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Report Produced: 11/28/2024 21:54 PM

Report Question ID Question Discussion Answer Year
20061047 CS Extension/CS Mets at Dx--Peritoneum: How are these fields coded for extraovarian peritoneal carcinomas presenting with multiple peritoneal implants? See Discussion.

Patient presented with large omental cake and multiple peritoneal implants including implants on the rectosigmoid serosa and right ovary. Path revealed papillary serous adenocarcinoma consistent with peritoneal primary.

Per AJCC Manual, extraovarian peritoneal carcinoma is usually staged with the ovarian staging classification.

We understand that the CS Manual will eventually be revised to include staging for extraovarian peritoneal primaries. In the meantime, how do we use the existing CS scheme for peritoneum to code these cases?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS Extension 99 [unknown] and CS Mets at DX 99 [unknown].

The issue has been sent to the CS steering committee for resolution. This answer will be updated when the steering committee provides a resolution.

 2006
20051011 CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.

Code SSF 4 and 5 000 [Nodes clinically negative].

 2005
20061045 CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded for a melanoma primary when melanoma is identified in lymph nodes but no primary skin tumor is found? See Discussion.

Excisional biopsy of an inguinal lymph node revealed metastatic melanoma. Multiple skin biopsies did not reveal the primary site.

Subsequent lymph node dissection of superficial inguinal nodes showed microscopic focus of malignant melanoma in subcutaneous fat adjacent to previous procedure site. No evidence of metastatic melanoma in 7 lymph nodes. Dissection of external iliac lymph nodes showed no evidence of melanoma in 5 lymph nodes.

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS Lymph Nodes 80 [Lymph nodes, NOS]. Code CS Mets at DX 00 [None]. Since it cannot be determined whether the lymph nodes are regional or distant, code CS Lymph Nodes to lymph nodes, NOS.

 2006
20081088 CS Lymph Nodes/CS Mets at Dx: How should these fields be coded for an in situ diagnosis when the patient was diagnosed by biopsy only and there is no information in the chart regarding an evaluation of lymph nodes or metastatic sites? See Discussion.

In reference to the case below, does it make a difference if the CS T stage is known based on the primary excision but there is no clinical information in the record regarding the nodes or metastasis evaluation.

This scenario is seen on outpatient records of breast biopsies and melanoma excisions; i.e., punch bx followed by gross excision of the lesion but the medical record contains no clinical information or statement of everything else normal.

I&R Question 17625 2/16/2006

A patient was diagnosed with ductal carcinoma in situ by needle core biopsy of the right breast. There was no further information in the chart stating if or where the patient went for staging work-up and treatment. What are the codes for CS Extension, CS Regional Lymph Nodes and CS Distant Mets at Dx?

I&R Answer: Sufficient tissue must be taken to determine the T category. If this is the case, CS Extension = 00.

Unless the physician makes the statement that the physical exam is negative, code the CS Regional Lymph Nodes = 99 CS Distant Mets at DX = 99.

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS Lymph Nodes and CS Mets at Dx 00 [None] for an in situ diagnosis with no other information.

The CS instructions state that CS LN's should be coded 00 for in situ because in situ by definition is non-invasive. The same logic applies to CS mets in the case of in situ. The I&R answer will be revised.

 2008
20051019 CS Lymph Nodes--Breast: How is this field to be coded if the pathologist staged the case pN1a and the lymph node is stated to be negative on H&E, is .3 cm on IHC stain for pancytokeratin but on review of smears shows no malignant cells?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS Lymph Nodes as negative [00]. The positive stain for pancytokeratin is contradicted by the statement "malignant cells are not identified." See also sinq 20010055.

 2005
20061017 CS Eval--Prostate: How is CS Ts/Ext Eval to be coded for a clinically inapparent prostate cancer that is treated with Lupron and a subsequent prostatectomy? See Discussion. Patient diagnosed with prostate cancer on biopsy for elevated PSA, CS extension code 15. Patient then receives 4 courses of Lupron. Subsequent radical prostatectomy shows bilateral lobe involvement with capsule invasion, SSF 3 pathologic extension code 032.

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS TS/Ext Eval 6 [surgical resection performed with pre-surgical systemic treatment, tumor size/ext based on path evidence]. For prostate, CS TS/Ext eval must reflect coding of CS extension and SSF 3. In this case, SSF 3 code 032 is based on the prostatectomy information which occurred after systemic treatment.

 2006
20071035 CS Extension--Prostate: Should CS Clinical Extension always be coded to 99 [Extension unknown] for prostatic adenocarcinoma found incidentally during surgery for another primary or at autopsy? See Discussion.

Patient had a cystoprostatectomy for bladder cancer. Pathology report states only 2 microscopic foci of prostate adenocarcinoma found on LEFT side of gland. Physician notes state patient has been followed for 4 years with a nodule in the RIGHT prostate and has refused biopsy despite rising PSA. There was no definite statement of suspected cancer.

Should CS Clinical Extension be coded 99 because prostate cancer wasn't clearly stated to have been suspected until cystoprostatectomy? Or could we code the right-sided "nodule" as clinically apparent (CS Extension 20), even though path found tumor only on the left (which is how we would code a standard prostate case)?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS extension 99 [Extension unknown]. This prostate cancer was not clinically evident; it cannot be clinically assessed based on the information provided.

Note: This is an unusual case. A DRE was performed and a nodule was palpated on the right that was not cancer. The other lobe is presumed to have been negative because it was not mentioned.

 2007
20061103 CS Extension--Bladder: How is extension coded if the bladder tumor involves the right ureter per cystoscopy but the TURB specimen demonstrates muscularis propria invasion?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS extension based on the area of deepest invasion. According to the TNM Supplement, which was used as a resource in the development of CS, "Direct invasion of the distal ureter is classified by the depth of greatest invasion in any of the involved organs." Record the greatest extent of disease using both clinical and operative/pathologic assessment.

 2006
20061092 CS Tumor Size--Breast: Should this field be coded to 999 [Unknown] or 008 [0.8 cm tumor] when the tumor size is not provided on a stereomammotomy biopsy for an in situ malignancy and a subsequent excision demonstrates 0.8 cm tumor of residual in situ disease?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS tumor size 008 [0.8cm]. A mammotomy specimen is very small, so for this case, the residual tumor size is quite accurate. Size is not a critical data element for in situ breast cancer.

 2006
20061039 CS Tumor Size/CS Site Specific Factor--Breast: Should the tumor size be coded to 1.5 cm or 2.5 cm and SSF6 coded to 020 or 030 respectively for a tumor with invasive and in situ components described as being a 2.5 cm tumor with a "greater than" 1.5 cm invasive portion? See Discussion. Should tumor size be coded to 1.5 cm and SSF6 coded to 020 [Invasive and in situ components present, size of invasive component stated and coded in CS Tumor Size] or should the tumor size be 2.5 cm with SSF6 coded to 030 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and in situ described as minimal (less than 25%)]?

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Code CS tumor size 992 [stated as greater than 1 cm] and SSF6 code 020.

The September 2006 revision to the CS Tumor Size table now lists the 992-995 range codes as "greater than ___ cm."

It is better to code the invasive size than the entire size of the tumor. In the TNM mapping, this would more accurately portray the tumor as T1c rather than T2.

 2006