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Report Produced: 02/27/2026 05:36 AM

Report Question ID Question Discussion Answer Year
20031093

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.

 2003
20031102

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.

 2003
20031096 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." 2003
20031196 EOD-Pathological Extension--Prostate: How is this field coded when biopsy findings differ from prostatectomy findings? See Description. Needle biopsy of prostate clearly states cancer arising in the apex. Clinical extension would then be 33. After prostatectomy, the path report states only one lobe involved with cancer and the apex was negative for cancer. Would the pathological extension then be coded to a 20 to truly reflect the surgical findings? For cases diagnosed 1998-2003: Combine the information from the needle biopsy and the prostatectomy and code the pathologic EOD to 34 [Extending to the prostatic apex]. The case example above is very similar to Example 4 on page 2 of the Prostate EOD Coding Guidelines. 2003
20031184

Surgery of Primary Site--Breast: How is this field coded when a patient has a reduction mammoplasty (for macromastia) and within the pathology specimen there is an incidental finding of carcinoma?

Code this reduction mammoplasty to the code which best fits the amount of tissue removed. Read the operative report carefully. Code as a partial mastectomy, skin- nipple- areola-sparing mastectomy, or total (simple) mastectomy. Use text fields to record the details.

 2003
20031116

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.

 2003
20031144 Histology (Pre-2007)--Breast: What code is used to represent the histology "Ductal carcinoma in situ; 6 mm focus of invasion is a pure mucinous carcinoma that appears to have arisen in the background of encysted papillary carcinoma."

Code to mucinous (8480) since that is the only clearly invasive component of this diagnosis.

According to our pathologist consultant, "Encysted papillary carcinoma is the same thing as intracystic papillry carcinoma, which I think of as an intraductal papillary carcinoma which has greatly expanded the duct to form a cyst-like structure. It generally behaves in an in-situ rather than an invasive fashion. The only clearly invasive component is the mucinous carcinoma, which is what I would code."

 2003
20031079 Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description.

We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall.

Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla".

Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9.

According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung].

 2003
20031092

Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: How is the histology of invasive small cell carcinoma of lobular histogenesis coded?

Could high grade ductal carcinoma in situ, comedo type be a recurrence of ductal carcinoma diagnosed 18 years earlier?

Is "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" one or two primaries? See Description.

 A patient was diagnosed in 1984 with 1st breast primary, histology was ductal carcinoma, T1N0, LIQ left breast. In 2002 a mass was found on mammogram, MRM with axillary sampling performed. Histology was invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type, nuclear grade 3/3, T2N1, UOQ left breast. Is the ductal carcinoma in situ recurrent disease from the 1st primary? Does it go with the lobular histogenesis, i.e., lobular carcinoma and DCIS histology code 8522/3 or is the ductal in situ a 3rd primary?

For tumors diagnosed prior to 2007:

According to our pathologist consultant:

Invasive small cell carcinoma of lobular histogenesis appears to be an unusual histology for a breast primary. Code it as such 8041 [Small cell carcinoma, NOS].

The 2002 lesion is most likely a new primary since the previous lesion was 18 years ago, in a different quadrant, and invasive. A comedo DCIS would probably not be asymtomatic for 18 years; an unlikely "recurrence" of an earlier ducal carcinoma.

Code "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" as two primaries. Code the small cell as a separate primary (8041/3), and the DCIS separately (8501/2).

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
20031182 Date of Diagnosis/Diagnostic Confirmation: How are these fields coded when a physician statement of diagnosis predates a positive biopsy? See Description. A mass seen on EGD with negative biopsy 12/28/01. Needle core biopsies 1/14/02 were diagnostic of GIST. Gleevec treatment was initiated 2/02, and in discharge summary 5/27/02, the physician says the GIST was diagnosed on EGD. Code the date of diagnosis as 01/2002. Code the diagnostic confirmation as positive histology. EGD revealed a "mass." Biopsies of the "mass" seen on EGD were negative before January 2002. 2003