Histology (Pre-2007)--Breast: What code is used to represent the histology "infiltrating lobular carcinoma, solid and classical subtypes"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8520 [Lobular carcinoma].
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/Grade, Differentiation--Lymphoma: What code is used to represent the histology "high grade malignant lymphoma with features of so called blastic NK cell cutaneous lymphoma [hematodermic lymphoma]" found on punch biopsy?
For cases diagnosed prior to 1/1/2010:Code the Histology field to 9709/3 [cutaneous lymphoma, NOS]. Code the Grade, Differentiation field to 8 [NK 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-Extension--Meninges: How do you code extension for a malignant meningioma that invades into the adjacent brain tissue?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60. Code 60 is defined as a brain tumor that extends into the meninges. It is also the appropriate code to use for a tumor that extends from the meninges to the brain.
Histology (Pre-2007)/Grade, Differentiation--Lung: What code is used to represent the histology for a lung biopsy of "non-small cell carcinoma with features of poorly differentiated adenocarcinoma"? See discussion.
Non-small cell carcinoma does not appear to be an NOS term in ICD-O-3. The term "with features of" indicates a majority of tumor. Which rule should be used to code histology?
For tumors diagnosed prior to 2007:
Code the Histology and the Grade, Differentiation fields to 8140/33 [adenocarcinoma, poorly differentiated].
The term "non-small cell carcinoma" is used to represent a broad category of epithelial cancers. Non-small cell carcinoma [8046/3] is grouped in the ICD-O-3 under "Epithelial Neoplasms, NOS." The term can be used by a pathologist when he rules out the fact that the patient has a small cell cancer by stating that the malignancy is a non-small cell type of cancer. In this case, the type of non-small cell cancer present in the specimen is adenocarcinoma.
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/Primary Site--CLL/SLL: How should these fields be coded for a "chronic lymphocytic leukemia/small lymphocytic lymphoma" [CLL/SLL] diagnosed on a lymph node biopsy that is referred to by the clinician as CLL? See discussion.
Does the clinician's reference to this disease as CLL change the SEER rule to code to SLL if the disease arises in a lymph node or solid tissue?
For cases diagnosed prior to 1/1/2010:Code the Histology field to 9670/3 [Malignant lymphoma, small lymphocytic, NOS] and the Primary Site field to C77._ [lymph nodes] when CLL/SLL is diagnosed in lymph node or solid tissue, even if the clinician refers to CLL. When CLL/SLL is diagnosed in the blood, code as leukemia.
Refer to clarification #6 on the ICD-O-3 Errata and Clarifications. "...if disease is diagnosed only in the blood or bone marrow, code the primary site to C42.1, bone marrow and assign the leukemia morphology code. If the diagnosis is made on any other tissue (typically lymph nodes, lymphatic structures, breast, and stomach), code to the tissue involved and assign the lymphoma morphology. If the diagnosis is made on both blood or bone marrow and a tissue biopsy, code the tissue involved and assign the lymphoma morphology."
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.
Surgery of Primary Site/Surgical Procedure of Other Site--Bladder: What codes are used to represent these fields for a deeply invasive bladder primary treated initially with a TURP (for suspected prostate extension that turns out to be pathologically negative) and a TURB that is subsequently treated with a cystoprostatectomy?
For cases diagnosed 1/1/2003 and after, code:
1. Surgery of Primary Site field to 60 [Radical cystectomy (male only)] because the cystoprostatectomy was the most extensive (definitive) surgery performed to the primary site.
2. Surgical Procedure of Other Site to 2 [Non-primary surgical procedure to other regional sites] based on the TURP.
Date of Diagnosis/EOD-Extension--Placenta: How do you code these fields for a patient who presents with a vaginal metastatic lesion for a placenta primary? Should EOD-Extension be coded to 60 [Other genital structures NOS: vagina, ovary, broad ligament, fallopian tube] or 85 [metastasis other than lung]? See discussion.
Pt had D&C Feb 5 with features of complete mole. On March 7, pt seen for a mass just inferior to the urethral meatus. At path, vaginal introitus fragments were consistent with choriocarcinoma. At time of March 23 admit for chemo, history is given as large hydatidiform mole evacuated Feb 5. Her beta hCG titers initially fell but approximately one month later hCG titers rose. At that time, she had an obvious vaginal metastatic lesion.
For cases diagnosed 1998 or after: Code the Date of Diagnosis field to March 7, which is the date that the choriocarcinoma was first diagnosed. There was no slide review or clinical statement that the first occurrence was obviously malignant. Therefore, the vaginal mets is not progression and is codeable as extension. Code the EOD-Extension field to 60 [other genital structures, NOS] according to the current EOD scheme for placenta. Even though the mass is discontinuous, it is still included in code 60 per the guidelines of the FIGO system on which the EOD is based.
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.
MP/H Rules/Histology--Breast: What code is used to represent the histology "ductal carcinoma in situ and invasive lobular carcinoma"? See discussion.
Is the histology coded to the combination code of 8522/3 (ductal and lobular) or to the invasive component 8520/3 (lobular)?
For cases diagnosed 2007 or later:
Assuming ductal carcinoma in situ and invasive lobular carcinoma are present in a single tumor, code 8520/3 [Infiltrating lobular carcinoma, NOS].
Using the 2007 MP/H rules for breast, the single tumor invasive and in situ carcinoma module, start and stop at rule H9 and code the invasive histology.
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.