Histology--Prostate: We are seeing numerous pathology reports with the following diagnosis: "Conventional (acinar) prostatic adenocarcinoma (M81403)." What is the correct histology code?
For cases diagnosed prior to January 1, 2007, assign histology code 8550/3 [Acinar adenocarcinoma].
Diagnostic Confirmation--Prostate: How do we code this field when there is an elevated PSA, no other work-up and there is a clinical diagnosis of adenocarcinoma?
Code the Diagnostic Confirmation field to 5 [positive laboratory test/marker study] to indicate the diagnosis is based upon an abnormal PSA tumor marker if the physician uses the PSA as a basis for diagnosing prostate cancer.
EOD-Extension--Lung: For a left upper lobe lung tumor that extends across the fissure into the left lower lobe, should this field be coded to 10 [Tumor confined to one lung] or 77 [Separate tumor nodules in different lobe]?
For cases diagnosed 1998-2003: Assign EOD extension code 10 [Tumor confined to one lung]. EOD extension code 10 applies to a single tumor within one lung, even one that crosses over a fissure into another lobe. EOD extension code 10 is not correct if the tumor extends to the pleura, or if there is atelectasis, obstructive pneumonitis or malignant pleural effusion. Code 77 is incorrect because that is a separate tumor nodule in a different lobe.
Histology--Lymphoma: Is histology for "large B-cell lymphoma evolving from extranodal marginal zone B-cell lymphoma" coded to 9680/3 [Malignant lymphoma, large B-cell, diffuse, NOS] or 9699/3 [Marginal zone B-cell lymphoma]?
For cases diagnosed prior to 1/1/2010:
Code the histology as 9699 [marginal zone B-cell lymphoma]. Code the histology from the original diagnosis.
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.
Surgery of Primary Site--Skin: What surgery code is used to reflect the amputation of a finger for subungual melanoma?
47 [Wide excision or reexcision of lesion or minor (local) amputation with margins greater than 2cm] is the correct surgery code for amputation of a finger for melanoma.
Reportability--Lung: One of our facilities has a case they are not really sure how to report.
This patient came in for a double lung transplant due to COPD which occurred on 1/27/14. At time of transplant, the team found out the donor hospital had identified a small nodule in the right lower lobe donor lung, which they biopsied and deemed negative. However, the slides were reviewed and felt to represent adenocarcinoma. The team performed a right lower lobe lobectomy of the donor lung before transplanting into the patient.
So, we are not really sure how to handle this case. The adenocarcinoma actually belongs to the donor patient from another hospital, however, they actually didn’t identify it at that facility as their pathology was negative for a malignancy.
This very interesting case is not reportable to either facility. Since the right lower lobe nodule was resected prior to transplantation, the case does not belong to your patient. Ideally, the cancer should be assigned to the donor; however, donor information is confidential.
Surgery of Primary Site--Ovary: How should this field be coded for an ovarian primary when there is a BSO and only the fundus of uterus is removed (not a full hysterectomy)?
Assign surgery code 52 [Bilateral (salpingo-) oophorectomy; WITH hysterectomy]. Code 52 does not exclude a partial hysterectomy.
Terminology/Terms of involvement: When the terms "lytic" or "lysis" are used in an imaging study, are they to be interpreted as synonymous with metastasis, or can these terms be used to describe a non-malignant condition?
Although the term "lytic lesion" is often used to describe bone lesions and "tumor lysis" develops in response to systemic therapy, the words are not a part of the SEER list of terms used to describe involvement. Do not code distant metastasis based only on these words.
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