Report | Question ID | Question | Discussion | Answer | Year |
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20140026 | Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246? |
Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma. |
2014 | |
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20031125 | Histology/Reportability/Behavior Code--Testis: Is a mature teratoma that is metastatic to lymph nodes reportable? See Description. |
Pathology report states, "Histologic sections reveal lymph node metastases, consisting predominantly of mature teratoma. In addition, there are cells scattered through the fibrous stroma which exhibit mild cytologic atypia but have low N:C ratios. The largest metastasis grossly measures 10cm. In addition extracapsular extension is identified. Diagnosis: Lymph Nodes--Metastatic Testicular Carcinoma Involving Multiple Lymph Nodes." The morphology code for mature teratoma is 9080/0. The pathologist does not classify this as an immature teratoma (9080/3). Is this reportable? |
Yes, this metastatic teratoma is reportable. This is a malignant teratoma by virtue of the lymph node metastases. Code the histology as 9080/3 [Teratoma, malignant, NOS]. Primary site is testis [C62_]. |
2003 |
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20210062 | Histology/Reportability--Heme and Lymphoid Neoplasms: Is a case that is compatible with low grade myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) reportable, and if so, is the histology plasma cell myeloma or myelodysplastic syndrome (MDS)? See Discussion. |
HL-7 e-path report, Final Diagnosis High normocellular marrow with maturing trilineage hematopoiesis, multilineage dyspoiesis, compatible with MDS-MLD and involvement by plasma cell neoplasm/myeloma, IgA kappa positive, approximately 20-25% of total cellularity present. See comment. Comments Correlation with other relevant laboratory (amount and type of serum and urine paraprotein levels, renal function tests, serum calcium level, and anemia) and radiologic (lytic bone lesions) findings is recommended for complete interpretation. Dyspoiesis of all lineages is seen and the findings are compatible with low grade myelodysplastic syndrome (MDS-MLD), assuming that other possible causes are excluded. Correlation with cytogenetic and molecular studies is recommended for complete characterization |
This case is reportable. Assign MDS, NOS (9989/3) based on the information provided for this case. “Compatible with” can be used for reportability; however, it cannot be used for assigning histology. There is no confirmed diagnosis of plasma cell myeloma/neoplasm; the comment specifically addresses the need for further evaluation of this case. |
2021 |
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20210070 | Histology/Reportability--Digestive System: Is “neuroendocrine neoplasm” reportable? See Discussion. |
We are confused by SINQs 20180097, 20150001, and 20140051. The latter two indicate that “well-differentiated neuroendocrine neoplasms” of the duodenum and appendix are reportable because they’re synonymous with neuroendocrine tumor (NET). Yet 20180097 states “primary hepatic neuroendocrine neoplasm” is NOT reportable unless there is documentation that it’s being used as a synonym for Primary Hepatic Neuroendocrine Tumor (PHNET). In addition, we see in the 2021 ICDO-3.2 update that only “poorly differentiated neuroendocrine neoplasm” is listed with behavior code /3 and noted to be reportable for 2021+ on the companion annotated histology list. Does reportability of neuroendocrine neoplasms depend on primary site, differentiation terminology within the histology name, or something else? Our casefinding staff is hoping for a general reportability guideline to follow when they come across “neuroendocrine neoplasms” NOS. For example, we have a 2020 pathology report for a core biopsy of a soft tissue pelvic mass with final diagnosis of low grade neuroendocrine neoplasm; there is no further clarification as to whether it is felt to be primary or metastatic, and we have no other associated records for this patient in our central registry. |
Reportability of neuroendocrine neoplasms depends on primary site, terminology, and differentiation. "Neuroendocrine neoplasm" is an umbrella term for a variety of neuroendocrine tumors and carcinomas. Neuroendocrine neoplasm, not otherwise specified (NEN, NOS) is not reportable as in your example unless it is being used as a synonym for neuroendocrine tumor (NET), as with digestive system tumors. According to WHO Classification of Digestive System Tumors, 5th ed., NENs of the appendix and liver are epithelial neoplasms with neuroendocrine differentiation, including well-differentiated tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The guidance in SINQ 20180097, 20150001, and 20140051 is still valid. |
