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Report Produced: 08/14/2024 15:25 PM

Report Question ID Question Discussion Answer Year
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
20031140 Primary site--Unknown & ill-defined site/Kidney: How should this field be coded when humeral metastases are compatible with renal cell carcinoma pathologically, no kidney lesion is found clinically and the physician's signout diagnosis is "no primary found, as of now unknown"? See Description. Path states "biopsy of humerus, mets sarcomatoid carcinoma consistent with renal cell carcinoma." Material was sent to Mayo Clinic for consult & they state "with focus of clear cells, agree that a likely primary is renal cell carcinoma." Abdominal CT showed no abnormality in kidneys. When the registrar abstracted the case she spoke to the managing physician who told her that "no specific site was found and it was, as of now, unknown." This was stated about three months after dx. Can we code as a renal primary based on pathologic information or should we code unknown based on CT and physician's statement?

Code this case to C64.9 [Kidney, NOS].

ICD-O-3 rule H states that the topography code attached to a morphology term may be used when the topographic site is not given in the diagnosis. Topography code C64.9 is attached to morphology code 8312/3 [Renal cell carcinoma] in ICD-O-3.

 2003
20031060

Histology--Hematopoietic, NOS: Because histology 9895/3 [Acute myeloid leukemia with multilineage dysplasia] was recognized as a distinct entity by WHO with too few cases of the subtypes [with or without prior MDS] to warrant separate histology codes for each, should the wording for the non-bold definitions in ICD-O-3 be changed to the following in both the alpha and numeric sections? See Description.

AML with multilineage dysplasia and prior MDS

AML with multilineage dysplasia and without prior MDS

How do we code histology for the following case of AML?

Patient was admitted for profound anemia and thrombocytopenia with

no immediate explanation. Path final diagnosis on bone marrow biopsy: acute myelogenous leukemia (AML). Per micro description: findings are

characteristic of AML that appears to be arising within the context of a myelodysplastic syndrome. The discharge diagnosis (2 days after bone marrow biopsy) read: myelodysplastic syndrome with profound anemia and

thrombocytopenia.

Do we code the histology per the final path diagnosis (code 9861/3)?

Using the current version of ICD-O-3, we could arrive at a histology code of 9895/3 based on the micro findings of AML with prior myelodysplastic syndrome. However, per the above-mentioned SEER e-mail, we would not because there was no mention of multilineage dysplasia.

For cases diagnosed prior to 1/1/2010:To assign code 9895, it is important that the diagnosis includes "multilineage dysplasia." Use code 9895 when the diagnosis is with or without prior (not concurrent) myelodysplastic syndrome AND multilineage dysplasia. Acute myeloid leukemia without prior myelodysplastic syndrome and without multilineage dysplasia is coded 9861 [Acute myeloid leukemia, NOS].

Although the wording of 9895 cannot be changed, coders can make a note that the synonyms are intended to include:

-Acute myeloid leukemia WITH multilineage dysplasia with prior myelodysplastic syndrome

and

-Acute myeloid leukemia WITH multilineage dysplasia without prior myelodysplastic syndrome.

The histology code for the case example is 9861/3 [Acute myeloid leukemia, NOS].

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
20031020

Surgery of Primary Site--Head & Neck: Is the removal of the left tonsil during a bilateral tonsillectomy for a right tonsil primary coded in the surgery of the primary site field to 27 [Excisional bx], 30 [Pharyngectomy, NOS], 31 [Limited/partial pharyngectomy; tonsillectomy; bilateral tonsillectomy], or to code 2 under the Surgical Procedure of Other Site field? See discussion.

Our notes document a 1/99 SEER e-mail stating that tonsillectomy/tonsillectomy with wide excision would be code to 31. Is this still correct? Some of our coders felt that code 27 or 30 would be more appropriate.

Is the removal of the contralateral tonsil incidental removal or do we code it under Surgery of Other Regional Site, Distant Site, or Distant Lymph Nodes? If it is coded, would 5 be the correct code?

Assign code 31 [Limited/partial pharyngectomy; tonsillectomy, bilateral tonsillectomy]. Do not code removal of the contralateral tonsil under Surgical Procedure of Other Site. Surgery to remove regional tissue with the primary site during the same procedure is coded in the Surgery of Primary Site field.

 2003
20031036 Histology--Hematopoietic, NOS: When both the path and clinical diagnoses simultaneously reflect reportable diagnoses but one is a worse form of the same disease process, which diagnosis do we code? See Description. Would this case be coded to RAEB or AML? Bone marrow diagnosis: Hypercellular marrow with profound trilinieage dyspoietic changes. Comment: the features are consistent with RAEB. Clinical diagnosis five days later states: Myelodysplastic syndrome, early acute myelocytic leukemia (likely AML).

For cases diagnosed prior to 1/1/2010:When several diagnoses are made as part of the diagnostic process within two months, code the one with the worst prognosis.

Code the case example as acute myelocytic leukemia.

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
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
20031186 Immunotherapy/Radiation Therapy: Is I-131 labeled immunoglobulin coded as immunotherapy or radiation therapy? Code treatment with I-131 labeled immunoglobulin as radiotherapy. The primary action is radiotherapeutic. Radioimmunotherapy (RIT) uses antibodies to deliver the radiotherapy to the site of the tumor. 2003
20031086 EOD-Clinical Extension--Prostate: Must all three criteria be met (an elevated PSA; documentation that the physical exam was negative; and, if a TRUS was done, there is documentation that the findings were negative) in order to code this field to 15 [Tumor identified by needle by elevated PSA]?

For cases diagnosed 1998-2003:

Refer to the Prostate EOD Coding Guidelines, Final version distributed to SEER Registries 6/20/2001.

Prostate clinical EOD extension code 15 is used when all three criteria are met as listed on page 3 of the Prostate EOD Coding Guidelines. Meeting 1 or 2 of the 3 criteria is not sufficient for code 15. PE must be done and documented as negative. TRUS may or may not be done, but if done, must be documented as negative. PSA must either be elevated or there is no documentation about the PSA.

Codes 20 and 23-24 would be used with positive physical exam or positive TRUS.

Use codes 30-34 when there is no documentation that the physical exam was negative, or no documentation that the TRUS was negative, or when the prostatic apex is involved.

 2003
20031030 Primary Site--Head & Neck: What is the primary site for a tumor location described as being in the "gingiva between teeth #s 18 and 19?

Code the primary site as C03.1, lower gum.

According to the system used by the American Dental Association, tooth #18 and tooth #19 are lower. Teeth #1-16 are upper. Teeth #17-32 are lower.

 2003
20031134 Surgery of Primary Site/Immunotherapy--Bladder: Is administration of BCG coded as both surgery and immunotherapy? Yes, code as both surgery and immunotherapy. The CoC included immunotherapy/BCG under surgery and also under immunotherapy by request of the clinical advisor for bladder, reflecting the mixed-modality nature of the treatments. [Answer from CoC I & R] 2003