Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are coded and what code(s) is/are used to represent the histology "invasive ductal carcinoma with extensive spindle metaplastic change [metaplastic carcinoma] with a second, separate, tumor "invasive ductal carcinoma, moderately differentiated with extensive associated DCIS"? See Description.
The comment on the pathology report states, "due to the associated DCIS this smaller lesion is felt to most likely represent a synchronous second primary." Is this two primaries, one coded 8575/33 and the other coded 8500/32 or is this a single primary with a combination code -- 8523/33?
For tumors diagnosed prior to 2007:
Abstract as two breast primaries. Code to 8575/33 (metaplastic carcinoma) and 8500/32 (infiltrating duct carcinoma). There are two lesions with different histologic types.
Do not use code 8523 to combine separate tumors with different histologies.
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.
EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description.
Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]?
For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall.
Other Therapy/Immunotherapy--Hematopoietic, NOS: How should erythropoietin be coded for leukemia or other hematopoietic diseases?
Do not code Erythropoietin as treatment, it is used as an ancillary drug for leukemias or other hematopoietic diseases. Record information about erythropoietin in the text field.
EOD-Extension--Thyroid: Is this field coded as involvement of the thyroid capsule if the thyroidectomy path specimen reveals papillary thyroid ca "tumor present within capsular blood vessels?"
For cases diagnosed 1998-2003: Tumor present within the blood vessels of the thyroid capsule is localized (extension code 30). The tumor has not penetrated the capsule itself if it is contained within the blood vessels.
Keep in mind that tumor size determines the extent of disease for thyroid extension codes 10, 20, 30 and 40.
EOD-Pathologic Review of Number of Lymph Nodes Positive and Examined: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Description.
A breast cancer patient had a FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases.
Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection.
Example 2: Patient received no neoadjuvant therapy.
For cases diagnosed 1998-2003, the number of Regional Nodes Positive and Examined include all nodes examined by the pathologist, unless there is disease progression. In other words, these fields are cumulative. An FNA alone, positive for regional lymph node metastasis is coded as 97 for number positive and 95 for number examined. 1 & 2. Assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Case example: Code number of regional nodes positive as 01, number examined as 07.
Primary site--Melanoma: Should melanoma of the nipple be coded to C50.0 [Nipple] or C44.5 [Skin of the trunk]?
Code to C44.5 [skin of trunk]. External melanoma is an epidermal malignancy, beginning in melanocytes in the basal layer of the epidermis. C50.0 excludes skin of breast.
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.
First-Course of Cancer-Directed Therapy Fields/Hematopoietic, NOS: How do you code treatment for a myelodysplastic syndrome when a patient is admitted to receive a "second transfusion 7 months after diagnosis"?
The first course of treatment for these hematopoietic primaries lasts until there is a treatment change. For the case you cite the second transfusion (7 months after diagnosis) would be first course treatment. Code the Other Cancer-Directed Therapy Field to 1 [Other cancer-directed therapy].
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.
EOD-Size of Primary Tumor--Prostate: Is this field coded to the size of a hypoechoic mass identified on a TRUS when there is no tumor size from the prostatectomy specimen?
For cases diagnosed 1998-2003: Ultrasound measurement of a malignancy can be used to code EOD-Size of Primary Tumor. Information on tumor size taken from imaging/radiographic techniques has low priority, just above physical examination.
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