2021 |
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20081038 | Histology/Primary site: What is the correct histology code for sarcomatoid carcinoma of the mandible diagnosed in 2007? See Discussion. |
Left mandible resection: Malignant tumor, favor high grade sarcomatoid carcinoma. Please see comment. Comment: Considering the focal stain with P63 and the consult from Mayo Clinic done on the previous biopsy, the diagnosis of sarcomatoid carcinoma is more likely. Gross: left mandible resection...sectioning reveals a...mass that has replaced the majority of the mandibular bone and is at the medial, anterior lateral and posterior soft tissue margins and comes to within 2.4 cm of the anterior boney resection margin and 1.9 cm of the smooth articular temporal mandibular joint surface. The combination of C411 and 8033/3 is impossible (with no override available). |
Code the primary site C031 [Mandibular gingiva]. Code the histology 8033 [sarcomatoid carcinoma]. This tumor originated in the mandibular gingiva and invaded the bone (mandible) -- It did not originate in the bone. This type of tumor does not originate in bone. |
2008 |
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20190084 | Histology/Heme & Lymphoid Neoplasms: Should the histology be coded to chronic myeloid leukemia (CML), BCR-ABL1-positive (9875/3) regardless of the quantitative analysis percentage of BCR-ABL1 that was detected? See Discussion. |
Example: Bone marrow biopsy diagnosis is chronic myelogenous leukemia, chronic phase, and the RT-PCR test result proved, BCR-ABL1 p210 (Major Breakpoint) - Detected, 3.3659%. Even though the p210 fusion transcript was less than 5%, it was detected. The presence of BCR-ABL1 does define whether or not patients are treated with tyrosine kinase therapies. Therefore, it seems likely that the presence of any BCR-ABL1 would be captured using the more specific histology code 9875/3, instead of the non-specific CML, NOS histology code 9863/3. Are there minimum threshold requirements for these quantitative studies in order to code the histology to the more specific type of CML? |
Code chronic myeloid leukemia (CML) BCR-ABL1-positive as 9875/3. According to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th edition, CML BCR-ABL1-positive is characterized by the chromosomal translocation t(9;22) which results in the formation of the Philadelphia (Ph) chromosome containing the BCR-ABL1 fusion gene. The diagnosis requires detection of the Ph chromosome and/or BCR-ABL1. If the mutation is detected, regardless of percentage, it is positive. Quantitative levels of BCR-ABL are used to monitor response to tyrosine kinase inhibitor therapy. |
2019 |
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20230038 | Histology/Heme & Lymphoid Neoplasms--Mycosis Fungoides: What is the histology code for lymphomatoid papulosis that transforms initially to mycosis fungoides (MF)/cutaneous T-cell lymphoma (CTCL) and subsequently to CTCL with large cell transformation, and is it a new primary? See Discussion. |
Disease History 2018 - Lymphomatoid papulosis (non-reportable) 2020 - Transform to CTCL (and called Mycosis Fungoides specifically) (CTCL/MF same primary) 2021 - Transform to CTCL with large cell transformation |
Abstract a single primary and assign code 9700/3 for MF. According to our subject matter expert, this is all MF. When MF progresses, there can be large cd30 positive T cells. This is not the same as anaplastic large cell lymphoma. |
2023 |
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20210049 | Histology/Heme & Lymphoid Neoplasms--Leukemia: Is this the correct histology for a case of acute myeloid leukemia (AML) with recurrent genetic abnormalities? If the only information was AML with recurrent genetic abnormalities,"what code would you use: AML, NOS (9861/3) or AML with recurrent genetic abnormalities (9896/3)? See Discussion. |
