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Report Produced: 09/05/2025 03:13 AM

Report Question ID Question Discussion Answer Year
20051093 CS Lymph Nodes/Scope of Regional Lymph Node Surgery--Prostate: When prostate cancer is an incidental finding at cystoprostatectomy for bladder cancer, is the pelvic lymph node dissection coded for the prostate as well as the bladder?

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.

Yes, the pelvic lymph node dissection is coded as regional lymph node surgery for both primaries and the nodes are counted in collaborative staging for both primaries. The examination of the pelvic lymph nodes is relevant to both the bladder and the prostatic primaries.

 2005
20091046 CS Lymph Nodes/CS Site Specific Factor--Melanoma: When CS Lymph Nodes is coded 13, 14 or 15 (codes used when satellite nodule(s) or in-transit metastases are present), why must CS SSF 3 be coded 000 (No lymph node metastasis)? See Discussion.

3/11/05 Consult - PE: huge exophytic lesion right lower leg (mushroom-type lesion), 6cm. Below that lesion is another ulcerative lesion 2cm. Right upper arm lesion w/ satellite nodule. Note from physician states malignant melanoma on right lower leg metastatic to the left arm/shoulder. No scans done so there is no assessment of the lymph nodes.

We coded CS LNS to 13, which captures the satellite nodule, CS SSF3 = 999 and CS Reg Nodes Eval = 0. SEER Edit 216 requires the SSF3 to be 000. SSF 3 is coded 999 as there is no information about the clinical status of lymph nodes.

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.When CS lymph nodes is coded 13-15, SSF 3 must be coded 000. Follow the instruction in the SSF 3 Note: Use code 000, No lymph node metastases, if ... there are satellite nodules or in-transit metastases, but no regional lymph node metastases, i.e., CS Lymph Nodes is coded 13-15.

For this case, assign CS lymph node code 15 [Satellite nodule(s) or in-transit metastases greater than 2cm from primary tumor WITHOUT regional lymph node involvement or involvement of regional nodes not stated]. The arm lesion is more than 2cm from the leg lesion.

 2009
20081080 CS Lymph Nodes/CS Site Specific Factor--Head and Neck: How should these fields be coded when the information is from an out of state data exchange and the record provides no supporting text, all the required fields are not coded and the codes that are provided are in conflict? See Discussion. A parotid case with CS LN coded to 10 [single positive ipsilateral regional node]; Regional LNs Positive coded to 68 and Regional LNs Examined coded to 74. No SSFs were coded. Based on the number of nodes coded as positive, the CS LN code was incorrect. Because the only information available to the central registry was that multiple regional LNs NOS were positive, we coded CS LN to 80 [lymph nodes NOS] and coded all SSFs to 999. Upon running the SEER edits, this case popped up on edits yielding a CS Site-Specific Factor codes, CS Lymph Nodes and Head/Neck Schemas conflict. Provide some guidance as how to properly code CS LNs & SSFs 1-6 for this case given the very limited information provided to us?

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.This is an unusual situation with conflicting information. If possible, request the pathology report and/or audit the case.

If you cannot obtain any further information or clarification, there are two choices:

  • Code CS LN's 80; code SSF 1 & 2 999, code SSF 3-6 000.

  • Code CS LN's 99; code SSF 1-6 999.

    		•  2008
    		20051011 CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?

    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 Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.

    Code SSF 4 and 5 000 [Nodes clinically negative].

    		 2005
    		20051128 CS Lymph Nodes/CS Site Specific Factor 3--Breast: How are positive intramammary lymph nodes reflected in these fields? See Discussion. Patient with breast cancer underwent mastectomy. No axillary lymph nodes were positive, but 1 out of 2 intramammary lymph nodes were positive for mets (greater than 2 mm). CS Lymph node codes describe axillary and internal mammary nodes, but do not describe intramammary lymph nodes.

    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.

    Intramammary lymph nodes are coded as axillary lymph nodes for staging purposes. Intramammary node are nodes within the breast tissue. Both staging and treatment suggest these are equivalent to axillary nodes.

