1) If Van Nuys nuclear grade 2 is the only grade given for an in situ breast primary, would it be coded as a 3-component system (e.g., 2/3 = 3)?
2) Is there a way of determining grade if only the total Van Nuys Prognostic index score is given (e.g., score 7/9)?
1. Code Van Nuys grade 2 as code 2 [Grade 2] in the Grade, Differentiation field.
2. Code Van Nuys score of 7 as 9 [Cell type not determined, not stated or not applicable] in the Grade, Differentiation field.
Currently, there is no conversion from the total Van Nuys score to grade because "grade" represents only one of the three Van Nuys factors that make up the total score. The other factors are tumor size and margin. The grade represents from 1 to 3 points within the total Van Nuys score. The total score can be between 3 and 9.
Reportability--Hematopoietic, NOS: Is the term "plasma cell dyscrasia" a synonym for multiple myeloma?
For cases diagnosed prior to 1/1/2010:
Plasma cell dyscrasia, NOS, is nonreportable. It is not a synonym for multiple myeloma. Plasma cell dyscrasia represents a broad spectrum of disease characterized by plasma cell proliferation that appears inappropriate or uncontrolled. Multiple myeloma is one disease type that falls into that classification. However, there are several other malignant and benign diseases also classified as such because of their immunoglobulin abnormalities. Reportability to SEER regarding a disease classified as a plasma cell dyscrasia is dependent on identifying the specific cell type associated with the disease in the ICD-O-3.
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--Cervix: How do you code tumor extension described as "the in situ lesion extends from the cervix to the mucosa of the vagina"? See discussion.
Example: Cone biopsy of cervix and vaginal vault both show ca in situ. The op report stated: "lesion extending from the left lateral portion of the cervix onto the left lateral portion of the vagina." The pathologist stated it "appeared to be an in situ lesion extending from the cervix to the mucosa of the vagina."
For cases diagnosed 1998-2003:
Code the Primary Site to C53.9 [Cervix uteri] and the EOD-Extension filed to 00 [in situ]. In situ is a measurement of invasion. Extension of the cervical in situ carcinoma via the mucosa to the vagina does not affect the EOD extension code.
Reportability/Diagnostic Confirmation--Melanoma: Would a shave biopsy diagnosis of "highly suggestive of early melanoma", followed by a re-excision diagnosis of "no residual disease", be SEER reportable if the clinician referred to the case clinically as a melanoma? If so, what would the Diagnostic Confirmation be? See discussion.
Pathology report from a shave biopsy states: "...markedly atypical junctional melanocytic proliferation. Changes highly suggestive of early melanoma arising adjacent to superficial congenital nevus." The re-excision pathology report states "biopsy proven melanoma" in the "Clinical History" section of the report (which is a reference to the original shave biopsy). The re-excision final pathology diagnosis states "no evidence of melanoma." The physician states that he thinks this is a melanoma. Should it be reported? Should Diagnostic Confirmation be coded to 1 or 8?
The case is reportable because the physician documented a clinical diagnosis of malignant melanoma. Code the Diagnostic Confirmation field to 8 [Clinical diagnosis only (other than 5, 6 or 7)].
Histology (Pre-2007): Can adenocarcinoma in either a villous or tubulovillous polyp or adenoma be coded as histology for sites other than colon or rectum? See discussion.
When adenocarcinoma of the endometrium arises in a villoglandular polyp is the histology coded as 8263/3?
For tumors diagnosed prior to 2007:
Code the Histology field to 8263/3 [adenocarcinoma in a tubulovillous adenoma]. Histology codes 8261 [adenocarcinoma in a villous adenoma] and 8263 [adenocarcinoma in a tubulovillous adenoma] are used for non-colorectal sites when the cancer arises in a polyp.
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.
Terminology/EOD-Clinical Extension--Prostate: Is "firm" a term that implies clinically apparent prostate disease? See discussion.
PE: Prostate firm on DRE
IMP: Rule out prostate cancer
For cases diagnosed between 1998-2003:
Code the EOD-Clinical Extension field to clinically inapparent. The clinically apparent term list classifies "firm" as "maybe" being involved. If a maybe term such as "firm" is the only description available, code as clinically inapparent.
Scope of Regional Lymph Node Surgery/EOD-Number of Regional Nodes Examined: What codes is used to represent these fields when the surgeon states that a "lymph node dissection" was done, but no nodes are identified in the pathology report?
For cases diagnosed 1/1/2003 and after: Code the Scope of Regional Lymph Node Surgery field to 3 [Number of regional lymph nodes removed unknown or not stated; regional lymph nodes removed, NOS] and code the EOD-Number of Regional Nodes Examined field to 00 [No nodes examined].
The surgery fields reflect the procedures the physician performed. The EOD fields reflect the results of those procedures.
Diagnostic Confirmation--Testis: How do you code this field when a testicular mass is confirmed to be cancer on physical exam and testicular antigen, but the orchiectomy specimen was negative and yet the final signout diagnosis on the medical record was "testicular cancer"?
Code the Diagnostic Confirmation field to 5 [Positive laboratory test/marker study] because the disease was confirmed both clinically and by a positive marker. Code 8 [Clinical diagnosis only] is used when the diagnosis is based on information other than that coded in 5, 6, or 7 [positive lab test/marker study, visualization, and radiography or other imaging techniques]. Code 8 is rarely used.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field when the phenotype is combined B cell and T cell?
For cases diagnosed prior to 1/1/2010:Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. There is no combination code for B cell and T cell. There is also no hierarchy established for choosing one code over the other. Therefore coding such a case as a pure B cell or a pure T cell would misrepresent the phenotype.
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.
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