Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
EOD-Clinical Extension--Prostate: In the SEER EOD manual, there is a list of terms to distinguish apparent from inapparent tumor for prostate primaries. Are terms in the "maybe" category and are terms not on the list clinically inapparent or clinically apparent when there is no physician staging of the case? See discussion.
The rectal examination states that there is "asymmetrical enlargement of the prostate, firmness over the right lobe" and the physical exam impression is extensive carcinoma of right lobe. A needle biopsy of the right lobe was positive. "Enlarged" is on SEER's list of clinically inapparent terms; "asymmetrical" and "firm, NOS" are on the "maybe" list.
For cases diagnosed 1998-2003:
On the basis of the physical exam impression, code the EOD-Clinical Extension field to 20 [involvement of one lobe, NOS] for this case. Although the medical record did not provide a physician's staging of the case as clinically apparent, the physician did suspect carcinoma prior to the biopsy.
If clarifying stage information is missing and the term is in the "maybe" category or the term is not on the list, then code extension as 30 [localized, NOS] for cases that appear localized.
EOD-Clinical Extension/EOD-Lymph Nodes--Prostate: How do you code clinical extension and lymph nodes for path only prostate cases treated with a TURP? Would clinical extension be coded to unknown or localized, NOS?
For cases diagnosed 1998-2003: Code the EOD-Clinical Extension field to 30 [localized, NOS] and the EOD-Lymph Nodes field to 0 [no lymph node involvement]. Per Note 7: Use code 30 when there is insufficient information as to whether the tumor is clinically apparent or inapparent but the tumor is confined to the prostate. This is an example of a case where there is insufficient information as to whether the tumor is clinically apparent or inapparent. Assume the tumor is confined to the prostate.
Surgery of Primary Site--Skin: Explain the difference between code 30 and code 45.
Code 30 [Biopsy of primary tumor followed by a gross excision of the lesion]
Code 45 [Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm, NOS. Margins MUST be microscopically negative.]
For cases diagnosed 1/1/2003 and after: Code 30 represents a biopsy or excision in which the margins of excision are less than 1 cm or the margins are unknown. Code 45 represents a wide excision in which it is known that the margins of excision are greater than 1 cm.
Primary Site--Breast: What subsite code should be used for a diagnosis of "inflammatory carcinoma"?
Code the Primary Site field to C50.9 [Breast, NOS] for a breast primary presenting with inflammatory cancer unless there is a palpable mass within the breast. If there is a palpable mass, code the primary site to the position of the mass.
EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion.
CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]?
For cases diagnosed 1998-2003:
Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present.
Histology (Pre-2007)--Colon: What code is used to represent histology when the surgeon describes a sessile polyp and the final path diagnosis is stated as: "Rectal sessile polyp: Invasive moderately differentiated adenocarcinoma" (pathologist does not state that it is "arising in a sessile polyp")?
For tumors diagnosed prior to 2007:
Code the Histology field to 8210/3 [adenocarcinoma arising in a polyp]. The structure in which this adenocarcinoma is arising, is 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.
EOD-Extension--Mycosis Fungoides: Explain the difference between extension codes 25 [% of body surface not stated, no tumors] and 30 [skin involvement, NOS; extent not stated, no tumors. Localized, NOS]?
For cases diagnosed 1998-2003:
For mycosis fungoides: Use code 25 when skin involvement is present but only a general location/site is mentioned (i.e., face, legs, torso, arms).
Use code 30 when there is skin involvement but there is no mention of location/site.
Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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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