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Report Produced: 07/21/2024 18:12 PM

Report Question ID Question Discussion Answer Year
20031207 Hormone Therapy--Hematopoietic, NOS: Is hormonal therapy coded for myelodysplastic syndrome, NOS? See Description. Patient with myelodysplastic syndrome refused chemotherapy and was treated with high dose steroids. Patient also received Rituxan. Hormones, such as glucocorticoids and androgens, are generally of little if any benefit to patients with myelodysplastic syndrome, according to the NCI PDQ. Do not code steroids as treatment in the example above. 2003
20031055

Histology (Pre-2007)/Primary Site/Diagnostic Confirmation: How would these fields be coded for a diagnosis of cholangiocarcinoma based on clinical findings only? See Discussion.

We have a case of reported "cholangiocarcinoma" of the liver diagnosed only by a CT of the abdomen. There is no pathologic confirmation. CT ABD: Heterogeneous liver mass suspicious for cholangiocarcinoma; mass causes right portal & right hepatic vein occlusion & right and left biliary duct dilatation....

Should this be coded to cholangiocarcinoma by radiology alone and should it be liver as primary site?

For tumors diagnosed prior to 2007:

Code according to the prevailing medical opinion in this case. If no further information can be obtained, code as cholangiocarcinoma of the intrahepatic bile duct.

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.

 2003
20031193 Surgery of Primary Site--Lung: Is a core-out of the main bronchus coded in this field? See Description. Patient with right lung cancer was not a surgical candidate because of extent of disease. Prior to receiving radiation, patient underwent bronchoscopy, which revealed obstruction from right main bronchial tumor. Core-out of the tumor was undertaken, and a specimen was sent for path evaluation. The physician stated that this was a palliative procedure to relieve obstruction.

Do not code bronchoscopy to clear the airway as surgery of primary site. When combined with laser therapy, cryosurgery, or other tumor destruction, or when combined with excision of tumor, code as surgery of primary site.

For cases diagnosed 1998-2003: Code surgery of primary site for the case described above to 23 [Excision, NOS]. Tissue was excised and sent to pathology.

 2003
20031138 EOD-Size of Primary Tumor--Testis: Should this field be coded to the gross pathological size when the pathology states "tumor dimension essentially the same as testicle, but is not appropriate in this case because the infiltrate does not form a mass lesion"? See Description. Gross describes a testicle that measures a 4cm. Path micro states "several large atypical cells...These never form a true mass. Path comment states, "tumor dimension essentially the same as testicle, but is not appropriate in this case because the infiltrate does not form a mass lesion." For cases diagnosed 1998-2003: Code the tumor size as 999 [Not stated] for the case example above. Keep in mind that tumor size is not used in analysis for certain sites such as testis, stomach, colon & rectum, ovary, prostate, and urinary bladder. Tumor size is important for analysis for certain sites such as lung, bone, breast, and kidney. 2003
20031129 Primary Site: How is this field coded for cholangiocarcinoma involving the intrapancreatic bile duct? Code the primary site as C24.0 [Extrahepatic bile duct, includes Common bile duct] for a cholagiocarcinoma originating in the common bile duct. A portion of the common bile duct is within the head of the pancreas: The intrapancreatic segment of the common bile duct. 2003
20031016

Surgery of Primary Site--Head & Neck: Will you clarify the use of code 20 [local tumor excision, NOS] versus code 27 [excisional biopsy] when there is no clinical description of a tumor and the pathology report describes more than one specimen from surgery performed on the vocal cords? See discussion.

Specimen A is labeled vocal cord biopsy. Specimen B is labeled left true vocal cord nodule. For specimen B the gross portion of the pathology report describes a .5 cm tissue portion. Is the term "nodule" enough information to code this as an excision? Can we code site specific surgery to code 20 or 27?

Code 20 [local tumor excision, NOS] based on information from the size and description of the specimen.

