CS Extension--Hematopoietic, NOS: Can this field be coded to 10 [Localized disease] for an extramedullary plasmacytoma that is limited to an extramedullary primary, such as appendix, given that this histology is not listed as one of the allowable histology/CS extension combinations for this code? See Discussion.
The Hematopoietic Diseases scheme for CS lists specific histologies for which CS Extension can be coded to 10. Included is plasmacytoma, NOS [9731/3]. However, extramedullary plasmacytoma [9734/3] is not listed as one of the histologies.
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 code 10 [Localized disease].
Both the 2007 SEER manual (page C-1072) and the CS Version 01.04.00 manual (page II-550) have been updated to include 9734 [extramedullary plasmacytoma] under extension code 10.
CS Site Specific Factor--Colon: If the patient has a polypectomy followed by definitive surgery, can a higher CEA reported after the polypectomy but before the colon resection be coded?
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.If the tumor was in the polyp, do not use the post-polypectomy CEA even if it is higher than CEA's prior to the polypectomy. In this situation, the polypectomy would be treatment.
Conversely, if this is a frank adenocarcinoma or the tumor was so invasive that the polyp removed only a portion, use the post-polypectomy CEA because the polypectomy would not be treatment in this situation.
Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
Multiple Primaries (Pre-2007)--Head & Neck: How many primaries are abstracted if a patient has bilateral involvement of tonsils with the same histology (e.g. squamous cell carcinoma)? See Discussion.
Patient was initially found to have mass on right tonsil. Biopsy of right tonsil on June 16 showed invasive carcinoma, favor squamous cell. On July 17 patient underwent right neck dissection, radical resection of right tonsil tumor and left tonsillectomy. Right tonsil showed squamous cell carcinoma, poorly differentiated. Left tonsil showed squamous cell carcinoma, poorly differentiated. Microscopic report stated: Right tonsil: Invasion of deep peritonsillar tissue and skeletal muscle. Sections of left tonsil demonstrate squamous cell ca focally distributed in the tonsil, predominantly in situ, but with focal microscopic invasion. Path staged each tonsil specimen. Right tonsil was T2N1. Left tonsil was T1Nx.
For tumors diagnosed prior to 2007:
Code as two primaries. Squamous cell carcinoma diagnosed in both left and right tonsils are multiple primaries unless one is stated to be metastatic from the other.
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.
CS Extension--Head & Neck: If a 2 cm left tonsil primary extends to the lateral aspect of the soft palate, should extension be coded to 40 [Soft palate, inferior surface including uvula or soft palate NOS] or 42 [Soft palate, superior (nasopharyngeal) surface] for a tonsil primary?
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.
Extension code 40 is for extension from the tonsil to the back (lower) part of the soft palate, or soft palate, NOS. Code 42 is for extension to the front (higher, nasopharyngeal surface) part of the soft palate.
Inferior soft palate is the back (lower) part of the soft palate (C051). Superior soft palate is the front, (nasopharyngeal surface) of the soft palate (C113).
2004 SEER Manual Errata/CS Lymph Nodes--Head & Neck: On page C-353, in the supraglottic larynx schema, there is no mention of Level IV nodes in the CS Lymph Node codes.
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 CS Steering Committee is aware of this issue and is working to resolve it.
Reportability--Colon: Is a pathologically confirmed "tubulovillous adenoma with high grade dysplasia" reportable if clinical diagnosis at the time of the subsequent re-biopsy states "follow-up for colon polyps with ca in situ"? See Discussion.
SINQ 20000245 states that high grade dysplasia is not synonymous with behavior code 2 (in situ). However, the 2004 SEER manual states that "cases clinically diagnosed are reportable. If the physician treats a patient for cancer in spite of the negative biopsy, accession the case."
A pathologic diagnosis has priority over a clinical diagnosis. According to the pathologist, this case is not reportable. A re-biopsy is not treatment.
Histology (Pre-2007)--Melanoma: How is a "plaque-like nodular spitzoid malignant melanoma" coded?
For tumors diagnosed prior to 2007:
Code histology to 8721 [nodular melanoma]. Essentially, "plaque-like nodular spitzoid malignant melanoma" is nodular melanoma. Code 8721 is the most specific ICD-O-3 histology code available for this diagnosis.
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.
Multiple Primaries--Lymphoma: Is a diagnosis of mycosis fungoides followed a year later with a biopsy proven diagnosis of anaplastic large T-cell lymphoma stated to represent a transformation of the previous mycosis fungoides reportable as one or two primaries?
For cases diagnosed prior to 1/1/2010:
This is one primary. Code the histology according to the original diagnosis, mycosis fungoides. The physician states that this one disease process started as mycosis fungoides and progressed into lymphoma. A physician's statement has priority over other sources in determining the number of hematopoietic primaries.
In October 2006, a committee will begin working on multple primaries among hematopoietic diseases. The committee will provide further guidance on dealing with disease transformation and other issues.
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.
Surgery of Primary Site--Lung: Is this field coded to 30 [Resection of lobe or lobectomy] or 33 [Lobectomy with mediastinal lymph node dissection] when a lobectomy specimen includes 2 AP window lymph nodes? See Discussion.
LUL lobectomy: 1.7cm apical tumor, DX=mod well diff subpleural SCC, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0.
1. No lymph node dissection or sampling was stated to be done
2. The lobectomy specimen contained the LNs
3. Scope of regional LN surgery is coded
Would the surgery to primary site code 30 or 33?
Code surgery of primary site to 30 [Resection of lobe or lobectomy]. According to the information provided, there was no lymph node dissection in this case. The 2 AP window nodes were obtained as part of the lobectomy specimen.
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