    		 2005
    		20041083 CS Lymph Nodes/CS Reg Nodes Eval -- Rectum: If the rectal tumor is not treated with a resection but on endoscopic ultrasound the patient is stated to have a lymph node above the primary tumor and the physician stages the case clinically as N1, should the CS Lymph Nodes field be coded to 30 [Regional lymph node(s), NOS] or 10[Rectal, NOS]? Should the evaluation field be coded to 0 [No lymph nodes removed. Evidence based on other non-invasive clinical evidence] or 1 [No lymph nodes removed. Evidence based on endoscopic examination.]? See Discussion.

    Rectal primary:

    5/04 sigmoidoscopy w/bx of rectal mass: adenocarcinoma. 6/04 Endoscopic ultrasound of rectal mass: invasion through wall but no definite invasion of prostate or seminal vesicles; 7.5mm lymph node located above tumor, no other enlarged lymph nodes detected. Patient did not have surgery. Physician staged lymph node involvement to clinical N1.

    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.Assign CS Lymph Nodes code 10 [Regional lymph nodes] based on the physician's N1. Assign code 10 because it is the lowest numerical CS code that corresponds to N1 in the scheme for rectum. Use the physician's assignment of TNM when the information in the medical record is incomplete or ambiguous. Code CS Reg Nodes Eval field 0 [No lymph nodes removed] for the case described above because there is no indication that N1 was assigned based on the endoscopic exam. The NI may be based solely on TNM documentation provided by the clinician and you do not know what the clinician used as the basis for the staging.

    		 2004
    		20081088 CS Lymph Nodes/CS Mets at Dx: How should these fields be coded for an in situ diagnosis when the patient was diagnosed by biopsy only and there is no information in the chart regarding an evaluation of lymph nodes or metastatic sites? See Discussion.

    In reference to the case below, does it make a difference if the CS T stage is known based on the primary excision but there is no clinical information in the record regarding the nodes or metastasis evaluation.

    This scenario is seen on outpatient records of breast biopsies and melanoma excisions; i.e., punch bx followed by gross excision of the lesion but the medical record contains no clinical information or statement of everything else normal.

    I&R Question 17625 2/16/2006

    A patient was diagnosed with ductal carcinoma in situ by needle core biopsy of the right breast. There was no further information in the chart stating if or where the patient went for staging work-up and treatment. What are the codes for CS Extension, CS Regional Lymph Nodes and CS Distant Mets at Dx?

    I&R Answer: Sufficient tissue must be taken to determine the T category. If this is the case, CS Extension = 00.

    Unless the physician makes the statement that the physical exam is negative, code the CS Regional Lymph Nodes = 99 CS Distant Mets at DX = 99.

    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 Lymph Nodes and CS Mets at Dx 00 [None] for an in situ diagnosis with no other information.

    The CS instructions state that CS LN's should be coded 00 for in situ because in situ by definition is non-invasive. The same logic applies to CS mets in the case of in situ. The I&R answer will be revised.

    		 2008
    		20081048 CS Lymph Nodes/CS Mets at Dx--Ovary: How are renal lymph nodes coded for ovary primaries?

    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 involvement of renal lymph nodes under CS Mets at Dx. Renal lymph nodes are not listed as regional lymph nodes for ovary; therefore, code involvement of renal lymph nodes under CS Mets at Dx.

    		 2008
    		20071015 CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?

    This question was answered by the CoC:

    Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.

    		 2007
    		20061045 CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded for a melanoma primary when melanoma is identified in lymph nodes but no primary skin tumor is found? See Discussion.

    Excisional biopsy of an inguinal lymph node revealed metastatic melanoma. Multiple skin biopsies did not reveal the primary site.

    Subsequent lymph node dissection of superficial inguinal nodes showed microscopic focus of malignant melanoma in subcutaneous fat adjacent to previous procedure site. No evidence of metastatic melanoma in 7 lymph nodes. Dissection of external iliac lymph nodes showed no evidence of melanoma in 5 lymph nodes.

    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 Lymph Nodes 80 [Lymph nodes, NOS]. Code CS Mets at DX 00 [None]. Since it cannot be determined whether the lymph nodes are regional or distant, code CS Lymph Nodes to lymph nodes, NOS.

    		 2006