that same way because it better represents the differentiation of the tumor. In his opinion, coding all other 3-component systems to a differentiation of 2, 3 and 4 respectively, is overstating the degree of differentiation.
The rules for coding histology are approved and used by all of the major standard setters through agreements reached in the NAACCR Uniform Data Standards Committee. This issue is under review by our medical advisors and a special committee. Changes will be taken to the Uniform Data Standards Committee for review and approval.
Primary Site--Head & Neck: What is the anatomical distinction among tonsillar fossa, tonsillar pillar, and tonsil NOS?
Operative findings describe a right tonsil three times the size of the left tonsil. Tonsil is dissected from the tonsillar fossa. There appeared to be no involvement of tumor below the tonsillar capsule.
The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.
Code C09.9 [Tonsil NOS] as the primary site for the case above.
EOD-Pathologic Extension--Prostate: Does capsular invasion (code 32) take priority over apex extension (code 34) on prostate primaries? See discussion.
On prostatectomy, adenocarcinoma involves left apex and also left mid lobe where it focally invades capsule. Do we code extension to 34 - the highest numerical code, or to 32 to capture the capsular invasion? Do codes 33 and 34 represent a subset of code 31, and would code 32 represent greater tumor involvement?
For cases diagnosed 1998-2003:
Code the EOD-Pathologic Extension field to 32 [Invasion into (but not beyond)prostatic capsule] when there is both capsular and apex invasion of the prostate.
Although numerically lower, code 32 takes precedence over codes 33 [arising in the apex] and 34 [extending to the apex]. Codes 33 and 34 are "subsets" of code 31 [Into prostatic apex/arising in prostatic apex].
Collaborative Staging--Hematopoietic, NOS: Which Collaborative Staging schema is used for a connective, subcutaneous and soft tissue primary of the pelvis [C495] with the morphology of Langerhans cell sarcoma [9756/39]? See Discussion.
On page C-411 of the SEER manual for the connective, subcutaneous, and other soft tissues schema it lists exceptions for certain morphologies and the above is not listed as an exception. On the Hematopoietic scheme it lists the above morphology.
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.Use the hematopoietic schema on page C-709 of the 2004 SEER manual. The histologically defined schemas have priority over the site schemas when both apply. See page 115 of the 2004 SEER manual.
The morphology codes listed on page C-411 pertain to the SEER Site Specific Guidelines.
MP/H Rules/Histology--Brain: How many primaries are reported and what is the histology for a single brain tumor described as a low grade astrocytoma at the time of the initial partial resection and a low grade glioneuronal neoplasm at the time of the subsequent total resection? See Discussion.
On 4/20/07 a partial resection of a brain tumor is interpreted as low grade astrocytoma. Patient has a gross total resection on 8/13/07 with this diagnosis: low grade glioneuronal neoplasm (see comment). Comment: This case has been reviewed at ---. Dr. agrees with our interpretation (low grade glioneuronal neoplasm, possibly a dysembryoplastic neuroepithelial tumor).
For cases diagnosed 2007 or later, this is a single primary. A single tumor is always a single primary.
Assign histology code 9400/3 [Astrocytoma, low grade]. This diagnosis was not revised or amended based on the later surgery. It is possible that the malignant component was entirely removed during the first surgery.
Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion.
On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008.
For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.
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