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20031202 | Surgery of Primary Site--Head & Neck: How is this field coded for a surgery titled "Parotidectomy with facial nerve dissection"? See Description. | If the operative report is not titled "total parotidectomy," can we assume that less than total parotidectomy was done? Can we assume that "facial nerve dissection" and "facial nerve monitoring" are other ways of stating "facial nerve spared"? | Use the best information available to determine whether or not all of the parotid has been removed. It is important to read the entire operative report and review the content of the pathology report. The Op report will usually include wording about how much was removed, and this can be confirmed by the path report. Do not make assumptions about the extent of the surgery based solely on the title used on the operative report.
For cases diagnosed 1998-2003: Code 30 [less than total parotidectomy] can be used when the parotid is not totally removed, but the exact type of partial parotidectomy cannot be determined. "Facial nerve monitoring" and "Facial nerve dissection" are synonymous with "facial nerve sparing." |
2003 |
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20021090 | Primary Site--Ovary/Peritoneum: How should the Primary Site field be coded when no resection is done and it is uncertain whether the primary site is in the ovary or the peritoneum? See discussion. | CT: ascites, omental cake and peritoneal studding. H&P impression: probable ovarian or peritoneal primary. Repeat CT: no enlarged adnexal mass seen to suggest ca of ovary, but possibility couldn't be ruled out. Omental bx: Metastatic ca. Comment: "IHC stains have been performed and are not typical of ovarian ca, although do not exclude an ovarian primary." After the bx, there were two clinical diagnoses written a month apart with no evidence of further work-up between those dates. The first diagnosis was "ovarian ca". The second was "Peritoneal carcinomatosis 2 month ago; Primary is unknown, possibly ovarian." | Use the best information available to identify the primary site. In this case, it is the physician's clinical assessment. Code the Primary Site to C56.9 [Ovary] for this example because the ovary is indicated to be the primary site according to the physicians involved.
When there is no surgical procedure involving the removal of the ovaries, code the Primary Site based on the clinical assessment of the disease location. If the disease is only noted to be in the peritoneum, code site to peritoneum, NOS. If the disease is seen clinically in both the ovary and the peritoneum, code site to ovary. |
2002 |
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20031072 | EOD-Pathologic Extension--Prostate: Is extracapsular extension implied by the phrase "tumor invades the fibrous tissue of the capsule"? See Description. |
The physician staged to a pathology stage of T3. It appears the physician regards the following pathology statement to be equivalent to capsular invasion on the right side: "Tumor invades the fibrous tissue of the capsule on the right side where it approaches to within 1 mm. of the surgical margin." Should pathologic extension be coded to 42[unilateral extracapsular extension]? |
Use the best information available to stage the case. In this case, the best information is the pathologist's description of the tumor extension rather than the AJCC stage. For cases diagnosed 1995-2003: Extracapsular extension is not implied by the phrase in the question. Code the capsular involvement described to 32 [invasion into but not beyond the prostatic capsule] on the basis of the pathology report. |
2003 |
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20150022 | Grade--Bladder: Do you use the grade stated on the pathology report for coding the grade/differentiation field for bladder and renal pelvis field? See discussion. |
Please confirm correct coding for grade for papillary urothelial carcinoma of the bladder/renal pelvis and urothelial carcinoma of the bladder/renal pelvis. SEER Manual 2014 and 2015 state: "Do not use these tables to code grade for any other groups including WHO (CNS tumors), WHO/ISUP (bladder, renal pelvis), or FIGO (female gynecologic sites) grades." They also state "In transitional cell carcinoma for bladder, the terminology high grade TCC and low grade TCC are coded in the two-grade system" in the Grade section. These statements are not included in SEER Manuals prior to 2014. |
Use the grade stated on the pathology report to code grade/differentiation for bladder and renal pelvis field unless the grade is stated to be WHO/ISUP grade. |
2015 |
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20230025 | Histology--Cervix: Can human papilloma virus (HPV) or p16 testing results from a non-reportable high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN 3) pathology report be used to code histology as squamous cell carcinoma (SCC), HPV-positive (8085), if subsequent excision/resection identifies invasive SCC and no further HPV or p16 testing is done on the invasive specimen? See Discussion. |
