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Report Produced: 07/25/2025 20:56 PM

Report Question ID Question Discussion Answer Year
20130219 Date of diagnosis/Ambiguous terminology--Breast: Can a mammogram BIRADS 4 or 5 assessment be used to assess reportability and can the date of the mammogram be used to code the date of diagnosis? See Discussion.

  1. Assessment: BIRADS category 4-suspicious. Findings are considered suspicious/indeterminate for malignancy

  • Assessment: BIRADS 5- highly suspicious. Findings are highly suggestive of malignancy.

  • Assessment: BIRADS 4- suspicious abnormality consider biopsy

    • Can the BIRADS number be used to assess reportability? Can a BIRADS assessment of "suspicious" be used to code the date of diagnosis?

    		BIRADS category 4 and category 5 mammograms are not to be interpreted as a reportable "malignancy" for cancer registry purposes nor are they to be used to code the date of diagnosis should the patient subsequently have a malignancy confirmed. 2013
    		20130168 Date of diagnosis--Heme and Lymphoid Neoplasms: Is the date of diagnosis coded to the date a bone marrow biopsy revealed "plasma cell neoplasm; plasma cells are < 10%" or the date a diagnosis of myeloma was noted in the Discharge Summary? See Discussion.

    Bone marrow biopsy pathology states: Plasma Cell Neoplasm. The plasma cells are < 10%.

    Subsequent to the bone marrow biopsy, the Discharge Summary indicated the patient has a diagnosis of myeloma, hypercalcemia and negative bone marrow surveys.

    What date is used for the date of diagnosis?

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Use the date of the Discharge Summary as the date of diagnosis. In this case, the date of diagnosis is the date the physician confirmed the diagnosis of myeloma using all information available.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2013
    		20130057 Histology--Heme & Lymphoid Neoplasms: How is the histology coded if the bone marrow biopsy favors lymphoplasmacytoid lymphoma and the physician states the diagnosis is lymphoplasmacytic lymphoma-Waldenstrom's macroglobulinemia? See Discussion.

    Bone marrow biopsy: Focal bone marrow involvement with B-cell lymphoproliferative disorder. Comment: This patient has 2 monoclonal proteins in serum, IgM kappa and IgG kappa clones. The marrow does have focal involvement with a small cell lymphoproliferative disorder. A lymphoplasmacytoid lymphoma is favored.

    Flow Cytometry: Bone marrow reveals a low level, kappa-bearing-B-lymphoproliferative population that has an immunophenotype compatible with mantle cell lymphoma or related small, mature non-Hodgkin lymphoproliferative disorder.

    Physician statement: lymphoplasmacytic lymphoma-Waldenstrom's macroglobulinemia.

    Per the Heme DB, the criteria to diagnosis WM is the serum paraprotein IgM. This patient's IgM was 6020 mg/dL. It was described as elevated per the physician. The physician also states the patient's IgG is elevated. According to the Heme DB, when both IgG and IgM are elevated it is indicative of LPL.

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Code the histology to 9671/3 [lymphoplasmactyic lymphoma (LPL)] per the Heme DB Abstractor Notes and Rule PH17. When IgG and IgM are elevated, code to lymphoplasmacytic lymphoma. Waldenstrom's macroglobulinemia is caused by increased lymphocytes which causes an increase in IgM. LPL has mixed abnormalities, both the lymphocytes and plasma cells are increased which results in an abnormally high IgM and IgG.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2013
    		20130124 Reportability--Heme & Lymphoid Neoplasms: Is Rosai-Dorfman's syndrome (histiocytosis) a reportable malignant condition? Rosai-Dorfman disease is not reportable. Rosai-Dorfman disease is a rare non-neoplastic disease. This disease can mimic lymphoma and extranodal involvement is frequent. 2013
    		20130097 Reportability--Heme & Lymphoid Neoplasms: Are either heparin-induced thrombocytopenia or heparin-induced thrombocytopenia that becomes refractory thrombocytopenia reportable?

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Heparin-induced thrombocytopenia is not reportable.

    If the diagnosis is changed to refractory thrombocytopenia, then this case is reportable.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2013
    		20130077 Reportability--Heme & Lymphoid Neoplasm: What is the histology code if a myeloproliferative disorder is reportable should a physician suspect this diagnosis and treats the patient? See Discussion. Physician suspects patient has a myeloproliferative disorder and treats her with a phlebotomy and Hydrea. Patient receives Hydrea during an inpatient stay, but does not see the Heme/Onc again. The patient is subsequently only seen by a Palliative Medicine physician who also states she has an underlying myeloproliferative disorder. The patient died while an inpatient.

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].

    The term is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4). Also, the patient was treated for a myeloproliferative disorder, making this a reportable clinical diagnosis per the SEER Manual (Reportability, Pg 4, Exception 1).

    Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2013
    		20130093 MP/H Rules/Histology--Lung: What histology code is used for an adenocarcinoma in situ/bronchioloalveolar carcinoma (BAC) of the lung? See Discussion.

    Classification of lung malignancies has undergone a change. The bronchioloalveolar carcinoma histology is being replaced by adenocarcinoma in situ and minimally invasive adenocarcinoma, using an evaluation of lepidic growth pattern in the tumor.

    The final diagnosis is "adenocarcinoma in situ/BAC" and the comment states, "The findings in the current biopsy are most compatible with low grade malignant lesions which, in this sample, shows features of adenocarcinoma in situ (former bronchioloalveolar adenocarcinoma), given the proliferation of pneumocytes is limited to the alveolar lining with no evidence of invasion. However, classification of the lesion depends, per reference guidelines (Travis et al. J THOR ONCOL 2011 6,(2):244-275), on its size and its overall histologic features, to rule out the presence of an invasive component and therefore can only be performed upon examination of it in its entirety, upon resection." The radiation oncologist staged this T1N0M0, stage 1 BAC.

    Code the histology to 8140/2 [adenocarcinoma in situ, NOS].

    The comment for this case is consistent with information from the CAP protocol, which says, "The diagnosis of bronchioloalveolar carcinoma requires exclusion of stromal, vascular, and pleural invasiona requirement that demands the tumor be evaluated histologically in its entirety. It is therefore recommended that a definitive diagnosis of bronchioloalveolar adenocarcinoma not be made on specimens in which the tumor is incompletely represented."

    This tumor was not completely resected. Therefore, code to adenocarcinoma in situ based on the information provided.

    		2013
    		20130119 Reportability--Heme & Lymphoid Neoplasms: Would this case be reportable? Patient with a myelodysplastic syndrome secondary to a copper deficiency. Myelodysplastic syndrome is a reportable disease. Document in the text that the MDS was due to a copper deficiency. 2013
    		20130132 Diagnostic confirmation--Heme & Lymphoid Neoplasms: What is the diagnostic confirmation code for a death certificate only (DCO) diagnosis of acute myeloid leukemia?

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Always code diagnostic confirmation to 9 [Unknown whether or not microscopically confirmed; death certificate only] for DCO cases.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		 2013
    		20130103 First course treatment--Heme & Lymphoid Neoplasms: Why isn't darbepoietin coded as treatment for hematopoietic diseases?

    Darbepoietin is a synthetic form of erythropoietin. It stimulates erythropoiesis (increases red blood cell levels) and is used to treat anemia, commonly associated with chronic renal failure and cancer chemotherapy.

    Darbepoietin is a support medication; it does not treat cancer. It is used to treat anemia caused by cancer directed chemotherapy treatments. It is not indicated for patients with myeloid cancers; cancers that originate in the bone marrow like leukemia.

    Darbopoietin is an ancillary drug and is not coded as treatment.

    		2013