Report | Question ID | Question | Discussion | Answer | Year |
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20150048 | Reportability--Skin: Is low grade trichoblastic carcinoma, with a small focus of high grade carcinoma of the scalp reportable? See discussion. |
Pathology report states: the individual nodules of trichoblastic cells resemble those seen in trichoblastoma, but the lesion is very poorly circumscribed with an infiltrative border that extends into the subcutis. the lesion may behave in a locally aggressive fashion, and should be completely removed. High grade trichoblastic carcinomas can metastasize. |
Trichoblastic carcinoma of the skin is not reportable. The WHO classification lists trichoblastic carcinoma as a synonym for basal cell carcinoma, 8090/3. Basal cell carcinoma of the skin is not reportable. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf. |
2015 |
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20150058 | MP/H Rules/Multiple Primaries: Is this counted as one or two primaries?
Patient is diagnosed with SCC esophageal cancer. Work-up reveals a lung nodule. Lung FNA (cytology) is read by the pathologist as SCC, favor metastatic esophageal SCC. However, the managing physicians are treating the patient as two separate primaries. |
If the patient is being managed and treated as a case of primary lung cancer, report the lung diagnosis as a separate primary. |
2015 | |
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20150013 | Surgery of Primary Site: What is the most extensive, invasive or definitive surgical procedure when the second surgical procedure performed has a lower surgery code? See discussion.
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Examples
8/xx/13 TURBT with path specimen (27): Papillary Urothelial Carcinoma, HG 9/xx/13 Bladder fulgeration w/o path specimen (12)
5/xx/14 Segmental Mastectomy(24): Ductal carcinoma with <1mm marg 6/xx/14 Breast Re-excision (23): Residual ductal carcinoma 1.5mm, marg neg |
The code in Surgical Procedure of Primary Site should correspond to the most invasive, extensive, or definitive surgery when the patient has multiple surgical procedures of the primary site even if there is no residual tumor found in the pathologic specimen from the more extensive surgery. The timing of the procedures does not affect the code choice.
Assign code 27 for the first example. Assign code 24 for the second example. |
2015 |
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20150015 | Primary Site--Testis: What is the prmary site for a 38 y/o male diagnosed with testicular cancer in a formerly undescended testis that was treated with orchiopexy at age 10-11? See discussion. |
Should it be coded to where the testis was physically at the time of diagnosis (C621), or should it be coded to C620 to reflect the increased risk for developing malignancy in an undescended testis? |
Code the primary site C621 (descended testis). The primary site of this neoplasm is a scrotal (descended) testis. The history of orchiopexy can be noted in a text field, but does not change the primary site in this case. |
2015 |
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20150040 | Surgery of Primary Site--Pleura: How is this field coded if the patient underwent an exploratory thoracotomy with partial decortication that excised some, but not all, of the pleural mesothelioma tumors? See Discussion. |
This patient underwent a "partial decortication" per the operative report. While the operative report does not specifically note that this was performed with a partial pleurectomy, it appears the patient had a partial pleurectomy because the largest specimen removed was a "pleural peel" specimen, which included the parietal and visceral pleural surfaces with a small amount of underlying lung tissue. The operative report notes the patient had involvement of both the lung and chest wall. A total resection was not possible due to the extent of the tumor. However, this patient does appear to have undergone at least a partial resection of the pleura/tumor burden. The patient did not simply undergo a pleurodesis to free adhesions. Per the NCI's PDQ, pleurectomy and decortication are performed together. Because the operative report and pathology report only called this procedure a "partial decortication" without specifically mentioning a pleurectomy, would this be coded as a tumor excision (surgery code 20)? Or should we assume the procedure is best coded as a partial pleurectomy and decortication and use code 30 (simple/partial resection)? |
Read the operative report and the pathology report and assign the surgery code that best represents the extent of the surgery. In this case, code 30 seems most appropriate. Do not assign the surgery code based only on the name of the procedure; use all information available to chose the most representative code. |
2015 |
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20150042 | Surgery of Primary Site--Breast: Is the surgery code 42 or 52? Does it matter that the procedure states no axillary LN, but the pathology found 2 additional LN? See discussion.
