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20200029 | Systemic/Surgery Sequence: The note associated with code 4 in Systemic Treatment/Surgery Sequence in the 2018 SEER Manual says: Code 4 is intended for situations with at least two episodes or courses of systemic therapy. Does this mean two different types of systemic therapy before and after surgery? See Discussion. |
For example, chemotherapy and immunotherapy administered first, followed by surgery, then immunotherapy and hormone therapy after surgery. Or is code 4 used for two administrations of chemotherapy before surgery and two more courses after surgery? |
Assign code 4 for the example you describe. Code 4 also applies to cases with one course of chemotherapy before surgery and another course after surgery. |
2020 |
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20200067 | Summary Stage 2018/Extension--Colon: What is the Summary Stage for adenocarcinoma of cecum where the tumor extends into the proximal portion of attached vermiform appendix? See Discussion. |
2020 Diagnosis: Patient had a right hemicolectomy showing adenocarcinoma of cecum, tumor extends into proximal portion of attached vermiform appendix. Tumor invades through muscularis propria into pericolorectal tissues (NOS). Regional lymph nodes: 06/39. Primary Tumor EOD: Where does the appendix involvement come into coding or will this be based on the pericolorectal tissue (NOS) invasion? What is my Summary Stage? I know it is at least 3 due to regional ln involvement, but the appendix involvement is making me question 3 vs 4. |
Assign code 4, Regional by BOTH direct extension AND regional lymph node(s) involved. In this case, the Regional component for Summary Stage 2018 is based on Note 6, under Colon and Rectum where Regional is defined as: -Mesentery -Peritonealized pericolic/perirectal tissues invaded [Ascending Colon/Descending Colon/Hepatic Flexure/Splenic Flexure/Upper third of rectum: anterior and lateral surfaces; Cecum; Sigmoid Colon; Transverse Colon; Rectosigmoid; Rectum: middle third anterior surface] -Pericolic/Perirectal fat |
2020 |
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20230042 | First Course Treatment/Surgery of Primary Site--Rectum: What surgery code should be used for laparoscopic C/T open low anterior resection with colorectal anastomosis, loop ileostomy in diagnosis year 2020, code 30 or 40? See Discussion. |
Can you provide clarification on Rectum primary surgical code 40 Pull through WITH sphincter preservation (colo-anal anastomosis)? Would this be code 30 or 40 due to the colorectal anastomosis? |
Assign code 40, Pull through WITH sphincter preservation (colo-anal anastomosis). The National Cancer Institute Dictionary of Cancer Terms defines coloanal anastomosis as a surgical procedure in which the colon is attached to the anus after the rectum has been removed. It is also called coloanal pull-through. |
2023 |
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20200026 | EOD 2018--Lung: How should EOD Primary Tumor be coded when imaging describes a large left upper lobe 9.1 cm mass that Also noted is no pleural effusion and normal chest wall. See Discussion. |
It is unclear if code 300 is appropriate, since technically the fissure is comprised of pleura, involvement of the fissure appears to imply a tumor that is no longer localized. An argument could be made for code 400, since the term traverses could be interpreted as crossing into adjacent lobe, however the lower lobe is not mentioned in this scan. |
Assign code 400 as the term "traverses" indicates involvement with extension to the major fissure and is no longer confined to the left lobe. |
2020 |
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20160007 | Surgery of Primary Site--Breast: If the diagnosis is a single primary involving both breasts, do we code 41 Surgery Primary site with 1 in Surgery Other site, or code 76 Surgery Primary site with 0 in Surgery Other site? See discussion. |
In Appendix C- Breast (SEER Manual 2015) it states under the codes for TOTAL MASTECTOMY (Codes 40-49, 75): For single primaries only, code removal of involved contralateral breast under the data item Surgical Procedure/Other Site (NAACCR Item # 1294). [SEER Note: Example of single primary with removal of involved contralateral breast--Inflammatory carcinoma involving both breasts. Bilateral simple mastectomies. Code Surgery of Primary Site 41 and code Surgical Procedure of Other Site 1.] HOWEVER, underneath that it states code 76 is used for: 76 Bilateral mastectomy for a single tumor involving both breasts, as for bilateral inflammatory carcinoma. So |
Assign code 41 with 1 in surgery other site for simple mastectomy. Assign code 76 with 0 in surgery other site for a more extensive mastectomy. |
2016 |
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20170034 | Surgery of Primary Site--Breast: Would you code a unilateral breast simple mastectomy with tissue expanders and AlloDerm or an acellular dermal matrix as Code 45, Reconstruction with Implant, or Code 46, Reconstruction with Combined Tissue and Implant? See Discussion. |
Since acellular dermal matrix/AlloDerm comes from human tissue donors with cells removed and sterilized to promote regenesis and decrease rejection, is Alloderm coded as "Tissue' as it also "provides an additional layer of tissue between the skin and the implant? |
Assign code 43 for a simple mastectomy with tissue expanders and acellular dermal matrix/AlloDerm. The tissue expander indicates preparation for reconstruction. The acellular dermal matrix/AlloDerm is not coded because, while they often accompany an implant procedure, they are not the principle element of reconstructive procedures. The principle elements would be tissue from the patient and/or prosthetics (e.g., gel implants). |
2017 |
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20130088 | Grade--Heme & Lymphoid Neoplasms: Should Grade be coded to 5 [T-cell] or 9 [cell type not determined, not stated, not applicable] for anaplastic large cell lymphoma, NOS [9714/3]? See Discussion. | Under the Grade section in the Heme DB for anaplastic large cell lymphoma, NOS it indicates the following:
"Grade - Code grade specified by pathologist. If no grade specified, code 9."
