EOD-Extension--Lymphoma: How do you code stage and EOD for an extranodal lymphoma with bilateral involvement of a paired site? See discussion.
For example, we frequently see cases of lymphoma occurring in bilateral orbits, or both lungs. This issue was discussed at a 1991 SEER meeting with the tentative answer being that lymphoma involving both organs of a paired site will be coded as stage I (e.g., both eyes or both lungs), as this would be contiguous disease. However, an extranodal lymphoma involving tissue of both limbs (e.g., soft tissue of both arms) will be coded as stage IV because this represents wide areas of involvement that have no connection.
For cases diagnosed 1998-2003:
Bilateral involvement of an extralymphatic paired organ is coded as involvement of a single extralymphatic organ or site for lymphomas. The EOD extension code would be at least 11 (Stage IE). Staging lymphomas of any site depends on whether one or more lymph node regions and/or extralymphatic organs are involved, and whether sites on one or both sides of the diaphragm are involved.
EOD-Extension--Lung: If a CT scan indicates that a patient has evidence of "long-standing pneumonia," is that synonymous with "pneumonitis" for the purposes of coding extension for lung primaries?
No. These terms are not synonymous. For cases diagnosed 1998-2003, disregard the pneumonia and use the other available information to code extension.
EOD-Extension--Kaposi Sarcoma: Is a "markedly enlarged spleen" involvement for cases of Kaposi Sarcoma?
For cases diagnosed 1998-2003: No. Splenomegaly is not synonymous with "extension to" or "involvement of" the spleen in Kaposi's sarcoma. Look for a definite statement of Kaposi's lesion(s) involving the spleen.
EOD-Extension--Head & Neck (Larynx): When "fixed" is stated for a larynx primary does it specifically have to say that it is the vocal cord that is fixed? Are the terms "fixed" and "immobile" synonymous? Should these cases be coded to 40 rather than 35? See discussion.
1. The tumor is fixed, the arytenoid on left side is fixed and the right arytenoid is partially fixed. Palpation of the tumor reveals it to be fixed in the larynx. T3 N0 M0 Stage III.
2. Erythema and swelling of right false cord with bulging and immobility. Left cord moves normally. T3 N0 M0 Stage III.
For cases diagnosed 1998-2003:
Code the EOD-Extension field for both cases to 40 [Tumor limited to larynx WITH vocal cord fixation]. Code 35 [Impaired vocal cord mobility] implies that mobility is diminished in strength and/or quality but is not rigid. Impaired mobility is a T2 tumor. Because the second case is T3, the physician implies he/she is using the term "immobility" to describe complete fixation.
EOD-Extension--Colon: Is a pathology description of "superficial invasion of the muscularis mucosa in the upper stalk of the polyp" coded in this field to 10 [mucosa (including intramucosal) NOS], 12 [Muscularis mucosa], or 14 [Stalk of polyp]? See Description.
Do we use the highest applicable value because all three definitions are used in the following example? Ex: Path diagnosis: Sigmoid polyp: tubulovillous adenoma with a focus within upper portion of stalk consistent with superficially invasive (intramucosal) colonic adenocarcinoma (see Comment). Comment: ... in the upper stalk region, there is evidence of superficially invasive carcinoma which appears to be limited to the muscularis mucosa and thus would be intramucosal by classification.
For cases diagnosed 1998-2003: Code extension as 12 [muscularis mucosae]. For this case, "upper stalk" is a reference to location rather than extension. This adenocarcinoma extends to the muscularis mucosa.
EOD-Extension--Breast: If a negative bone scan is followed by a bone marrow biopsy that is positive for metastatic disease, is the bony involvement used when coding extension [85] or as progression of disease (ignore mets when coding extension)? See discussion.
Pt diagnosed with ductal carcinoma of the breast in May. On June 1, oncologist recommended chemo and XRT and planned a metastatic workup. A June 6 marrow MR consistent with mets. June 8 bone scan showed scoliosis of the L-spine with scattered focal areas of increased activity probably related to degenerative changes in the spine. On June 29, biopsies were done of the T2 vertebra with path diagnosis of metastatic adenocarcinoma consistent with breast primary. Chemo started July 15.
For cases diagnosed 1998-2003, is EOD extension code 85 correct? We felt that the bone mets was found within 4 months of diagnosis and is not progression of disease.
For cases diagnosed 1998-2003: Code the EOD-Extension field to 85 [metastasis]. Bone metastasis was documented during the original metastatic workup. Metastasis to the bone was suspected soon after diagnosis and confirmed prior to the start of treatment. The length of time between the diagnosis and the confirmation of the bone metastasis was not used to code extension on this case. The pt was still being worked up as evidenced by the fact that treatment had not yet started.
EOD-Clinical Extension--Prostate: Note 8 of the clinical EOD scheme for prostate states, "B1, Small, discrete nodule(s)<1.5 cm, and B2 Nodule(s)>1.5 cm ... " Does Note 8 still apply for cases diagnosed 1998 or later?
For cases diagnosed 1998-2003:
Note 8 in the EOD scheme does not apply because nodule size does not apply in the 5th or 6th edition of TNM.
EOD-Clinical Extension--Prostate: In the SEER EOD manual, there is a list of terms to distinguish apparent from inapparent tumor for prostate primaries. Are terms in the "maybe" category and are terms not on the list clinically inapparent or clinically apparent when there is no physician staging of the case? See discussion.
The rectal examination states that there is "asymmetrical enlargement of the prostate, firmness over the right lobe" and the physical exam impression is extensive carcinoma of right lobe. A needle biopsy of the right lobe was positive. "Enlarged" is on SEER's list of clinically inapparent terms; "asymmetrical" and "firm, NOS" are on the "maybe" list.
For cases diagnosed 1998-2003:
On the basis of the physical exam impression, code the EOD-Clinical Extension field to 20 [involvement of one lobe, NOS] for this case. Although the medical record did not provide a physician's staging of the case as clinically apparent, the physician did suspect carcinoma prior to the biopsy.
If clarifying stage information is missing and the term is in the "maybe" category or the term is not on the list, then code extension as 30 [localized, NOS] for cases that appear localized.
EOD-Clinical Extension--Liver: How do the segments of the liver described by AJCC Manual correspond to the lobes of the liver described by the SEER EOD Manual? See Description.
CT described hepatocellular ca involvement of the liver with nodules identified in segments 5 and 7. Would EOD-extension be coded to 30 [multiple tumors (one lobe)]?
Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes.
For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor.
Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging.
EOD Clinical Extension--Prostate: Can you assign code 15 if there is no TURP and no physical exam? See discussion.
[Code 15 = Tumor identified by needle biopsy, e.g. for elevated PSA, (T1c)]
Prostate case: Elevated PSA, Prostate u/s: no abnormal findings, Prostate biopsy: adenocarcinoma. Can this be clinically coded as 15? According to Prostate EOD Coding Guide (6/2001), code 15 requires documentation that the physical exam was negative, but in this case, we have no physical info.
For cases diagnosed 1998-2003:
Code the EOD Clinical Extension field to 30-34 when there is no documentation saying that the physical examination was negative.
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