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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.
EOD-Regional Lymph Nodes--Breast: Are subpectoral nodes the same as interpectoral nodes and, therefore, regional for breast primaries?
Subpectoral lymph nodes are regional nodes for breast primaries. Subpectoral is the term generally used to describe the placement of a prosthesis during reconstruction (under/behind the pectoralis major muscle). That is the same location for interpectoral, or Rotter's, nodes.
Histology (Pre-2007): What code is used to represent the histology "PD infiltrating duct ca with focal sarcomatoid pleomorphic features?"
For tumors diagnosed prior to 2007:
Code histology as 8500/33 [Infiltrating duct carcinoma, poorly differentiated]. "Features" is a term from the list indicating a majority of the tumor, however; in this case "features" is modified by "focal" which does not indicate a 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.
Terminology, NOS/Recurrence/Multiple Primaries (Pre-2007): Is the term "residual disease" equivalent to "recurrence"? See Description.
Example 1. Patient underwent excision and re-excision of lentigo maligna in 1998. Final path showed close but negative margins. In 1999 a biopsy of a brown patch (over the scar) in the same location was done. Pathology reported residual lentigo maligna. Is the 1999 melanoma a new primary because it was diagnosed more than two months after the first melanoma and there is no mention of recurrence? Or is the term "residual" another way of saying recurrence?
Example 2. In 1999, patient underwent excisonal biopsy of intraductal carcinoma of the right breast, followed by radiation therapy. In 2000, mammogram showed calcifications in right breast. Biopsy was done with path showing residual ductal carcinoma in situ. There is no mention of recurrence. Is this one or two primaries?
For tumors diagnosed prior to 2007:
According to our pathologist consultant, "residual" disease indicates incomplete eradication of the original disease process. Residual means that the disease process was not completely removed/eradicated in the initial therapy. Therefore cells from the original primary were never completely removed or destroyed.
In each example above, this is not a recurrence per se but rather
progression of disease. Do not abstract the latter diagnosis as a new primary.
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-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.
Grade, Differentiation: Is grade always coded to 4 for a diagnosis of Ewing's sarcoma?
Do not code the ICD-O-3 grade for Ewing sarcoma unless documented in the record.
In the TNM system, grade is required to place Ewing sarcoma into a stage group. For TNM staging purposes, Ewing sarcoma is classified as G4. Do not apply TNM rules to ICD-O coding.
Terms of involvement--Lung: Is "intense uptake" described on a PET scan an indication of involvement? See Description.
We are seeing increasing use of PET scans as diagnostic tools for cancer. PET scans use different terminology than the ambiguous terms listed in the EOD manual. Could we please have guidelines for interpreting PET scans?
Example: Patient with right lung cancer. PET scan showed intense uptake in the mediastinum and in the hilum. Can we code "intense uptake" as involvement of mediastinal and hilar lymph nodes?
Do not interpret "intense uptake" as involvement. Look for a statement of involvement or other terminology, such as "highly suspicious," "strongly suspicious for" malignancy, involvement, etc.
Reason No Cancer-Directed Surgery--Hematopoietic, NOS: Is this field always coded to 1 [not performed, not part of first course] for leukemias & other hematopoietic diseases?
For cases diagnosed 2003 and later: For sites where "Surgery of the primary site" is coded 00 or 98 (hematopoietic included), Reason for No Surgery of Primary Site should be coded as 1 [Surgery of the primary site not performed because it was not part of the planned first course of treatment]. On rare occasions, there may be surgery to the primary site for a hematopoietic disease, such as an excisional biopsy of a myeloid sarcoma. Refer to the "Abstracting and Coding Guide for the Hematopoietic Diseases" for cell-type-specific treatment information.
Histology (Pre-2007): Do the terms "keratinizing" or "non-keratinizing" have to be present in the final diagnosis to use codes 8071 through 8073? See discussion.
Should "squamous cell carcinoma, small cell variant" be coded to 8073 even though the final diagnoses does not include the phrase "non-keratinizing?"
For tumors diagnosed prior to 2007:
It is acceptable to assign code 8073/3 for squamous cell carcinoma, small cell, NOS. Code squamous cell carcinoma, large cell, NOS to 8072/3. Code to non-keratinizing unless the pathology report specifies keratinizing.
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.
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