Tumor Size--Pathologic--Anus: In 2019, the pathology report of an anal canal squamous cell carcinoma stated the tumor size is 2.5 cm from proximal to distal (3.5 cm in circumference). Is the pathologic tumor size tumor size 025 or 035?
Based on the information provided, code the tumor size as 035. We asked an expert pathologist to review this question and she said to use the larger measurement. She also said "the pathologist usually cuts the anus and rectum open like a tube; the “circumference” would be measured flat."
Primary site/Histology--Heme & Lymphoid Neoplasms: How are these field coded when a biopsy of a substernal mass and the pericardium show T-cell lymphoblastic lymphoma/leukemia, the CT scan showed mediastinal and hilar adenopathy and no bone marrow biopsy was done?
Code the histology to 9837/3 [T lymphoblastic leukemia/lymphoma].
To determine the primary site for leukemia/lymphoma histologies, first go to Module 4. Per Rule PH8, code the primary site to the site of origin when lymph nodes, tissue or organs are involved. To determine a more specific histology, go to Module 7, rules for coding primary site for lymphomas. Per Rule PH20, code the lymph node region when multiple lymph node chains within the same region are involved. Mediastinal and hilar lymph nodes are intrathoracic lymph nodes. The substernal mass is also intrathoracic and is presumed to be a lymph node mass which involved the pericardium. For this case, code the primary site to C771 [Intrathoracic lymph nodes].
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Primary Site: How is this field coded for cholangiocarcinoma involving the intrapancreatic bile duct?
Code the primary site as C24.0 [Extrahepatic bile duct, includes Common bile duct] for a cholagiocarcinoma originating in the common bile duct. A portion of the common bile duct is within the head of the pancreas: The intrapancreatic segment of the common bile duct.
Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case?
Code the primary site to C421 [bone marrow]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Reportability--Brain and CNS: Are hemangioma, NOS (9120/0), cavernous hemangioma (9121/0) or venous hemangioma (9122/0) reportable when they arise in the brain or CNS?
Hemangioma, NOS (9120/0) and cavernous hemangioma (9121/0) arising in the dura and parenchyma of the brain/CNS are reportable.
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous hemangioma arising in the brain is blood vessel (C490). The combination of 9122/0 and C490 is not reportable. This is a venous abnormality. Previously called venous angiomas, these are currently referred to as a developmental venous anomalies (DVA).
Surgery of Primary Site - - Esophagus/Stomach/Colon: Is an endoscopic mucosal resection (EMR) for an esophagus, stomach or colon malignancy coded to 20 [local tumor excision, NOS] or to a more specific code such as 22 [local tumor excision combined with electrocautery]?
Assign code 20 [local tumor excision, NOS] for a procedure described as an esophagus stomach or colon endoscopic mucosal resection (EMR), NOS. If there is additional information specifying electrocautery, laser or PDT (for example), assign a more specific code.
Reportability--Breast: Is a final path diagnosis of "phyllodes tumor, borderline (malignant, low grade)" reportable if the comment states "Features favor the diagnosis of a borderline phyllodes tumor (or also called malignant phyllodes tumor of low grade)"?
No, borderline phyllodes tumors (PT) are not reportable. The ICD-O-3 code is 9020/1. According to the WHO Classification of Tumours of the Breast and Female Genital Organs, borderline PT's are also called low grade malignant PT's.
Surgery of Primary Site--Colon: In the absence of detailed operative or pathology report descriptions of the specific segment(s) of the colon removed, should a hemicolectomy be coded if stated by the surgeon to be such?
Yes, code hemicolectomy as stated by the surgeon when there is no conflicting or additional information avaliable.
Primary site/Histology--Heme & Lymphoid Neoplasms: Should the primary site and histology codes be updated when a patient with a history in 2005 of a bone marrow diagnosis of chronic lymphocytic leukemia later presents in 2010 with lymph node biopsy diagnosis of small B-cell lymphocytic leukemia?
Per Rule M2, this is a single primary because there is a single histology. Code histology to 9823/3 [CLL/SLL]/
The distinction of CLL vs. SLL cannot be made on bone marrow biopsy in isolation. The pathologist cannot make a diagnosis of CLL vs SLL without having peripheral blood counts available for review. If the patient was treated for CLL in the past, that may alter the peripheral counts seen in 2010 (e.g., lymphocytosis). The distinguishing feature is peripheral lymphocytosis in CLL (not seen in SLL). The disease looks the same and both will often have bone marrow involvement and lymph node involvement. If the patient had true CLL in 2005, then any subsequent lymph node (or other) biopsy consistent with CLL/SLL remains consistent with the original diagnosis of CLL. I would not change the original CLL code.
I agree with the previous response. We have to assume the 2005 diagnosis included a peripheral blood supporting that diagnosis. Otherwise, CLL and SLL look the same in nodes and marrow. The interplay between the two "diseases" is expected. This is why they are considered a single disease.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
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