There is no reference in the Grade section that we should look at the Abstractor Notes or a specific Module in the Heme DB for additional information. However, in the Abstractor Notes section it states, "Grade is T-cell (5) unless pathologist specifically designates as a B-cell (see G2 rule)." These two statements are conflicting. Which is the correct grade? |
Assign code 5 [T-cell] for anaplastic large cell lymphoma [9714/3] unless the pathologist specifies that the histology is a B-cell disease process. See Grade rule G2, Note 2.
In the Heme DB, there is a default value in the Grade field for histologies that do not have a grade specified. However, this particular histology does not default to code 9. There was an error in the Grade section of the 2010 and 2012 versions of Heme DB that has now been corrected in the latest release. |
2013 |
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20210044 | Diagnostic Confirmation--Heme & Lymphoid Neoplasms--Plasma Cell Myeloma: Can serum protein electrophoresis (SPEP) be used as a definitive diagnostic method in the absence of a bone marrow biopsy? Is it appropriate to assign code 5 (Positive laboratory test/marker study) if there is no histological confirmation? See Discussion. |
Patient was diagnosed with lambda myeloma based on the M spike found on serum protein electrophoresis. A bone marrow biopsy was performed, but it was an insufficient sample. SPEP is not listed in the Hematopoietic Database as a lab test that can be used as a definitive diagnostic method. Since the physician did base the diagnosis on the SPEP result, would it be appropriate to assign code 5 (Positive laboratory test/marker study) since there was no histological confirmation? Under code 5, the Hematopoietic Manual states: Laboratory tests are listed under Definitive Diagnostic Methods in the Hematopoietic Database. |
Assign code 5 in Diagnostic Confirmation. We consulted with an expert hematopathologist who stated that SPEP would qualify for a diagnostic confirmation code of 5. He also stated that normally a SPEP is followed by a bone marrow biopsy. SPEP has been added to the Definitive Diagnostic Methods for plasma cell myeloma (9732/3). |
2021 |
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20140025 | Grade--Heme & Lymphoid Neoplasms: Why isn't "T-cell granular lymphocytic leukemia" (9831/3) coded as "5 T-cell" instead of "9" as specified in the Heme database? My path department did not specify any type of grade, but since "T-cell" is part of the name, wouldn't you code it to "5"? |
Assign code 5 when the diagnosis on the pathology report specifies "T-cell granular lymphocytic leukemia." The Heme DB grade instruction states "Code grade specified by pathologist. If no grade specified, code 9." In this case, T-cell was specified - code it. The code for T-cell (5) was not automatically assigned in the Heme DB because of the alternate names for this neoplasm. Some of these include NK-cell. Assign code 8 for alternate names with NK.
The alternate names are: Chronic lymphoproliferative disorder of NK cells, Chronic NK-cell lymphocytosis, Chronic NK-large granular lymphocyte (LGL) lymphoproliferative disorder, CLPD-NK, Indolent large granular NK-cell lymphoproliferative disorder, NK-cell lineage granular lymphocyte proliferative disorder, NK-cell LGL lymphocytosis |
2014 | |
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20170055 | First Course of Treatment/Surgery of Primary Site--Corpus uteri: Do you code total hysterectomy or radical hysterectomy when a specimen indicates the uterus, cervix, ovaries, fallopian tubes, and right and left parametrium were resected, but shows no portion of the vagina. See Discussion. |
AFS1-AFS2-frozen section control, endomyometrium; AFS3-frozen section control, subserosal intramural mass; A4-anterior cervix; A5-posterior cervix; A6-anterior cervical endometrial junction; A7-posterior cervical endometrial junction; A8-A10-anterior endomyometrium, including tumor; A11-A13-posterior endomyometrium, including tumor and adjacent mass; A14-random section subserosal mass; A15-left parametrium at margin of resection; A16-right parametrium at margin of resection; A17-A18-left ovary and fallopian tube; A19-A20-right ovary and fallopian tube. The final diagnosis includes Endometrial adenocarcinoma, favor serous carcinoma, with papillary and solid areas. Tumor involves: Cervix present, Right ovary, Left ovary, Right fallopian tube, Left fallopian tube, Right parametrium, Left parametrium. |
Assign code 50 for total hysterectomy. According to Appendix C Surgery Codes for Corpus Uteri of the 2016 SEER Coding and Staging Manual, total hysterectomy is surgery to remove the entire uterus, including the cervix; whereas, radical hysterectomy includes the vagina. |
2017 |
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