First Course of Cancer-Directed Therapy--All Sites: How do we code retinoic acid?
The code for retinoic acid depends upon the primary site and histology of the tumor. Code retinoic acid (also called Vitamin A, tretinoin, ATRA, all-transretinoic acid or Vesanoid) in the Immunotherapy field as 01 [Immuno administered as first course therapy] for acute promyelocytic leukemia. This drug is given to patients as an alternative to chemotherapy.
For all other sites/histologies, code retinoic acid in the Other Cancer-Directed Therapy Field. Use code 2 [Other experimental cancer-directed therapy] or 3 [Double-blind clinical trial, code not yet broken] if the drug is given as part of a protocol. If the drug is not being given as part of a protocol or you don't know whether it is part of a protocol, use code 1 [Other cancer-directed therapy].
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.
EOD-Extension--Pancreas: How would you code extension for the following non-surgically treated pancreas primaries? None of these cases has TNM staging to assist with classifying the extent of disease. See discussion.
1) CT scan: Cystic lesion in body of pancreas. Discharge dx: pancreas ca.
2) Discharge dx: CBD obstruction due to probable early ca in head of pancreas.
3) CT scan: mass involves the head and body of the pancreas. No evidence of abdominal mets. Discharge dx: Locally advanced pancreatic ca.
4) H&P: Pt with splenomegaly probably secondary to splenic vein thrombosis and a large ca of the tail of pancreas. Imp: Advanced pancreatic ca of the tail of pancreas. Would you code extension to splenic vein [56]?
5) H&P: Pancreatic ca with extension or mets into porta hepatis. (Would you assume direct extension or mets?)
6) CT scan: Pancreas ca. Significant peritoneal implants. (Would you assume the implants to be related to the pancreas primary and code as involvement?)
For cases diagnosed 1998-2003:
The information provided for these pancreatic primary examples is very limited. Additional information should be sought. If not available, code the EOD-Extension field to:
1) 10
2) 10
3) 10
4) 99
5) Assuming primary in head, body or tail of pancreas, 76
Histology (Pre-2007): Can the histology code 8582/3, "thymoma, mixed type, malignant" only be used when you have a thymoma with both type A and type B features? See discussion.
Can this same histology be used when you have two type B features in the thymoma specimen? What code is used to represent the histology?
Example 1: Thymoma, spindle cell and epithelial type
Example 2: Thymoma, mixed lymphocytic and epithelioid type
For tumors diagnosed prior to 2007:
For example 1, code histology to 8582 [Thymoma, type AB]. This code is only applicable to "Type AB thymoma [mixed]" in the WHO classification. Use 8582 only for thymomas with type A and type B features. Spindle cell is a type A feature and epithelial is a type B3 feature.
For example 2, code histology to 8585 [Thymoma, type B3]. Lymphocytic is a B1 feature (8583) and epithelial is a B3 feature (8585). There is no type A component. Code the histology based on ICD-O-3 rule K on page 34.
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--Meninges: Should the primary site for a meningioma of the right frontal lobe be coded to C71.1 or C70.0? See discussion.
In the opinion of some neurologists it is more important to capture the lobe in which the meningioma is located rather than code the primary site to meninges. Should a meningioma always be coded to meninges for primary site?
Code the Primary Site field to C70.0 [cerebral meninges], the suggested site code for most meningiomas. Meningiomas arise from the meninges, not the brain (although they can invade brain). ICD-O-3 does not differentiate the specific location of the brain that the meninges cover. The information of interest to neurologists would have to be captured in an optional or user-defined field.
Histology (Pre-2007): What code is used to represent the histology "non oat cell carcinoma"?
For tumors diagnosed 2001-2006:
Code the Histology field to 8046/3 [non-small cell carcinoma] if the pathologist does not provide a more specific histologic type. "Non oat cell" is a synonym for "non-small cell."
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.
Multiple Primaries (Pre-2007)--Breast: When simultaneously diagnosed breast tumors of the same histology in the same breast are stated by the pathologist and/or clinician to be more than one primary, should these be reported as multiple primaries? See discussion.
For example, based on special pathology studies that showed a difference in appearance between tumors, a pathologist may state that two ductal, NOS tumors diagnosed at the same time in the same breast represent two primaries.
For tumors diagnosed prior to 2007:
Code as a single primary. Follow the guidelines in the SEER Program Code Manual for determining multiple primaries. Simultaneous multiple lesions of the same histologic type in the same site (same breast) are a single primary for SEER, even though the pathologist may perform special studies and state that the patient has more than one 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.
Grade, Differentiation--All Sites: What code is used to represent this field when a pathology report describes a tumor as a low grade neoplasm consistent with a specific histologic type (e.g., Low grade neoplasm consistent with carcinoid)?
Code the Grade, Differentiation field to 2 [Low grade].
Measured Thickness--Melanoma: Can in situ melanoma cases have "depth of invasion" coded to something other than 999? See discussion.
Biopsy of the left arm: Melanoma, 0.2mm in thickness. The in situ component extends to a peripheral margin.
For cases diagnosed 1998-2003:
Code the Measured Thickness (depth) field to 020 [0.2 mm] for this case.
In situ disease can have a depth of invasion because the surface epithelium can be of varying depths without the melanoma breaking through the basement membrane.
Histology (Pre-2007)--Breast: For a path diagnosis of ductal carcinoma in situ, cribriform type with apocrine features, does the term "apocrine" modify the term cribriform or does it represent another type of ductal carcinoma in situ? See discussion.
It can be difficult to determine if two terms mentioned in a pathology report are describing different aspects of the same morphology or if the two terms are describing two different morphologies.
For tumors diagnosed prior to 2007:
Code the Histology field to 8401/2 [Apocrine carcinoma in situ]. According to our pathologist consultant "Because apocrine is the more unusual tumor, and pulling it out of the cribriform category keeps the latter a little cleaner (because most cribriform ductal carcinoma in situ is not particularly apocrine), I am inclined to code to the histology to apocrine ductal carcinoma in situ."
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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