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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)?

Foreskin circumcision shows: Penile intraepithelial neoplasia, differentiated type (differentiated PeIN). If reportable, how would the histology and behavior be coded? Is this behavior /2?

Operative report indicates a wire localized lumpectomy was performed. The pathology report includes a final diagnosis for two specimens as follows:

A) LEFT BREAST, EXCISION: INFILTRATING DUCTAL CARCINOMA

B) LEFT BREAST, NEW DEEP MARGIN, EXCISION: BENIGN BREAST TISSUES AND BENIGN FIBROFATTY SOFT TISSUES; NO EVIDENCE OF NEOPLASIA.

The definition for Breast surgery code 23 is "Reexcision of the biopsy site for gross or microscopic residual disease". There is no indication whether the re-excision has to be a separate procedure or can be during the same procedure as the excisional biopsy (lumpectomy). Some hospital registrars in our region believe code 22 is more appropriate.

The patient was diagnosed with a carcinoid tumor of the small intestine. The pre-surgical work-up also identified a lung nodule that showed no octreotide uptake, but was indeterminate on biopsy. The imaging differential diagnosis included carcinoid, hamartoma, or a non-calcified granuloma. The patient underwent a resection of the primary small bowel tumor, and the physician noted the lung nodule was of unclear diagnosis. The physician stated a solitary lung metastasis would be atypical, but that lung metastatic involvement could not be ruled out. The physician recommended resection of the lung nodule to ensure that the patient was disease free. The lung wedge resection proved a pulmonary hamartoma.

The rules for coding Surgical Procedure of Other Site are not entirely clear. The definitions for First Course of Therapy in the SEER Manual do state that treatment includes, "Procedures that destroy or modify primary (primary site) or secondary (metastatic) cancer tissue." This would seem to exclude the lung resection as it did not destroy, modify or remove metastatic cancer tissue. However, the instructions for coding Surgical Procedure of Other Site do not address removal of distant sites that are not incidental. The lung resection was not incidental; the physician recommended it to ensure the lung was not involved, but it also disproved metastatic involvement. Should the Surgical Procedure of Other Site field be coded 0 (none) or 4 (non-primary surgical procedure to distant site) in this case?

There is a 1988 case that hit the SEER edits for other reasons but not because of that site/histo combination (C000 and 8090/3); however, there is no text.

Per a Dataminer query, there are 42 cases in the state database with C000-C009 and 8090.  On review, a few did have a mention of the word "upper lip/mucosa" in the PE text or OP findings (not path because a lot of these are removed in the MD office and we don't see the path report). Other times, there is no mention but the abstractor used the C00 codes instead of C44 so the cases get through.

SINQ #20031110 addresses this in relation to C000, Lip, NOS but we want to know if this answer meant you would never report a basal carcinoma lip case period (even if there is a mention of mucosa or any mention of mucosa in the path report). Are there any exceptions?

It seems if you would never report a basal lip carcinoma, then SEER would block those cases from being reported/submitted and the wording would be stronger in the SEER manual.

Right now the reportability only addresses if someone codes C44 but if someone decides to use C00 codes then it is allowed. Under Primary Site, there is even a listing under 12 for "absence of any additional information" and lists "Colored / lipstick portion of upper lip" as code C000.