EOD-Extension--Breast: If a negative bone scan is followed by a bone marrow biopsy that is positive for metastatic disease, is the bony involvement used when coding extension [85] or as progression of disease (ignore mets when coding extension)? See discussion.
Pt diagnosed with ductal carcinoma of the breast in May. On June 1, oncologist recommended chemo and XRT and planned a metastatic workup. A June 6 marrow MR consistent with mets. June 8 bone scan showed scoliosis of the L-spine with scattered focal areas of increased activity probably related to degenerative changes in the spine. On June 29, biopsies were done of the T2 vertebra with path diagnosis of metastatic adenocarcinoma consistent with breast primary. Chemo started July 15.
For cases diagnosed 1998-2003, is EOD extension code 85 correct? We felt that the bone mets was found within 4 months of diagnosis and is not progression of disease.
For cases diagnosed 1998-2003: Code the EOD-Extension field to 85 [metastasis]. Bone metastasis was documented during the original metastatic workup. Metastasis to the bone was suspected soon after diagnosis and confirmed prior to the start of treatment. The length of time between the diagnosis and the confirmation of the bone metastasis was not used to code extension on this case. The pt was still being worked up as evidenced by the fact that treatment had not yet started.
Multiple Primaries (Pre-2007)--Breast: Should just one primary be reported when only ductal carcinoma in situ is diagnosed initially but the mastectomy performed as part of the first course of cancer-directed therapy, but more than 2 months after diagnosis, contains a diagnosis of invasive ductal carcinoma? See discussion.
How do we code this case in light of the EOD guideline that states we include all information collected within 4 months of diagnosis or through the completion of first surgery in the absence of disease progression when coding.
For tumors diagnosed 1998-2003:
Report this case as one invasive primary, unless stated to be two primaries by the clinician. This appears to be a single primary with different behaviors, rather than separate tumors.
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)/Terminology: Are "pattern", "architecture", and "architectural pattern" terms that indicate a majority of tumor?
For tumors diagnosed 2004 to 2006:
The terminology "Architectural pattern: ____________," when used in the final pathology diagnosis, indicates a subtype that can be coded. This type of format in a pathology report is based on a College of American Pathologists (CAP) protocol. Disregard "pattern" and "architecture" when not used in accordance with the CAP protocol. See www.cap.org for cancer protocols.
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.
Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"?
Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone.
First Course Treatment: 1) When is Decadron (Dexamethasone) coded as cancer treatment? 2) When Decadron is given to a patient with multiple myeloma, is it coded as treatment only if given in combination with chemotherapy? See discussion.
SEER Book 8 states that Decadron is an important therapeutic agent for treatment of multiple myeloma. In the Abstracting and Coding Guide for the Hematopoietic Diseases, Decadron is a hormonal treatment for multiple myeloma "when given as part of a chemotherapy regimen".
For cases diagnosed 1/1/2003 and after:
1. Code hormone therapy to 01. Code any therapy administered to treat cancer tissue that achieves its effect on cancer tissue through a change in the hormone balance in the hormone therapy field. Decadron is coded for leukemias, lymphomas and multiple myelomas primaries. It is coded for other sites only when stated to be cancer-directed treatment.
2. Code hormone therapy to 01. Decadron should be coded as hormone therapy for multiple myeloma when given alone or as part of a first course of treatment chemotherapy regimen.
Scope of Regional Lymph Node Surgery/Radiation Sequence with Surgery/Date Therapy Initiated: Is the Scope of Regional Lymph Node Surgery field used to code date of first therapy and radiation sequence with surgery? See discussion.
Example: There is no primary site surgery and only an aspirate of a lymph node and the date of therapy is based on this procedure.
Yes, the Scope of Regional Lymph Node Surgery field is used to code the Date Therapy Initiated field and the Radiation Sequence with Surgery field.
Multiple Primaries (Pre-2007)/Primary site/EOD-Extension--Head & Neck: How many primaries are represented by an invasive squamous cell carcinoma of the floor of mouth with in situ squamous cell carcinoma involvement of the frenulum?
For tumors diagnosed prior to 2007:
Code the Primary Site field to C04.9 [floor of mouth]. Because the cancer did not INVADE into a neighboring site (through wall, through soft tissue), it just spread along the mucosa (in situ) to involve the frenulum, this is one primary.
For cases diagnosed 1998-2003, in situ extension via mucosal spread to the frenulum is ignored for purposes of coding EOD-Extension.
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)--Bladder: What code is used to represent the histology "transitional cell and small cell carcinoma" of the bladder? See discussion.
Code 8045/3 is used for combination codes that represent a mixture of small cell carcinoma and any other carcinoma. When we use this histology code for bladder primaries with mixed transitional cell and small cell carcinoma, we encounter a problem with the SEER edits (site and morphology conflict).
For tumors diagnosed prior to 2007:
Please see SEER Inquiry question ID number 20041104.
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--Breast: Should clinically mentioned "thickening" of the breast be ignored if the pathology report does not mention thickening or skin involvement? See discussion.
For cases diagnosed 1998-2003: Can clinical "thickening" of the breast be coded to 20-28 extension code when there is no mention of the thickening or skin involvement in the pathology report? How do we code cases when pathology reports don't support the clinical finding of skin involvement.
For cases diagnosed 1998-2003: Do not use code 20-28 when there is no preoperative treatment and the pathology report does not confirm skin invasion. The clinical diagnosis of skin involvement was not supported by the pathology report.
Histology/Date of Diagnosis--Hematopoietic, NOS: What code is used to represent histology for a June 2001 diagnosis of "myelodysplastic syndrome" followed by a September 2001 bone marrow biopsy diagnosis of "myelodysplasia evolving into an acute leukemic state"?
For cases diagnosed prior to 1/1/2010:
Code the Histology field to 9989/3 [myelodysplastic syndrome] and the Date of Diagnosis field to June 2001.
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.
An official website of the United States government
Home