Example #1: Cervix loop electrocautery excision procedure (LEEP) pathology: Histologic Type: Squamous cell carcinoma, HPV-associated. Histologic Type Comments: High-risk HPV testing on previous Pap test sample reported as positive for high-risk HPV. The prior Pap diagnosis was HSIL only with molecular results positive for high-risk HPV. Example #2: Cervix endocervical curettage and biopsy with CIN 3, p16 diffusely positive. Subsequent LEEP with superficially invasive squamous carcinoma (no HPV or p16 testing done). This was followed by an additional cone excision that was negative for residual malignancy and p16 testing was also negative. |
Use the histology codes SCC, HPV-associated (8085/3) and SCC, HPV-independent (8086/3) only when HPV testing is done on that specimen. Do not use previous HPV tests to code the histology. Code as SCC, NOS (8070/3) in both examples as no HPV testing was performed on the LEEP procedure specimens that identified the SCC. |
2023 |
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20091084 | Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? Are there priority rules for coding subsite for sites other than Head and Neck? See Discussion. | The path report for a hemicolectomy says, " Specimen: left colon..." and the microscopic says, "...received in formalin designated left colon..." The Operative procedure report says, "Postoperative diagnosis - splenic flexure tumor." The text of this report says, "Mobilizing the splenic flexure mass was incredibly difficult..." and then goes on to describe exactly how and where it was resected. The discharge summary says adenosquamous carcinoma of the splenic flexure. SINQ20051010 says to use the pathology report first, but this was written before the new MP/H rules. | Use the operative report information to code primary site in this case. It is more accurate. The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her. The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69. |
2009 |
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20110093 | Residence at dx: After living elsewhere (Florida) and traveling around the country in an RV with his spouse, is a patient a resident of this area for either primary if he was diagnosed with his first primary less than a month after arriving in the area and a second primary more than a year after parking his RV here? |
Use the patient's usual residence to determine residency. If the usual residence is not known or the information is not available, use the residence the patient specifies at the time of diagnosis. The SEER rules for determining "usual residence" match the rules used by the US Census Bureau. |
2011 | |
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20160010 | Grade--Head & Neck: How should grade be coded for a tonsillar primary (or other solid tumor) with resection pathology final diagnosis of poorly differentiated SCC with histologic grade: G2-3 of 3. See discussion. |
We are seeing multiple head and neck cases with unclear or multiple grade assignments. Another example is alveolar mucosa SCC with histologic grade stated as: Moderately differentiated (G2 of 3). Grade Coding for Solid Tumor instruction 5.b. is not clear regarding this situation. Does a statement of differentiation take priority? Should we disregard the differentiation statement and code using the 3-grade systems? |
Use the three-grade system table in instruction #7.b to code grade for the situations you describe. Use the Grade Coding Instructions in order. Instruction #7.b (three-grade system) comes before instruction #8 (terminology).
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2016 |
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20130194 | Reportability--Brain and CNS: Are blood vessel tumors arising in CNS sites reportable? See Discussion. |
Previous instructions from the CDC (Cancer - Collection and Coding Clarification for CNS Tumors - NPCR) stated that non-malignant blood vessel tumors in CNS sites are reportable and should be coded to the CNS site in which they arose. SINQ 20081113 also states that a blood vessel tumor, cavernoma/cavernous hemangioma, in the brain is reportable. However, SINQ 20120034 contradicts this previous answer stating the site should be coded to C490 [blood vessel] for a blood vessel tumor (venous angioma) in the brain. If blood vessel tumors arising in a CNS site are no longer reportable, please specify the site/histology codes for these non-reportable tumors and when this change took place. |
Vascular tumors of the CNS are reportable when they arise in the dura or parenchyma of the CNS and should be coded accordingly. The instructions in the CDC book regarding primary site coding are not the most current instructions.SEER assumed responsibility for brain and CNS reporting instructions in 2007. The tumor in SINQ 20120034 is not reportable because it arises in a blood vessel. The cavernous hemangioma in SINQ 20081113 is reportable because the primary site is the white matter of the cerebral cortex. |
2013 |
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20120034 | Primary site--Brain and CNS: How is the primary site to be coded if a clinician used an MRI to diagnose a left cerebellar venous angioma? See Discussion. |
According to the WHO Classification of Brain/CNS Tumors, code 9122/0 (venous angioma) does not appear under tumors of the cerebellum (C716). |
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous angioma arising in the cerebellum is C490. The combination of 9122/0 and C490 is not reportable. Venous angioma is a venous abnormality, currently referred to as a developmental venous anomaly (DVA). |
2012 |
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