Report | Question ID | Question | Discussion | Answer | Year |
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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 | |
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20031199 | CS Extension/Polyp--Colon: How is CS extension coded for tumor invasion described as "Haggitt level 4"? See Description. | Polypectomy specimen revealed adenocarcinoma of the rectum in a tubulovillous adenoma. Per path extent of invasion was Haggitt level 4. The micro description of the tumor stated that there was malignant epithelial neoplasm in colonic mucosa. | In a 1985 Gastroenterology journal article, Haggitt described five levels of polyp invasion: Level 0-confined to mucosa Level 1-head Level 2-Neck Level 3-Stalk Level 4-Submucosa of underlying colonic wall.
For cases diagnosed 2004 and forward: Use the best information available to code CS extension. The following conversion may be used when the only information available is the Haggitt level. Level 0 - Extension 10 Level 1 - Extension 13 Level 2 - Extension 15 Level 3 - Extension 14 Level 4 - Extension 16 |
2003 |
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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 |
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20031120 | Primary site: How is this field coded for a malignant spindle cell neoplasm in a subcutaneous mass of the right knee? See Description. |
The pathology report says: Right knee tumor: A. discrete subcutaneous mass 3.5x5.2x1.4 cm malignant spindle cell neoplasm (see Comment) B. A focus of subcutaneous malignant neoplasm is identified in the superior resection margin. C.All other margins are clear. The comment mentions that the specimen has been sent to Mayo Clinic and the Mayo clinic consult says, "we still believe that the diagnosis of spindle cell carcinoma is correct. Obviously the differential diagnosis involves melanoma and sarcoma also. The results of the immunoperoxidase stains strongly support the prior diagnosis of a carcinoma." |
Code the site to C49.2 [Connective, subcutaneous and other soft tissues of lower limb and hip]. The site is a subcutaneous mass. C49 with 8032/3 will not be impossible following the next updates to the SEER edits. |
2003 |
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20031062 | Primary Site--Melanoma: How would this field be coded for a pleural effusion consistent with metastatic melanoma and "no skin lesions?" | Code primary site as C44.9 [Skin, NOS]. ICD-O-3 does not list a suggested site code for 8720/3 because melanoma can arise in other parts of the body. However, C44.9 [Skin, NOS] is the default when the primary cannot be found. | 2003 | |
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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 |
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20031131 | Multiple Primaries (Pre-2007): Would osteosarcoma of the right arm diagnosed four years after malignant fibrous histiocytoma, also in the right arm, be a second primary when the physician states, "the patient's disease progressed to sarcoma after radiation was administered?" |
For tumors diagnosed prior to 2007: The osteosarcoma is a second primary. The first three digits of the histology codes are different: 8830 [Malignant fibrous histiocytoma] and 918_ or 919_ [Osteosarcoma]. In addition, the diagnoses are four years apart. According to SEER rules, these are separate primaries. 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 | |
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20031145 | 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. | 2003 |
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20031180 | Histology (Pre-2007)--Breast: What code is used to represent the histology "ductal adenocarcinoma with medullary features?" | For tumors diagnosed prior to 2007:
Medullary is a subtype of duct and "with features of" is a term that indicates a majority of tumor. If this is an invasive adenocarcinoma with no in situ component, code to 8510/3 [Medullary adenocarcinoma]. If only one of the components is invasive, code that component.
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 | |
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20031205 | EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded when an autopsy report reveals pathologically involved regional lymph nodes but does not state how many nodes were positive nor how many were examined? See Description. | A final autopsy report described widely disseminated adenocarcinoma, probably lung primary. Metastatic tumor in brain, lungs, and in lymph nodes. The Gross description of the autopsy report stated that there were numerous metastases to hilar and mediastinal lymph nodes. The Micro description of the autopsy report did not add any clarification. In the absence of a stated number of lymph nodes, the options for coding number of regional lymph nodes examined are codes 96-98. These codes include descriptions of surgical procedures such as sampling and dissection. How do we code number of regional lymph nodes examined when the pathological examination of lymph nodes was done only at autopsy and not during a surgical procedure? | For cases diagnosed 1998-2003: The rules that apply to the use of pathology reports for EOD coding also apply to autopsy reports. When a cancer diagnosis is made and positive lymph nodes are discovered on autopsy, in the absence of a stated number of lymph nodes, code the number of lymph nodes positive to 97 [Positive nodes but number of positive nodes not specified]. Code the number of lymph nodes examined to 97 [Regional lymph node removal documented as dissection and number of lymph nodes unknown/not stated]. An autopsy is a dissection. |
2003 |