 2003
20031015 EOD-Extension--Lymphoma: How is the following guideline of "any mention of lymph nodes is considered indicative of involvement" applied for EOD-Extension of lymphoma cases when there is a discrepancy between physicians as to the stage at diagnosis? See discussion. A biopsy of mesenteric nodes confirmed lymphoma. A bone marrow biopsy was negative. A CT of the chest indicates "small mediastinal and bilateral hilar nodes, but without convincing adenopathy." The case was Stage 2 per the oncologist and Stage 3 per the surgeon's TNM form.

For tumors diagnosed 1998-2003:

Based on the information provided for this example, the lymphoma involves one site, mesenteric nodes. Code EOD extension as 10 [Involvement of a single lymph node region].

The statement "For lymphomas, any mention of lymph nodes is indicative of involvement" refers to the terms in the paragraph above it on page 8 of the EOD manual: Palpable, enlarged, visible swelling, shotty, lymphadenopathy. While these terms are ignored for other malignancies, they should not be ignored for lymphomas. None of these terms apply to the example provided here. According to the CT, the mediastinal and hilar nodes are "small" "without convincing adenopathy." In other words, the mediastinal and hilar nodes are negative.

 2003
20031035 Reportability/Histology--Hematopoietic, NOS: Does the presence of sideroblasts on a bone marrow biopsy confirm a diagnosis of refractory anemia with sideroblasts?

Final path diagnosis of bone marrow biopsy:

I. Hypercellular marrow for age with trilinear hyperplasia.

II. Decreased iron stores with decreased sideroblasts.

Comment: Although the overall picture is not diagnostic of a specific entity, it is most consistent with an early stage myelodysplastic syndrome which would best be considered refractory anemia at this point.

In this case the percentage of sideroblasts is not stated. Would the path diagnosis of "decreased sideroblasts" along with the path comment of "refractory anemia" indicate that this case should be coded to 9982/3 [Refractory anemia with sideroblasts]?

For cases diagnosed prior to 1/1/2010:

For the hematologic diseases, do not accession the case unless there is a definite positive diagnosis. A positive diagnosis, such as "Refractory anemia" must be stated in order to code that diagnosis. Other words associated with the positive diagnosis, such as "sideroblasts" are NOT to be used alone to assume a diagnosis.

Decreased sideroblasts does not make a diagnosis of Refractory anemia with sideroblasts. The sideroblasts for 9982/3 [Refractory anemia with sideroblasts] are characteristic in rings, and are INCREASED to make the diagnosis.

Based on the information provided, this case is not reportable. The final path diagnosis is not a reportable disease. The comment further states that the overall picture is not diagnostic of a specific entity. Therefore, it should not be reported at this point.

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.

2003
20031204 Surgery of Primary Site--Breast: How is this field coded for cryosurgery of the breast?

For cases diagnosed 2003 and later: For cryosurgery alone, without a pathology specimen, assign site-specific surgery code 19 [Local tumor destruction, NOS]. Cryosurgery, cryotherapy or cryoablation uses extreme cold to destroy the tumor cells.

If a specimen is sent to pathology use code 20 [Partial mastectomy, NOS] rather than code 19.

If cryosurgery is followed by further surgery, do not use code 19.

 2003
20031148 EOD-Systemic Symptoms at Diagnosis--Lymphoma: Would the description, "three days of typical cold symptoms including congestion, sneezing, chills and advanced difficulty breathing and some fever" qualify as B-Symptoms?

For cases diagnosed 1998-2003:

Use the following criteria to determine whether or not certain clinical findings qualify as "B" symptoms.

1. Fevers. Unexplained fever with temperature above 38 degrees C.

2. Night sweats. Drenching sweats that require change of bedclothes.

3. Weight loss. Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to diagnosis.

Pruritus alone does not qualify for B classification, nor does alcohol intolerance, fatigue, or a short, febrile illness associated with suspected infections.

The clinical description in the example above does not meet the criteria for B symptoms. Generally, the symptoms in the B category have to occur over an extended period of 7 to 30 days. In this case the fever is explained by "typical cold symptoms" and in addition, three days of fever is not a long enough period.

 2003