Reportability/Diagnostic Confirmation: If a diagnosis based solely on positive flow cytometry is reportable even if a bone marrow biopsy is negative, how is diagnostic confirmation coded?
For cases diagnosed prior to 2010
The case is reportable if a recognized medical practitioner says the patient has cancer.
A flow cytometry alone is not diagnostic but it may be supported by either a positive bone marrow or a clinician's statement. If the clinicians statement is based only on flow cytometry, code diagnostic confirmation to 8 [Clinical diagnosis only].
MP/H Rules/Multiple Primaries--Lung: If the biopsy for a lung primary is actually taken from a pleural mass, can the default rule "when there are several lung masses and only one lesion is biopsied, consider this a single primary" apply? See Discussion.
Scenario: A parenchymal lesion in each lung. One lung also has a pleural lesion. MD biopsies the pleural mass only and it is positive for cancer.
For cases diagnosed 2007 or later:
Do not assume the biopsy of the pleural mass is a biopsy of the lung. Apply the 2007 MP/H Lung rules to the lung tumors only. For this case, the pleural lesion would be a metastasis (outside the lung). The 2007 MP/H rules do not apply to metastatic lesions.
The 2007 MP/H Lung rules do not apply to pleura as a primary site. If the pleural lesion is primary, it should be abstracted as a separate primary.
Date of Diagnosis: Can the phrase "suspicious for a primary lung tumor" from a CT be used to code date of diagnosis? See Discussion.
Thorax CT on 4/18/05 states 'enlarged RUL nodular opacity suspicious for a primary lung tumor.' Biopsy confirmation was not done until 8/4/05 because patient declined further work-up until then. Would date of diagnoses be 4/18/05 or 8/4/05?
Code the diagnosis date 08/04/2005 based on the biopsy.
The statement "suspicious for a primary tumor" is not a clinical diagnosis of cancer or malignancy.
CS Site Specific Factor/Melanoma: How is CS SSF1 (depth of invasion) coded for a melanoma that demonstrates dermal invasion to a depth of "less than .2 mm" be coded to 999 [unknown]? See Discussion.
The path report says "superficial spreading malignant melanoma; 2 areas of papillary dermal invasion to depth of less than .2mm."
The revised CS pages include codes for "less than" a certain tumor size, but these are not included in the depth of invasion SSF. Using 999 results in an unstageable melanoma, when we know it is "less than .2mm".
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 SSF1 (depth of invasion) to 019 [.19mm]. For any case with an SSF1 code in the range of 001-100 mm, the T category will be determined using CS extension and SSF2 [ulceration]. All cases with an SSF1 code in the range of 001-100 mm will map to a T1 (either T1NOS, T1a or T1b).
Reportability/Histology: Is a case reportable if the Final Diagnosis in a pathology report indicates a non reportable diagnosis but the Diagnosis Comment on the same report indicates a non reportable diagnosis followed by a reportable diagnosis in parenthesis? See Discussion.
08/13/2007 polypectomy final diagnosis: tubulovillous adenoma with severe epithelial atypia. Dx Comment (on same path) ...atypia including focal cribriform glandular architecture (carcinoma in situ).
This case is reportable as carcinoma in situ. The histology code is 8263/2 [adenocarcinoma in situ in a tubulovillous adenoma].
According to our pathologist consultant, a "comment" in a path report is a part of the diagnosis - it often elaborates on or clarifies the diagnosis. Placing [carcinoma in situ] in the comment, even in parentheses, indicates that is the appropriate diagnosis for our purposes.
Multiplicity Counter--Breast: How should the multiplicity counter be coded for a 3.8 cm infiltrating duct carcinoma with two "satellite nodules" measuring 5 mm and 7mm that are not described as either metastases or multiple foci?
Include these nodules in the multiplicity counter because they are measured and are part of the final diagnosis on the pathology report.
MP/H Rules/Reportability/Diagnostic Confirmation--Colon: Please clarify how to code diagnostic confirmation when there is no mention of a malignant polyp in the pathology report of a familial polyposis case given this statement: "Even if you have only one malignant polyp it is a single primary if there is a diagnosis of FAP. Even if there is no mention of a malignant polyp, if there is a diagnosis of FAP you will use this rule."
For cases diagnosed 2007 or later:
In the very unlikely event of a FAP diagnosis with no malignancy, the case would not be reportable.
When FAP is diagnosed along with a colon malignancy, it is presumed that the malignancy originated in one of the numerous polyps, even if this is not explicitly stated. Use rule M3 for any colon malignancy (in a polyp, frank, or not stated) with a diagnosis of FAP and abstract as a single primary.
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?
This question was answered by the CoC:
Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.
Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
An official website of the United States government
Home