Surgery of Primary Site--Kidney, renal pelvis: How do you code a laparoscopic renal mass core biopsy followed by cryoablation of the tumor? See Discussion.
The note under the local tumor destruction codes states "No specimen sent to pathology from this surgical event 10-15." The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted?
Code for Surgery of Primary Site to 13 [Cryosurgery]. While the core biopsy provided a pathology specimen, it is not coded as surgery of the primary site.
Grade--Kidney, renal pelvis: How is this field coded for a non-invasive high grade papillary urothelial carcinoma of the renal pelvis? See Discussion.
Per instructions in the 2010 SEER Manual, Appendix C, Coding Guidelines for Bladder, "Code grade 9 (unknown) for non-invasive urothelial (transitional) tumors." The Coding Guidelines listed under Renal Pelvis, Ureter are only for Kidney [C649]. Do the grade instructions under bladder apply to ALL non-invasive urothelial tumors, or are we to use the kidney grading instructions to code grade for renal pelvis and ureter malignancies?
Code grade to 4 [high grade]. Follow the instructions in the main part of the 2010 SEER Manual under the data item Grade (pages 73 - 76). There are no specific instructions for coding grade for renal pelvis. Apply the general instructions in the absence of site-specific instructions.
Histology--Heme & Lymphoid Neoplasms: Should the higher histology code associated with grade 1 follicular lymphoma [9695/3] be used rather than grade 2 follicular lymphoma [9691/3] in cases of follicular lymphoma grade 1-2?
Code histology to 9691/3 [follicular lymphoma, grade 2], histology. For follicular lymphoma, when there is a grade such as 1-2 indicated, take the histology associated with the higher grade disease process, even though the lower grade histology code is higher.
Laterality--Breast: Should laterality be coded to 9 [Paired site but no information concerning laterality] or to the side with the positive lymph nodes for a case in which no breast mass is found but positive axillary lymph nodes are found on only one side?
Code laterality of the primary site to the side with the positive nodes when there are unilateral positive nodes and the laterality of the primary site is otherwise unknown.
Marital Status: Is marital status coded to 2 [married] if the patient is legally married to a same-sex spouse (e.g., patient has a Canadian spouse and in Canada, same-sex marriages are legal)?
Code marital status for same-sex persons based on the legal status. For the case example above, assign code 2 [married].
MP/H Rules/Histology--Lung: What would the histology code be for a wedge bx of the left lung, lower lobe, that was read out as well differentiated adenocarcinoma with micropapillary features?
Code papillary adenocarcinoma 8260/3. The ICD-O-3 codes for micropapillary have specific associations such as ductal, serous or transitional. None of those associations fit lung primaries.
Primary Site--Melanoma: How would this field be coded for a pleural effusion consistent with metastatic melanoma and "no skin lesions?"
Code primary site as C44.9 [Skin, NOS]. ICD-O-3 does not list a suggested site code for 8720/3 because melanoma can arise in other parts of the body. However, C44.9 [Skin, NOS] is the default when the primary cannot be found.
Primary site--Bladder/Unknown & ill-defined sites: Should the coding of primary site be based on a molecular study when it is not verified by a clinical correlation? See Discussion.
Patient was seen in 2009 at Hospital A for bone pain and was found to have metastatic adenocarcinoma. A paraffin block specimen was sent to BioThernostics for THEROS CancerTYPE ID Molecular Cancer Classification Tests. The results came back with a 94% likelihood that the urinary bladder was the primary site. No scans were done on the abdomen or pelvis.
The patient was then sent to Hospital B for radiation to the bones and chemotherapy (Carboplatin and Taxol). The patient died within 6 months.
According to Hospital A, the primary site is bladder based on the molecular study report. Hospital B says this is an unknown primary. Which is correct? Do we take primary site from these tests, even when no clinical correlation is documented?
Code primary site to bladder in this case. Code the known primary site when given the choice between a known primary site and an unknown primary site.