CS Extension/EOD Extension--Renal Pelvis: Primary site is renal pelvis with direct extension to the rt adrenal gland. What is the correct extension code?
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 Extension code 67 [Adrenal gland from renal pelvis] for adrenal extension from renal pelvis -- T4 and regional direct extension.
Histology (Pre-2007)--Corpus Uteri: How should this field be coded when the D&C which shows "adenocarcinoma with mucinous and papillary features" and the TAH demonstrates only "endometroid carcinoma"? See Discussion.
Should Histology be coded to 8380 [endometroid adenocarcinoma] because it is the most representative sample or to 8323 [mixed cell adenocarcinoma], per the Complex Morphology Coding Guidelines? The instructions in the Guidelines seem to imply that it is most important to represent combination histologies first, with majority (most representative sample) of tumor having a lower priority.
For tumors diagnosed prior to 2007:
Code Histology based on the pathology report from the most representative tissue. For the example above, code Histology to 8380 [Endometroid adenocarcinoma] based on the TAH/BSO pathology report.
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--Ovary/Peritoneum: Should this field be coded to ovary or peritoneum when the bulk of the tumor is in the peritoneum and there is only surface involvement of the ovary?
If it is not clear where the tumor originated, use the following criteria to distinguish ovarian primaries from peritoneal primaries.
The primary site is probably ovarian, unless:
--Ovaries have been previously removed
--Ovaries are not involved (negative)
--Ovaries have no area of involvement greater than 5mm.
Descriptions such as "bulky mass," "omental caking" probably indicate an ovarian primary.
Descriptions such as "seeding," "studding," "salting" probably indicate a peritoneal primary.
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.
Multiple Primaries (Pre-2007): Is a small bowel carcinoid diagnosed 10 years after the diagnosis of metastatic carcinoid of unknown primary site a new primary or a new recurrence? See Description.
A patient was diagnosed in 1991 with metastatic carcinoid to liver-no primary found. In 2001, the patient is diagnosed with small bowel carcinoid at another hospital. Hospital 2 has no other information.
For tumors diagnosed prior to 2007:
Code as two primaries unless there is a physician's statement that the liver lesion is metastatic from the later small bowel carcinoid. Without such a statement regarding lesions 10 years apart, do not make an assumption that one is metastatic from the other.
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.
Histology (Pre-2007)--Lung: Should the histology "Polymorphic Adenocarcinoma" be coded to 8022/33 [Polymorphic Carcinoma] or 8140/33 [Adenocarcinoma, NOS]?
For tumors diagnosed prior to 2007:
The histology code for pleomorphic adenocarcinoma of the lung is 8140 [Adenocarcinoma, NOS]. According to our pathologist consultant, "Given lung as primary site I prefer 8140. This loses the pleomorphic modifier, but going to 8022 loses the adeno- designation which is more important. Pathologists occasionally use pleomorphic carcinoma for lung tumors which otherwise dont show any adeno or squamous differentiation, for which 8022 would be appropriate, but in this case we do have the adeno designation."
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.
Grade, Differentiation--Hematopoietic: Is this field coded to 6 [B-cell] from a flow cytometry that specifies the percentage of B-cells that exist within the percentage of lymphoid cells in the bone marrow biopsy? See Description.
Bone marrow biopsy, Final path diagnosis: consistent with small lymphocytic lymphoma/chronic lymphocytic leukemia. Comment: flow cytometry analysis was performed on bone marrow aspirate. The gated population of lymphoid cells comprises approximately 19% of total nucleated cells. Of these, 53% are B-cells which express CD19, CD22. These findings are consistent with the above diagnosis.
For cases diagnosed prior to 1/1/2010:Yes, assign code 6, B-cell. The flow cytometry analysis confirms B-cell.
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/Histology (Pre-2007)--Unknown & ill-defined site: How are these fields coded for a markedly atypical high grade malignant neoplasm diagnosed by a fine needle aspiration of a large iliac mass, right buttock area? See Description.
The diagnosis was made in Oct. 2002 by a CT guided fine needle aspiration of a large iliac mass, right buttock area. The cytology report says:
a. positive for malignant cells, markedly atypical high grade malignant neoplasm.
b. It is impossible to tell from this aspiration biopsy whether or not this represents a high grade sarcoma or a high grade carcinoma, but our consensus opinion is that this lesion is a high grade carcinoma.
The combination of soft tissue topography and carcinoma morphology is Impossible by SEER edits. How should we code this?
For tumors diagnosed prior to 2007:
Code the site to C76.3 [Pelvis, NOS]. Code the histology to 8010/34 [Carcinoma, NOS, high grade].
Unless there is better information available regarding the site, assign C76.3. The information provided above does not indicate the exact site of the mass.
Code the histology based on the consensus opinion stated above.
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.
Radiation: How would this field be coded for treatment with quadramet [radioactive samarium]? See Description.
Paitent is receiving quadramet for treatment of lung metastases.
Code Quadramet in the RX Summ-Radiation field as 3 [Radioisotopes]. Quadramet is a radioisotope used to palliate bone pain. The instructions in the SEER manual state: "Record all radiation that is given, even if it is palliative."
EOD-Size of Primary Tumor: Can the term "filling defect" be used to code tumor size? See Description.
Site: Bladder
CT abd/pelvis: 4 cm filling defect of the bladder encasing jetstream of distal ureter. 2-3 cm lesion may be extension to bladder. KUB: 3-4 cm filling defect within bladder.
Cystoscopy: large bladder tumor with small tumor extending out of the large tumor.
OP Findings: Large tumor on right of bladder extending from bladder neck lateral and posterior
Pathology: TURB: High grade TCC, Grade III with focal lamina propria invasion.
For tumors diagnosed 1998-2003:
Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, just above a physical exam.
The term "filling defect" from a CT or KUB may be used to code tumor size for bladder in the absence of more reliable size information from path, operative or endoscopic reports.
An official website of the United States government
Home