CS Extension--Bladder: How should this field be coded when the pathology states "papillary transitional cell carcinoma with no invasion into the submucosa or deep muscularis" but there is "focal extension of tumor into bladder diverticula"?
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 the CS Extension field to 01 [Papillary transitional cell carcinoma stated to be noninvasive]. Extension into bladder diverticula does not change the code. Diverticula are pouches in the mucosa (mucous membrane).
CS Extension--Lung: How is extension coded if there is only one cytology done on a pleural effusion that is negative for carcinoma (but shows an exudate) and there is no clinical assessment of the pleural effusion found in the medical record? See Discussion.
CS lung extension note 6 provides instructions from the SEER manual and also from the AJCC manual. Per SEER manual, "ignore the effusion that is negative for tumor." Do we ignore the pleural effusion for the case in question because it was negative? Per AJCC manual, "most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor. In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element." For the case in question, pleural fluid was examined only once and clinical judgment is not available. As a SEER registry, do we follow the SEER portion of the note and ignore the pleural effusion? Or do we code extension as involving pleural effusion because it was an exudate?
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.A single negative pleural effusion by itself does not impact the coding of extension.
The SEER note does not alter the AJCC note and the AJCC note does not alter the SEER note. They are two separate statements from two separate staging authorities. Registries follow both notes. For this case, ignore the pleural effusion because there is no clinical judgment available and there was only one cytology on the effusion.
CS Site Specific Factor 1--Colon: If the registrar did not support the CEA code recorded with the appropriate text documentation, should the central registry accept the registrars coding or change the value to 999?
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.Accept your registrars' codes at your discretion. It is encouraged, but not required, to enter text for CS data elements. These cases do not automatically default to code 999.
CS Extension: How is CS Ext coded for the following?
Rretroperitoneal primary
Cystic mucinous tumor with intraepithelial carcinoma
There is no CS Extension code for intraepithelial ca in the retroperitoneal scheme.
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.According to the American College of Surgeons I & R system, assign code 10 [confined to site of origin] for intraepithelial carcinoma of the retroperitoneum.
CS Site Specific Factor--Head & Neck: If a lymph node dissection of the neck reveals that 1/24 lymph nodes is positive and the positive 5.6 cm lymph node extends throughout levels II-IV, how are the SSF 3 (status of levels I-III lymph nodes) and SSF4 (status of levels IV-V lymph nodes) fields coded?
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.According to the CS Steering Committee, code 999 for SSF 3 and SSF 4. In this case, do not make assumptions about which level of lymph nodes were involved.
CS Tumor Size--Breast: How is this field coded for DCIS that is present in scattered small foci over five of eight slides, and the greatest aggregate dimension measures 0.5 cm? See Discussion.
Breast biopsy was prompted by abnormality seen on mammography. Would this be an example of when to code 996 (mammographic/xerographic diagnosis only, no size given; clinically not palpable) applies for the CS Tumor Size field?
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.Assign code 005 [0.5 cm] in this case. According to the General Instructions for CS tumor size, it is acceptable to code an aggregate size stated by the pathologist (see instruction 4.i).
CS Extension--Hematopoietic, NOS: Can this field be coded to 10 [Localized disease] for an extramedullary plasmacytoma that is limited to an extramedullary primary, such as appendix, given that this histology is not listed as one of the allowable histology/CS extension combinations for this code? See Discussion.
The Hematopoietic Diseases scheme for CS lists specific histologies for which CS Extension can be coded to 10. Included is plasmacytoma, NOS [9731/3]. However, extramedullary plasmacytoma [9734/3] is not listed as one of the histologies.
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.Assign code 10 [Localized disease].
Both the 2007 SEER manual (page C-1072) and the CS Version 01.04.00 manual (page II-550) have been updated to include 9734 [extramedullary plasmacytoma] under extension code 10.
CS Lymph Nodes--Head & Neck (Parotid): What code is used to represent a positive intraparotid or a periparotid lymph node for a parotid primary? See Discussion.
The CS scheme for parotid places intraparotid lymph nodes under code 10 as well as code 12. Periparotid lymph nodes are included under code 12. Should both intraparotid and periparotid lymph nodes be included under code 10 only?
For head and neck sites, several lymph node groups fall into the "Other groups" category. They are not included in the level I-VII groups. In the coding schemes for most (but not all) of the head and neck sites, the "other groups" category includes intraparotid and periparotid lymph nodes and is coded 12 (or 52).
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.Assign code 10 for a single positive intraparotid or periparotid lymph node. If multiple nodes are involved, assign the appropriate code from the 20 series.
A recent revision to the CS lymph nodes scheme for parotid places both intraparotid and periparotid lymph nodes under code 10. Please see the August 21, 2006 update to the CS staging manual.
CS Lymph Nodes: Are positive right superficial inguinal lymph nodes coded to 30 (which is the case for anal canal primaries) or 31 (which is the case for anus primaries) if the primary is stated to be in the "cloacogenic zone" or is an anorectal primary?
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.Assign code 30 for positive unilateral superficial inguinal lymph nodes for cloacogenic primaries. The cloacogenic zone is part of the anal canal.
CS Extension/CS Mets at Dx--Corpus uteri: Is a microscopic metastasis in a cul-de-sac implant more appropriately reflected in the CS Extension field code 80 [Further contiguous extension; cul-de-sac] or in the CS Mets at Dx field code 40 [Distant metastasis]?
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.Assign code 80 [Further contiguous extension; Cul de sac] for CS extension in this case. Endometrium and ovary are exceptions to the rules that only contiguous extension is coded in Extension code 80. Only true distant metastases are coded in Mets at Dx.
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