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Procedure stated = Bilateral skin-sparing mastectomies, left axillary sentinel lymph node biopsy. On the pathology report it indicates two additional lymph nodes were removed that were not SLN. The axillary aspect measures 2 x 2 x 1 cm. Two lymph nodes are identified ranging from 0.5 up to 1 cm. The lymph nodes are bisected and entirely submitted. Final Diagnosis Left breast, mastectomy including nipple: no residual carcinoma; FINAL DIAGNOSIS for LN = Lymph nodes, left axillary sentinel #1; excision: Two lymph nodes examined - negative for tumor (0/2); Two lymph nodes - negative for tumor (0/2) |
Assign surgery of primary site code 42. It is possible to obtain lymph nodes in a mastectomy specimen without an axillary dissection. Remember to capture the excised lymph nodes in the scope of lymph node surgery field. |
2015 |
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20150051 | Reportability--Brain and CNS: Is schwannoma of the extracranial part of a cranial nerve reportable? Some cranial nerves, like facial nerve, have intracranial and extracranial branches. |
An extracranial schwannoma is not reportable. The schwannoma must arise on the intracranial part of the nerve to be reportable. |
2015 | |
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20150011 | Surgery Primary Site--Breast: Please clarify how to code both simple mastectomy with tissue expander and AlloDerm reconstruction, and simple mastectomy with tissue expander (NOS). See discussion. |
There are multiple SEER Notes in the Breast Surgery Codes of Appendix C instructing us to code tissue expanders as reconstruction but none address the type of reconstruction to be coded.
1. Is a tissue expander always equivalent to Implant reconstruction? 2. Is AlloDerm always equivalent to Tissue reconstruction? 3. Is the combination of AlloDerm and tissue expander always equivalent to Combined (tissue and implant) reconstruction? |
Do not code AlloDerm as either a tissue or implant reconstruction, it is a graft material that usually accompanies implant reconstruction. Placement of a tissue expander is an indication of planned reconstruction. Additional information is needed to determine whether the reconstruction involves tissue or implant.
1. A tissue expander is not always equivalent to Implant reconstruction 2. AlloDerm is not equivalent to tissue reconstruction 3. The combination of AlloDerm and tissue expander is not equivalent to combined (tissue and implant) reconstruction |
2015 |
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20150018 | First course of treatment--Immunotherapy: Should Rituxan be coded to immunotherapy? See discussion. |
Is the instruction under #4.b. on page 114 of the 2014 SEER Program Coding and Staging Manual incorrect? It says to code Rituxan as chemotherapy. |
Rituxan changed categories from chemotherapy to a biologic therapy/Immunotherapy agent effective with cases diagnosed January 1, 2013. See page 150 or page 164 in the 2015 SEER manual. The instruction in the 2014 SEER manual was incorrect regarding Rituxan. |
2015 |
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20150064 | Primary site--Head & Neck: When there is invasive in one subsite and in situ in another, do you code the subsite with the invasive only? Would the correct site be C320, C328, or C329? See discussion. |
LARYNGOSCOPY - ENDOLARYNGEAL EXAM WAS GROSSLY UNREMARKABLE EXCEPT THAT SHE APPEARS TO HAVE A T1A SQUAMOUS CELL CARCINOMA OF THE RIGHT TRUE VOCAL FOLD. IT EXTENDS FROM ALMOST THE ANTERIOR COMMISSURE ALL THE WAY BACK TO THE VOCAL PROCESS AND IS EXOPHYTIC IN NATURE. IT DOES NOT EXTEND INTO THE VENTRICLE OR ONTO THE FALSE VOCAL FOLD. NO SUBGLOTTIC EXTENSION IS SEEN. A. RIGHT POSTERIOR FALSE VOCAL CORD FOLD, BIOPSY: SQUAMOUS CELL CARCINOMA IN SITU. B. RIGHT POSTERIOR TRUE VOCAL CORD FOLD, BIOPSY: SQUAMOUS CELL CARCINOMA, SUSPICIOUS FOR INVASION. C. RIGHT MID TRUE VOCAL CORD, BIOPSY: SQUAMOUS CELL CARCINOMA, SUSPICIOUS FOR INVASION. D. RIGHT ANTERIOR TRUE VOCAL FOLD, BIOPSY: INVASIVE AND IN SITU SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED. |
See the Head & Neck Terms and Definitions for guidance on coding the primary site, pages 17-18, http://seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
Based on the information provided, use the statement from the endoscopy report and assign primary site to right true vocal fold [cord], C320. |
2015 |