CS Lymph Nodes--Lung: If the lymph nodes listed in codes 10 and 20 were contralateral or bilateral, and the only description was "mass", "adenopathy", or "enlargement" on mediastinoscopy or x-ray, is this field coded to 60? See Discussion.
(CS Manual page 407) Note 2: If at mediastinoscopy/x-ray, the description is "mass", "adenopathy", or "enlargement" of any lymph nodes named as regional in codes 10 and 20, assume that at least regional lymph nodes were involved.
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.
Yes. The named nodes listed in codes 10 or 20 should be coded 60 if the "mass", "adenopathy", or "enlargement" on mediastinscopy or x-ray is described as bilateral or contralateral.
Primary Site--Unknown & Ill-defined Site: What is the primary site code for multiple malignant rhabdoid tumors (extra renal) in a newborn infant?
Search for additional information on the location of the primary in this case. A tissue specimen (biopsy) is required for a diagnosis of rhabdoid. Additionaly, there should be scans describing any tumors located in sites other than the biopsy site. If the biopsy site is not assumed to be a metastatic site and is the only location of tumor, code the site of the biopsy as the primary site.
If it is not possible to obtain further information for this case, code the primary site C809 [Unknown primary site].
According to our pathologist consultant, extra-renal rhabdoid tumors have been described in organ sites (liver, GI tract, thyroid, CNS, skin, to name a few) as well as in the soft tissue. Many of the organ site tumors are multiple/multifocal, so multiple tumors in one organ do not necessarily imply metastatic disease and therefore unknown primary site.
CS Site Specific Factor--Prostate: How is SSF 6 coded for this site when there is only one Gleason number documented and the number is less than 5 (e.g., Gleasons 3)?
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 999 [unknown or no information]. Note 1 was revised in September 2006 to clarify this situation.
Note 1 states "If only one number is given and it is less than or equal to 5, code the total score to 999, unknown or no
Histology (Pre-2007)--Head & Neck: How is a "sinonasal undifferentiated carcinoma (SNUC)" coded?
For tumors diagnosed prior to 2007:
Code histology to 8020 [carcinoma, undifferentiated]. "Sinonasal" refers to anatomic location of primary site not histology.
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 Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded for a melanoma primary when melanoma is identified in lymph nodes but no primary skin tumor is found? See Discussion.
Excisional biopsy of an inguinal lymph node revealed metastatic melanoma. Multiple skin biopsies did not reveal the primary site.
Subsequent lymph node dissection of superficial inguinal nodes showed microscopic focus of malignant melanoma in subcutaneous fat adjacent to previous procedure site. No evidence of metastatic melanoma in 7 lymph nodes. Dissection of external iliac lymph nodes showed no evidence of melanoma in 5 lymph nodes.
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 Lymph Nodes 80 [Lymph nodes, NOS]. Code CS Mets at DX 00 [None]. Since it cannot be determined whether the lymph nodes are regional or distant, code CS Lymph Nodes to lymph nodes, NOS.
CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]?
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 vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability.
Primary Site--Hematopoietic, NOS: Are there any guidelines for the use of topography code C420 [blood] rather than C421 [bone marrow], or C424 [Hematopoietic system, NOS] for hematopoietic diseases other than Waldenstrom macroglobulinemia?
For cases diagnosed prior to 1/1/2010:There are no specific guidelines concerning code C420 versus C421 or C424, other than the suggested topography codes in ICD-O-3 (see Rule H). The Hematopoietic task force is in the early phases of developing guidelines for these diseases. This issue will be presented to the task force for their consideration.
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)--Breast: Is histology coded from the more representative specimen or should the combination code 8522/3 [Infiltrating duct and lobular carcinoma] be used for a case in which a right breast mass needle core biopsy revealed infiltrating ductal ca, grade III and the subsequent right mastectomy revealed a 2.3 cm lobular carcinoma?
For tumors diagnosed prior to 2007:
Code the histology using the final diagnosis on the pathology report of the procedure that resected the majority of the primary tumor. In this case, the mastectomy removed more of the tumor than the needle biopsy. The final diagnosis from the mastectomy is infiltrating lobular carcinoma. Code histology to 8520/3 [lobular carcinoma].
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.
Primary Site: What site code best reflects the final diagnosis of a metastatic "pancreatobiliary" adenocarcinoma to the liver? See Discussion.
CT showed multiple masses in the liver and lymphadenopathy in areas of gastrohepatic ligament, celiac axis, superior mesenteric and left periaortic regions. No mention of a mass in pancreas or common duct. When the term "pancreatobiliary" primary is stated in the final diagnosis, what site code should be used?
Contact the physician for clarification of the term "pancreatobiliary." If no further information can be obtained for this case, assign code C249 [Biliary tract, NOS] based on the CT findings for the specific case in this question.
When the primary is described as "pancreatobiliary" with NO FURTHER INFORMATION, assign C269.
Primary Site--Unknown & ill-defined site: Should the primary site be coded to C809 [Unknown primary site] or C761 [Thorax, NOS] if the patient died following a limited work-up that included on a cytology on pericardial fluid that was positive for poor differentiated adenocarcinoma?
Based on the information provided, code the primary site to C809 [Unknown primary site]. There is not enough information provided to suggest that the primary site is the thorax or any other location.
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