Reportability/Ambiguous Terminology/Date of Diagnosis: If a "suspicious" cytology is reportable only when a later positive biopsy or a physician's clinical impression of cancer supports the cytology findings, is the Date of Diagnosis field coded to the later confirmation date rather than to the date of the suspicious cytology? Is a suspicious "biopsy" handled the same way?
Cytology reported as "suspicious" is not reportable. If the physician confirms the suspicious cytology by making a clinical diagnosis of malignancy, the Date of Diagnosis field is coded to the date of the clinical diagnosis, which may or may not be same date the cytology was performed.
Without supporting clinical documentation, the case will remain non-reportable and will not be submitted to SEER. The supporting documentation can be a physician's statement that the patient has cancer, a scan or procedure that identifies cancer, or a positive biopsy.
Suspicious "biopsies" are reportable according to SEER's list of ambiguous terms. Suspicious "cytologies" without supporting clinical statements are not.
Scope of Regional Lymph Node Surgery: Should this field be coded to "unknown or not applicable" for all hematopoietic morphologies, brain primaries and unknown primaries?
For cases diagnosed 1/1/2003 and after: Code the Scope of Regional Lymph Node Surgery field to 9 [Unknown or not applicable] for all hematopoietic morphologies, brain primaries and unknown primaries. .
EOD-Size of Primary Tumor--Prostate: If you only have a biopsy and not a resection of the primary site, can you code the size of the prostate nodule demonstrated on digital rectal exam? See discussion.
Example 1: Digital rectal exam reveals 1 cm left side prostate nodule. TRUS-guided biopsy of left side of prostate shows adenocarcinoma. Right side biopsy is negative. Is size coded to 010 or 999?
Example 2: Digital rectal exam reveals 1 cm left side prostate nodule. Bone scan was positive for metastatic disease. Is size coded to 010 or 999?
For cases diagnosed 1998-2003:
You need path confirmation that a malignancy exists in the prostate before you can code the size of the nodule seen clinically.
Example 1: Code the EOD-Size of Primary Tumor to 010 [1 cm], because the nodule in the prostate is confirmed as cancer by needle biopsy.
Example 2: Code the EOD-Size of Primary Tumor to 999 because there was no pathologic confirmation of malignancy.
Multiple Primaries (Pre-2007)--Skin: If a patient presents with two separate lesions on the left cheek (i.e., left lateral cheek and left upper cheek) that both are histologically confirmed to be superficial spreading melanoma on the same day, is this coded as one or two primaries?
For tumors diagnosed prior to 2007:
Code as 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.
Surgery of Primary Site--Breast: What code is used to represent this field for a breast primary treated with a "bilateral mastectomy"? See discussion.
Pt diagnosed with rt breast primary opted to be treated with rt modified radical mastectomy and lt simple mastectomy. Path revealed invasive ductal carcinoma on the rt and ductal carcinoma in situ on the lt. Path reported 14 axillary lymph nodes were found in the mastectomy specimen.
There are two primaries. For cases diagnosed 1/1/2003 and after: For the rt breast, code Surgery of Primary Site to 51. The contralateral left breast malignancy is not involved with the right breast primary by either direct extension or metastasis. Codes 42 and 52 are used to capture prophylactic mastectomy of the opposite noncancerous breast. In this case, the opposite breast has cancer so these codes cannot be used. Code Scope of Regional Lymph Node Surgery to 5 and Surgical Procedure of Other Site to 0.
For the lt breast, code Surgery of Primary Site to 41, Scope of Reg LN Surgery to 0, and Surgical Procedure of Other Site to 0.
Date of Diagnosis--Lung: Based on Note 7 in the lung EOD, should the Date of Diagnosis field be coded to an earlier CT scan date with a reported diagnosis of "RUL mass with mediastinal lymphadenopathy" or to the later biopsy date with a reported diagnosis of small cell carcinoma? See discussion.
Note 7 states that "mediastinal lymphadenopathy" indicates involved lymph nodes for lung primaries. Should the date of diagnosis be back-dated to the date of the scan?
For cases diagnosed 1998-2003:
No, code the Date of Diagnosis field to the later biopsy date. Note 7 is intended for use in coding the EOD-Extension field, not the Date of Diagnosis field. The earlier scan has a diagnosis of RUL "mass" not a "malignancy" so the fact that there is mediastinal lymphadenopathy mentioned in that scan is not used to help determine date of diagnosis.
Histology (Pre-2007)--Kidney: What code is used to represent the histology "renal cell carcinoma with granular cell morphology"? Kidney primary with diagnosis of renal cell CA with granular cell morphology. Do we code as granular cell carcinoma? Is the term "morphology" synonymous with "type"? See discussion.
Do we code this type of tumor as a granular cell carcinoma [8580/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8320/3 [granular cell carcinoma]. Renal cell carcinoma is a non-specific term that has several specific cellular subtypes, one of which is granular cell [8320/3].
Note: Do not code to granular cell tumor [9580/3], which is not a histology related to renal cell 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--CLL/SLL: If a tissue diagnosis of "small lymphocytic lymphoma" is made six months after an initial blood diagnosis of "chronic lymphocytic leukemia" should the histology be updated from 9823/3 to 9670/3?
For cases diagnosed prior to 1/1/2010:Do not change the histology to small lymphocytic lymphoma (9670/3). The chronic lymphocytic leukemia has advanced/progressed and disseminated into other tissues from the blood during the last six months. If the patient presents with disease in the blood and/or bone marrow only, code to CLL. If a lymph node or other solid tissue is involved initially, code to SLL. For the case cited, the tissue involvement occurred six months after the initial diagnosis and the histology code is not changed to reflect the progression of disease.
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.
Reportability/Ambiguous Terminology--Breast: Should the American College of Radiology (ACR) BI-RADS assessment categories 4 [Suspicious Abnormality--biopsy should be considered] and 5 [Highly Suggestive of malignancy-appropriate action should be taken], impressions for mammograms and sonograms, be used as the sole basis for reportability? See discussion.
ACR website:
Category 4: Lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant.
Category 5: lesions have a high probability of being cancer.
Grade, Differentiation--Prostate: Has SEER officially changed the conversion code for Gleason score 7 to poorly differentiated [grade 3]?
For cases diagnosed prior to 2003, there has been no change in SEER standards for converting a Gleason score to a grade. As described in the SEER Program Code Manual, Gleason score 7 is converted to moderately differentiated [grade 2]. ONLY if the pathology report lists moderately poorly differentiated IN ADDITION to the Gleason's score 7, would you code the case as 3.
For cases diagnosed in 2003 and later, please see question number 20031123.
An official website of the United States government
Home