Grade, Differentiation/Priorities: Which has priority, the differentiation or the nuclear grade for a liver biopsy histology described as "well differentiated hepatocellular carcinoma, nuclear grade 3/4"?
For most sites, differentiation has priority over the nuclear grade when both are specified (excluding breast and kidney). Assign grade code 1 [well differentiated] to the example above.
Reportability--Lung: Is sclerosing hemangioma of the lung with multiple regional lymph nodes metastases reportable?
No, it is not reportable. According to the WHO Classification of Lung Tumours, sclerosing hemangioma "behaves in a clinically benign fashion...Reported cases with hilar or mediastinal lymph node involvement do not have a worse prognosis."
Histology (Pre-2007)--Melanoma: How is a 2004 "malignant melanoma, nodular type, epithelioid cell type" coded?
For tumors diagnosed prior to 2007:
Assign code 8771 [Epithelioid cell melanoma]. Code the cell type when specified.
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.
Chemotherapy/Immunotherapy: How do we code Rituxan for Non-Hodgkin Lymphoma and Herceptin for breast cancer? See Discussion.
Page 195 of the SEER Manual 2004 lists these as examples of Immunotherapy. The new SEER*Rx categorizes these as chemotherapy.
(Sinq # 20041025 says to code Avastin and Erbitux as chemotherapy, too.)
Code Rituxan and Herceptin as chemotherapy.
SEER*Rx is effective for cases diagnosed 1-1-2005 and forward. It replaces all previous references. Be sure to use SEER*Rx [http://seer.cancer.gov/tools/seerrx/]
because some agents changed categories when SEER*Rx was deployed.
It is neither required nor recommended that cases treated prior to 2005 be recoded.
Histology/Reportability--Hematopoietic, NOS: Is "drug induced" myelodysplastic syndrome synonymous with "therapy related" myelodysplastic syndrome? If so, would "drug induced" myelodysplastic syndome be SEER reportable and coded with the histology 9987/3?
Page 44 of the "Abstracting & Coding Guide for the Hematopoiectic Diseases" lists this histology & behavior with the proper EOD code to use but yet on page 36 it states "Do not accession the following diagnoses coded to 285.0 and lists secondary SA as well as drug-induced SA.
For cases diagnosed prior to 1/1/2010:
There is considerable difference between therapy-related myelodysplastic syndrome (MDS) and drug-induced sideroblastic anemia (SA).
Therapy-related MDS is the result of irreversible damage to the bone marrow caused by certain kinds of myelotoxic drugs used to treat cancer. Examples are Cytoxan and Etoposide. There is usually a 10+ year delay between the first primary and its treatment and the therapy-related MDS. Therapy-related MDS is not reversible and is reportable as a malignancy. Because the drugs were almost always given to treat a malignancy, therapy-related MDS is almost always a second primary.
Drug-induced SA is not reportable as a malignancy. Drug-induced SA is the result of short term effects of certain drugs on the bone marrow. Drug-induced SA is reversible, as the marrow recovers once the drugs are out of the system.
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.
Chemotherapy--Breast: In the absence of more specific information, is the insertion of a port-a-cath one month after mastectomy enough documentation to code chemotherapy to 88 [Recommended]?
Assign chemotherapy code 88 [Chemotherapy was recommended, but it is unknown if it was administered]. Be sure to confirm whether or not treatment was administered and update this code accordingly.
Histology (Pre-2007)--Ovary: What codes are used to represent "mixed papillary serous and clear cell carcinoma" and "papillary serous carcinoma with focal clear cell features" of the ovary?
For tumors diagnosed prior to 2007:
Assign code 8323 [Mixed cell adenocarcinoma] to "mixed papillary serous and clear cell carcinoma." This is histology coding rule 3 in the 2004 SEER manual under single tumor (page 86). There is no other code for this mixture.
Example 1: 8323
Example 2: 8461 (clear cell is not coded according to Rule 6, page 87, because it is not the majority of the tumor).
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.
Priorities/CS Tumor Size--Breast: What is the priority order used in coding tumor size for this site when there is a larger 2 cm lesion noted on the PET scan and smaller sizes described in the pathology report as two malignant masses one measuring 0.8 cm and the second measuring 1.0 cm per the GROSS?
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 as 1.0 cm. The pathology report is the highest priority source for coding tumor size. When multiple tumors are present, code the size of the largest tumor.
Reportability/Recurrence (Pre-2007)--Bladder: If a patient has had recurrent invasive bladder cancers since 1971, should the latest recurrence in 2003 be SEER reportable because the case has yet to be reported to SEER?
For tumors diagnosed prior to 2007:
Because this 2003 recurrent bladder cancer was initially diagnosed prior to 1973, it is not reportable to SEER.
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/CS Mets at Dx--Pineal Gland: In Collaborative Stage, how is positive cerebral spinal fluid 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.Assign CS Mets at DX code 40 [Distant metastases] for a pineal gland primary with positive cerebral spinal fluid.
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