Histology (Pre-2007): What code is used to represent the histology "poorly differentiated invasive transitional cell carcinoma with extensive squamous and focal glandular differentiation"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8120/33 [transitional cell carcinoma, NOS, poorly differentiated]. The ICD-O-3 does not have a separate code for transitional cell carcinoma with squamous and/or glandular differentiation.
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.
Scope of Regional Lymph Node Surgery--Breast: How should this field be coded when a mastectomy that removed 3 sentinel lymph nodes is later followed by an axillary lymph node dissection that removed 17 lymph nodes? Should all of the lymph node information be coded to this field, even though the Number of Regional Lymph Nodes Examined field will be coded to the number of lymph nodes from the most definitive surgery (17)?
For cases diagnosed 1/1/2003 and after: Yes, all of the lymph node information should be coded to the Scope of Regional Lymph Node Surgery field using code 7 [Sentinel node biopsy and code 3, 4, or 5 at different times].
The Number of Regional Lymph Nodes Examined field no longer exists for this time frame.
Grade, Differentiation--All Sites: What code is used to represent this field when a pathology report describes a tumor as a low grade neoplasm consistent with a specific histologic type (e.g., Low grade neoplasm consistent with carcinoid)?
Code the Grade, Differentiation field to 2 [Low grade].
Primary Site/Histology (Pre-2007): What codes are used to represent site and histology for BSO specimen with a diagnosis, "Left and right adnexa: poorly differentiated serous carcinoma. Comment: The carcinoma occurs as multiple nodules within adnexal soft tissues. Direct involvement of ovaries is not seen, supporting an extraovarian origin." See discussion.
Per our pathologist consultant, the site should be pelvic peritoneum [C481] and the histology is primary serous papillary carcinoma of peritoneum [8461/3]. Does SEER agree?
For tumors diagnosed prior to 2007:
Code the Primary Site to C481 [Specified parts of peritoneum] and the Histology field to 8461/3 [primary serous papillary carcinoma of peritoneum].
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.
EOD-Extension/EOD-Lymph Nodes--Testis: If the patient received chemo, should "bulky retroperitoneal adenopathy" be coded as involved lymph nodes in the EOD lymph node involvement field for a testicular primary treated with an orchiectomy that rendered a path diagnosis of "seminoma confined to the testicle"? See discussion.
Per an orchiectomy path diagnosis a seminoma was confined to the testicle. The only other workup, other than a scrotal ultrasound, was a staging CT scan that revealed bulky retroperitoneal adenopathy in abdomen and pelvis, as well as mediastinal adenopathy. There was also a peripheral pulmonary nodule. No final clinical diagnosis or stage was provided in the chart. Following the orchiectomy the patient was treated with chemo. Should we also have coded distant site lung involvement?
For cases diagnosed 1998-2003, code the EOD-Lymph Nodes field to 9 [unknown] because "adenopathy" is not used to code lymph node involvement. The physician varied from the usual treatment for a localized testicular carcinoma, which is an orchiectomy. The physician proceeded immediately to chemotherapy as further treatment. It is not clear whether the decision to treat with chemo was based on the nodes and/or lung being involved.
Search the record for the physician's opinion regarding distant metastasis. Do not code distant involvement based on a peripheral pulmonary nodule seen on CT without further proof. If no further information is available, code the EOD-Extension field to 99.
Reportability/Behavior Code--Bone Marrow: Is T-cell large granular lymphocytic leukemia SEER reportable? Pages 102, 147, 156, 160-162 and 167 of the ICD-O-3 list it as 9831/1, but on page 17 this is listed as 9831/3.
For cases diagnosed prior to 1/1/2010:T-cell large granular lymphocytic leukemia [9831] is a very indolent form of leukemia. It was assigned a behavior code of 1 by the editors of ICD-O-3 (as noted on pages 102, 147, 156 160-162, and 167 of the ICD-O-3 manual). The table on page 17 is the World Health Organization list of hematopoietic and lymphoid tumors. WHO recognizes TCLGLL as a malignancy. The disease is infrequently symptomatic enough to be diagnosed. However, when any of the terms listed with code 9831 are described as malignant or aggressive, report to SEER as a malignancy with a behavior code of /3.
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.
Reportability--Hematopoietic, NOS: Are the terms "thrombocytosis, NOS" and "thrombocythemia, NOS" non-reportable to SEER? See discussion.
Our understanding from SEER about how to classify these types of clinical impressions for the 2001 and later reportable blood diseases is as follows: If we cannot prove that it is malignant, then we should be conservative and exclude the case for reporting to SEER.
For cases diagnosed prior to 1/1/2010:The terms "thrombocytosis, NOS" and "thrombocythemia, NOS" are not reportable to SEER.
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.
Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved?
Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.
Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).
Histology (Pre-2007): What code is used to represent the histology "non oat cell carcinoma"?
For tumors diagnosed 2001-2006:
Code the Histology field to 8046/3 [non-small cell carcinoma] if the pathologist does not provide a more specific histologic type. "Non oat cell" is a synonym for "non-small cell."
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.
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