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| Report | Question ID | Question | Discussion | Answer | Year |
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20160031 | MP/H Rules/Histology--Brain and CNS: What is the code for Rosette-forming glioneural tumor from a pathology report of a brain tumor biopsy for a date of diagnosis in 2015? See Discussion. |
This diagnosis is not listed in the ICD-O-3 though it is listed as code 9509/1 for this specific tumor in the 2007 WHO classification of Tumours of Central Nervous System. (See link: http://link.springer.com/article/10.1007/s00401-007-0243-4/fulltext.html.) |
Assign 9505/1 for Rosette-forming glioneuronal tumor. The new code, 9509/1, has not been implemented in the United States. 9505/1 is to be used until the new code is implemented. See page 7 of the NAACCR Guidelines for ICD-O-D Implementation, effective January 1, 2014, http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466. |
2016 |
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20220031 | Tumor Size/Neoadjuvant Treatment: If a patient discontinues neoadjuvant therapy and then has surgery, how is the pathologic tumor size coded with the pathologic tumor size greater than the clinical tumor size? Currently, we are instructed to code 999 for the pathologic tumor size when neoadjuvant therapy is given; what happens when neoadjuvant chemotherapy is discontinued after 3 cycles (plan for 4 cycles)? |
Assign 999 for pathologic tumor size when patient has received neoadjuvant therapy, even when neo-adjuvant therapy is not completed. Describe the details in text fields. |
2022 | |
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20200028 | 2018 EOD Primary Tumor/2018 EOD Mets--Lung: Is EOD Primary Tumor coded to 500 and EOD Mets 10 when there are bilateral lung nodules with nodules in same lobe as the primary tumor? How is EOD Primary Tumor coded when separate tumor nodes are in an ipsilateral lung but there is no documentation as to whether it is in the same or different ipsilateral lobe from the primary tumor? |
Assign 999 to EOD Primary Tumor if this is the only information you have for your case.The mention of nodules does not automatically mean that you have separate tumor nodules. There are many reasons for the appearance of nodules in the lung, some of which are not due to cancer. Unless you have further information on whether the physician has determined that they are related to the lung cancer, then assume that they are not related. Assign 00 to EOD Mets. Do not code EOD Mets to 10 since you cannot determine whether those nodules are based on the tumor or not. If you are able to obtain more information, then you can update the EOD Primary Tumor and EOD Mets. Regarding the second question, if separate tumor nodules are noted, you cannot assume that they are due to tumor. Further information, or clarification, is needed on whether the separate tumor nodules are related to the lung cancer. Without further information, code EOD Primary Tumor to 999. There is also some information in the CAnswer Forum since Separate Tumor Nodules are a Site-Specific Data Item: http://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/96061-lung-separate-tumor-nodules |
2020 | |
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20140009 | Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets. |
Assign C139 for a primary originating in the parapharyngeal space. This space contains part of the parotid gland, adipose tissue, lymph nodes, nerves, arteries and veins. |
2014 | |
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20160021 | Primary Site--Stomach: How do I code the primary site when the operative report and pathology report state that the tumor site is incisura of the stomach? |
Assign C163. Incisura, incisura angularis, gastric angular notch, angular incisure of stomach all refer to the sharp angular depression in the lesser curvature of the stomach at the junction of the body with the pyloric canal. See Gastric angular notch in #12 on page 76 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf. See also the SEER training website, #12 on the illustration corresponds to the angular notch, http://training.seer.cancer.gov/ugi/anatomy/stomach.html. We will correct the key for this illustration. |
2016 | |
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20180024 | Primary site--Colon: What is the correct topography code for appendiceal orifice? See Discussion. |
From a number of definitions reviewed, it seems unclear if it's part of the appendix or the cecum of the colon. For example: The cecum is usually located in the right iliac fossa. In the pole of the cecum, there is often the appearance of fusion of the three teniae coli around the appendix, giving rise to the tri-radiate fold (Mercedes Benz sign), but the anatomy can be variable. The most reliable landmarks of the cecum are the appendiceal orifice and ileocecal valve. The appendiceal orifice is usually an unimpressive slit, often crescentic in shape. The ileocecal valve is made up of the superior and inferior lips (usually not seen en face) and is the gateway leading into the terminal ileum. It is located on the prominent ileocecal fold encircling the cecum, between 3 and 5 cm distal to the cecal pole. (https://www.sciencedirect.com/science/article/pii/S2212097113701730) |
Assign C180, Cecum, when the neoplasm originates in the appendiceal orifice. The appendiceal orifice is a landmark in the cecum. During colonoscopy, visualization of the appendiceal orifice indicates that the entire colon was examined, from the anus to the cecum. |
2018 |
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20150035 | Primary site--Anus/Anal Canal: What site do you code squamous cell carcinoma of the anal verge? |
Assign C211 for anal verge. Anal verge is defined as the lower (distal) end of the anal canal, junction between the skin of the anal canal and the perianal skin, http://www.seer.cancer.gov/manuals/2015/AppendixC/rectosigmoid/coding_guidelines.pdf |
2015 | |
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20220041 | Primary Site/Histology--Intrahepatic Duct: How are primary site and histology coded for cholangiocarcinoma cases when the pathology only shows a liver tumor and other involvement. See Discussion. |
A common scenario is a patient has a positive CT of the abdomen/pelvis for liver mass only. Biopsy of the liver mass is positive for cholangiocarcinoma. The physician is also calling the liver tumor the primary site with histology of cholangiocarcinoma. There is no evidence of intrahepatic bile duct (C221) or gallbladder (C240) involvement which are sites specific to this histology. The hematology/oncology consult stages this as Stage IIIA, T3N0M0 intrahepatic cholangiocarcinoma. Can we code cholangiocarcinoma with site code C220 (liver) or should we assume that C221 (intrahepatic bile ducts) would be a better code to reflect this histology? |
Assign C221 (intrahepatic bile duct) as the primary site for cholangiocarcinoma (8160/3). Our expert GI pathologist confirms that even when intrahepatic bile ducts are not specifically mentioned, intrahepatic cholangiocarcinoma originates in the intrahepatic bile ducts. |
2022 |
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20210051 | Primary site/Biliary tract--Ampulla of Vater: What is the correct primary site code for intra-ampullary and periampullary adenocarcinoma, C241 (8144/3) or C249? See Discussion. |
Ampulla, biopsy: High grade dysplasia with focal intramucosal carcinoma in a background of ulceration with acute and chronic inflammation. Surgery pathology: Head of pancreas, duodenum, and distal stomach, pancreaticoduodenectomy-Ampulla, Adenocarcinoma, intestinal type, intra-ampullary and peri-ampullary (mixed type). Grade moderately differentiated, 1.5cm. Tumor invades into duodenal submucosa. Lymphovascular Invasion: Foci suspicious for lymphovascular invasion identified. Perineural Invasion: Present. Synoptic report: Tumor Site Intra-ampullary and peri-ampullary (mixed type). Histologic Type Adenocarcinoma, intestinal type. There is not enough information regarding site in radiology reports or operative report. CT-A/P/C:The patient's known ampullary mass is not well visualized on this exam. No significant intrahepatic or extrahepatic biliary ductal dilation is identified. The pancreatic duct is normal caliber. |
Assign C241. Ampulla (C241) includes both periampullary and intra-ampullary. |
2021 |
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20180016 | Primary site--Pancreas: Is the uncinate process of the pancreas coded to C259, C250, or C257? |
Assign C250 to the uncinate process of the pancreas. The uncinate process is part of the head of the pancreas. |
2018 |
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