Reportability/Date of diagnosis--Liver: Does the final diagnosis of a scan have higher priority than the findings in the discussion in the body of the report? See Discussion.
A patient with liver cancer becomes transplant eligible when the tumor is 2 cm in size. Frequently, liver tumors will be watched (no biopsy) for months until they meet the 2 cm size criteria. In the meantime, multiple scans will describe the tumor using variations of ambiguous terms that drift in and out of reportablility. One day the tumor is labeled "presumed hepatocellular carcinoma." Weeks later it is back to "worrisome for hepatoma." A single scan will use different terms in different sections of the report.
Example case: Abdominal CT reveals a 1 cm liver lesion. Per the discussion portion of the scan, the lesion is consistent with hepatocellular carcinoma. Per final diagnosis: 1 cm liver lesion, possibly hepatocellular carcinoma. Is this report diagnostic of cancer? Would the date of this report be the date of diagnosis? (Patient did receive a liver transplant for hepatocellular carcinoma months later.)
When a reportable ambiguous term is used in one part of a report or the medical record and a non-reportable ambiguous term is used in another part of the report or the medical record, accept the reportable term and accession the case.
The example above is reportable. "Consistent with" is a reportable ambiguous term. Accept "consistent with" over the non-reportable term "possibly."
The date of this report would be the date of diagnosis if this is the earliest report using reportable terminology.
Date of Diagnosis--All Sites: Is it better to estimate the month in the date of diagnosis field using the re-excision pathology report date or code the month to unknown if the only available information is the re-excision date? See discussion.
The only available information is the following pathology report:
On 7/18/00 a wide excision of the primary lesion is done. The report reads, "Lesion approximately 1 cm. Residual superficial spreading malignant melanoma with deepest penetration 4 mm."
Code the Date of Diagnosis field to 07/2000 for this case. Estimate the month of diagnosis whenever possible.
Given the usual delay between the initial excision of the lesion and a wide excision for a melanoma, estimate the month of diagnosis as July.
First course treatment/Surgery of Primary Site--Anus: Would infrared coagulation be coded as treatment for AIN III of the anus/anal canal? See discussion.
SINQ 20051064 indicates infrared coagulation is not treatment for cancer. Internet search explains that infrared coagulation delivers heat to destroy the tissue so it can be removed. In our region it is currently used to treat internal and external anal low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). While it is understandable that this wouldn't be coded as treatment for an invasive anal primary, could it be treatment for an in situ tumor? If it is treatment, should it be coded under Surgery code 15
Updated September 2026
Code infrared coagulation as cancer-directed treatment if the physician states IRC was used to treat AIN III. In this situation, code as A100 (Local tumor destruction, NOS) using the 2026 SEER Manual, Appendix C, Anus Surgery Codes.
MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion.
Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules.
For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS].
Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites.
In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma.
Extension/Ambiguous terminology: How should the terms "entrapped by tumor" and "encased by tumor" be interpreted when coding these fields?
Each case must be reviewed in its entirety to determine the appropriate coding of these fields. However, in general the terms "entrapped" and "encased" should NOT be interpreted as involvement unless there is other clinical or pathologic evidence to support involvement.
MP/H Rules/Histology--Testis: How should histology be coded for a testicular primary with a combination of teratoma, yolk sac tumor and embryonal carcinoma? See discussion.
Patient had a radical orchiectomy with the final diagnosis of "Mixed germ cell tumor with the following features -- histologic type: Mixed germ cell tumor (teratoma 50%, yolk sac tumor 25%, and embryonal 25%)."
Assign 9085/3. Code this combination of teratoma, yolk sac tumor, and embryonal tumor in the testis to mixed germ cell tumor (9085/3) based on the WHO Classification of Tumors of the Male Genital Organs.
First Course Treatment: If the patient receives no treatment at the time of diagnosis (either because it is not recommended or because the patient refused treatment at that time) but treatment is later instituted after disease progression, should this treatment be coded as part of the first course of treatment?
The SEER rules changed in 1998 regarding what constitutes First Course of Cancer-Directed Therapy.
For cases diagnosed on or after 1/1/98: The First Course of Cancer-Directed Therapy fields will all be coded to 0 [None] for these types of cases. The documented disease progression would stop the timeframe for inclusion of any treatment to be part of first course of therapy.
Date of Diagnosis: When a 4/04 clinical impression indicates the appearance of a carcinoma that is contradicted by a negative 4/04 biopsy but is confirmed by a 5/04 resection, should the diagnosis date be coded to April or May? See Discussion.
4/04 colonscopy: irregular fungating mass that has appearance of carcinoma. 4/04 Bx: high grade dysplasia. 5/04: LAR. 5/04 Path: 3.2 X 2.5 cm mass wd adenoca with invasion of muscularis propria.
Should the diagnosis date be 4/04 based on the clinical impression during the colonoscopy OR 5/04 since the path for the bx was negative?
The date of diagnosis for the example above is 05/04 -- the date of the pathology report confirming malignacy. The biopsy in 04/04 negated the 04/04 clinical statement.
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