Reportability/Behavior--Hematopoietic, NOS: Is a "myelodysplastic/myeloproliferative disease, unclassifiable" coded to 9975 with a behavior code of 3 as indicated in the WHO blue book on "Tumours of Haematopoietic and Lymphoid Tissues" or is it not abstracted because it has a behavior code of 1 which means the case is not reportable?
For cases diagnosed prior to 1/1/2010:Code MDS/MPD U to 9975/3 [Myelodysplastic/myeloproliferative disease, unclassifiable]. Change the behavior code to /3 according to ICD-O-3 Rule F. The case is reportable.
The WHO book is more recent and gives a specific code for this new hybrid category of the WHO/REAL classification.
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.
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
CS Extension/CS Mets: For primary sites within the peritoneum (abdominalpelvic walls) such as stomach, colon, does the presence of malignant ascites affect the coding of CS Extension or CS Mets?
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.
The Collaborative Staging system is governed by site-specific coding rules. Refer to each set of site rules rather than looking for a general answer for all sites in peritoneum. In particular, Ovary and Corpus allow malignant ascites to be coded in CS Extension, but not CS Mets at Dx. For each site, both CS Extension and CS Mets at Dx should be checked for the proper field to code malignant ascites.
CS Tumor Size--Breast: Should this field be coded to 999 [Unknown] or 008 [0.8 cm tumor] when the tumor size is not provided on a stereomammotomy biopsy for an in situ malignancy and a subsequent excision demonstrates 0.8 cm tumor of residual in situ disease?
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 tumor size 008 [0.8cm]. A mammotomy specimen is very small, so for this case, the residual tumor size is quite accurate. Size is not a critical data element for in situ breast cancer.
Reportability--Ovary: Is an "aggressive adult granulosa cell tumor with one of two lymph nodes positive for metastatic granulosa cell tumor" reportable?
Malignant granulosa cell tumor is reportable. The case described above is malignant as proven by metastasis to the lymph node.
Date of Diagnosis/Histology--Hematopoietic, NOS: How are these fields coded if a 3/17/03 bone marrow biopsy diagnosis of "malignant proliferative disorder" is subsequently confirmed to be a "low grade lymphoma" per a bone marrow biopsy in early 2006? See Discussion.
3-17-03: Bone marrow biopsy from rt iliac crest: Hypercellular marrow (90%) with extensive involvement by lymphoproliferative disorder (see description). Micro: The bone marrow is diffusely (>90%) involved by a malignant lymphoproliferative disorder. This consists of small lymphocytes,histiocytes, and large atypical cells with prominent nucleoli.
12-22-05 Extensive bone marrow involvement by lymphoproliferative disorder, bone biopsy from femur.
1-27-06 Hem/Onc Physician Note:
following pt for a lymphoproliferative disorder. ...bone marrow biopsy 2003, suggestive of, but not truly diagnostic, a lymphoproliferative disorder. Therefore, I elected not to do anything, but just follow her.
3-23-06 Hem/Onc Note:
pt with a history of an apparently low-grade lymphoma involving the marrow, as well as, I believe, the liver and recently pathologically diagnosed as a T-cell-rich B-cell lymphoma. ...followed in the past by Dr. ___ and has never actually had any treatment for this lymphoma, although it is documented even three years ago by bone marrow biopsy.
For cases diagnosed prior to 1/1/2010:
Code the diagnosis date to 3/17/03. The histology code is 9970/3 [Malignant myeloproliferative disorder]. The bone marrow biopsy confirms a "Malignant" lymphoproliferative disorder. Apply ICD-O-3 rule F and assign /3 to histology code 9970.
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.
Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
First Course Treatment--Lymphoma: Should the use of proton pump inhibitors be coded as treatment for lymphoma primaries in patients with H Pylori?
No, do not code proton pump inhibitors as treatment. These are used for gastric acid suppression. Proton pump inhibitors are used to treat symptoms, not the lymphoma itself.
Reportability--Anus: Is a final diagnosis on a pathology report of "squamous cell carcinoma of the anus, NOS" assumed to be a skin of anus primary or a primary of the anus?
Squamous cell carcinoma of the anus is reportable unless known or stated to be skin of anus.
Diagnostic Confirmation--Leukemia: How is this field coded when the clinician confirms that the diagnosis of CML is based on a combination of the clinical picture and positive cytogenetic studies?
Assign code 1 [Positive histology]. For leukemia only, assign code 1 for positive hematologic findings including peripheral blood smears, CBCs and WBCs.
Cytogenetics studies would have been done on blood. Therefore, histology provided diagnostic confirmation as it would with smear, bone marrow, or other special study of blood cells.
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