12/3/2020 Pathology: AML: Blasts 40% of nucleated cells. CD45 positive, CD34 negative, CD 117+, CD13 positive, CD33 positive in 59.6% and HLA-DR was dim and myeloperoxidase was dim. Cytogenetics normal karyotype. The next generation sequencing detected IDH 2p.(R172K)c515>A. Because this was AML NOS, we consulted with the physician. The physician stated the patient had AML with recurrent genetic abnormalities"and the basis for the diagnosis was the IDH-2 mutation identified on Next Generation Sequencing. We assigned 9896/3, based on the physician's interpretation of the pathology. This histology is being questioned. |
We found that the term AML with recurrent genetic abnormalities, NOS"was incorrectly included as an alternate name with code 9896/3. We followed back with our expert hematopathologist and he stated that this should have been coded to 9861/3 (AML, NOS), for AML with recurrent genetic abnormalities, NOS. This alternate name has been added to 9861/3. (Note: The same alternate name has been removed from 9896/3). IDH-2 is not listed as a genetic abnormality for any of the histologies listed in the database. It could be that this is a new genetic marker for one of the AML with recurrent genetic abnormalities that we are not aware of. Without further clarification on which histology the IDH-2 would indicate, you would have to default to 9861/3. There are several histologies that are grouped as AML with recurrent genetic abnormalities."All of these have specific genetics listed as part of the ICD-O-3 histology name. 9865: Acute myeloid leukemia with t(6;9)(p23;q34.1) DEK-NUP214 9866: Acute promyelocytic leukemia with PML-RARA 9869: Acute myeloid leukemia with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM 9871: Acute myeloid leukemia with inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11 9877: Acute myeloid leukemia with mutated NPM1 (2021+) 9878: Acute myeloid leukemia with biallelic mutation of CEBPA (2021+) 9879: Acute myeloid leukemia with mutated RUNX1 (2021+) 9896: Acute myeloid leukemia with t(8;21)(q22;q22.1); RUNX1-RUNX1T1 9897: Acute myeloid leukemia with t(9;11)(p21.3;q23.3); KMT2A-MLLT3 9911: Acute myeloid leukemia (megakaryoblastic) with t(1;22)(p13.3;q13.1); RBM15-MKL1 9912: Acute myeloid leukemia with BCR-ABL1 (2021)+ Of note, for the above histologies, since these are diagnosed solely based on genetics, diagnostic confirmation will always be 3. This instruction will be added to the Hematopoietic database for the 2022 update. |
2021 |
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20230039 | Histology/Hematopoietic and Lymphoid Neoplasms--AML: What is the histology code for Acute Myelogenous Leukemia (AML) with monocytic differentiation, 9891/3: acute monoblastic and monocytic leukemia or 9867/3: Acute myelomonocytic leukemia? |
Code AML with monocytic differentiation as acute myeloid leukemia, NOS (9861/3) per consultation with our expert hematopathologist. Acute monoblastic and monocytic leukemia (9891/3) and acute myelomonocytic leukemia (9867/3) are distinct entities according to the WHO. "AML with monocytic differentiation" is a descriptive diagnosis, whereas, "Acute monoblastic and monocytic leukemia" are specific diagnoses. In the WHO Classification of Tumours, Central nervous system tumours (4th Ed) in 2016, WHO began integrating information on molecular alterations that provide significant prognostic implications and/or a therapeutic target into the histology code/term itself. As a result it is also important to look at the molecular testing because acute myeloid leukemias can have different molecular mutations that could result in coding to a different histology code. In this case, there was no other information regarding additional immunophenotyping, so that is why AML, NOS was assigned. Acute myeloid leukemia with monocytic differentiation has been added to the Hematopoietic and Lymphoid Neoplasm Database as an alternate name for 9861/3. |
2023 | |
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20180103 | Histology/Grade--Small intestine: For a 2017 diagnosis, is the grade/differentiation field coded 1 or 9 when the diagnosis is well-differentiated neuroendocrine tumor (NET) (carcinoid)? It seems as though the term well-differentiated defines type of neuroendocrine tumor so they can diagnosis the carcinoid. See Discussion. |
5/15/17 Duodenal bulb, biopsy: Fragments of duodenal mucosa with well differentiated neuroendocrine tumor (carcinoid), extending to the edge of specimen and peptic duodenitis in the submitted tissue. No significant intraepithelial lymphocytosis. |
Assign grade code 1 for well-differentiated NET (8240/3). Well-differentiated is synonymous with NET, grade 1, according to WHO Classification of Tumors of the Digestive System. |
2018 |