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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20010119 | Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries? | For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary. |
N/A | Scope Regional LN Surgery | 2001 | |
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20010122 | Primary Site/EOD-Extension/EOD-Lymph Nodes--All Sites: What codes are used to represent these fields for an "extramedullary myeloid tumor (granulocytic sarcoma)" of the colon with positive or negative lymph nodes? |
For cases diagnosed 1998-2003: If only the extramedullary site is involved, such as colon, code the Primary Site field to the site of origin. Granulocytic or myeloid sarcoma is an exception to the rule that all leukemias should be coded to bone marrow as the primary site. Granulocytic sarcoma is a deposit of malignant myeloid cells in a site other than bone marrow (extramedullary). For EOD staging, granulocytic sarcoma [9930/3] is included in the Hematopoietic, Reticuloendothelial, Immunoproliferative and Myeloproliferative Neoplasms scheme and the Extension field is coded to 10 when the lymph nodes are negative, since it (like solitary plasmacytoma) is a localized deposit of tumor. However, if the regional lymph nodes associated with the extramedullary primary site are involved, code the EOD-Extension field to 80 [Systemic disease] because the disease is no longer an isolated deposit of malignant granulocytes (in other words, it is not localized). The EOD-Lymph Nodes field is coded to 9 regardless of whether or not the lymph nodes are involved because that is the only allowable code for that field. |
N/A | Primary site | 2001 | |
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20010123 | Scope of Regional Lymph Node Surgery/EOD-Lymph Node fields: How do you code these fields if a pt has multiple lymph nodes surgeries at different times? See discussion. | Example: 1/01/03 Biopsy of 1 sentinel lymph node: positive for metastasis. 1/10/03 Modified radical mastectomy and axillary lymph node dissection: ductal carcinoma with 8 neg lymph nodes. | For cases diagnosed 1/1/2003 and later: Code Scope of Reg LN Surgery to 7. Code EOD Lymph Nodes field to 6. Code EOD Pathologic Number of Reg LN Positive and Examined fields to 01 and 09 respectively.
For the Scope of Reg LN Surgery use the highest applicable code number if more than one Scope of Reg LN Surgery was performed. The EOD lymph node fields are cumulative and count all lymph nodes removed during the diagnostic and first course treatment procedures. |
N/A | Scope Regional LN Surgery | 2001 |
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20010124 | First Course Treatment: What code is used to represent each treatment modality field when there is no indication that a particular modality of treatment was recommended or started? | Code the individual treatment fields to 0 or 00 [None] when the modality is not addressed in the treatment plan (or when a treatment plan is lacking) and there is no indication that a particular modality of treatment was recommended or started. | N/A | First course treatment | 2001 | |
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20061022 | Reportability: Are glomus jugulare tumors reportable? |
Begining with cases diagnosed 2021, glomus jugulare tumor, NOS is reportable. It is listed in ICD-O-3.2 with a behavior code of /3. |
N/A | N/A | 2006 | |
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20051042 | Histology (Pre-2007)/Diagnostic Confirmation: Which histology code is preferred if the CBD brushing is positive for malignant cells, cytologically most consistent with ductal adenocarcinoma [8500/3], and the common hepatic artery lymph node biopsy has metastatic adenocarcinoma, consistent with cholangiocarcinoma [8160/3]? | For tumors diagnosed prior to 2007:
Assign histology code 8160 [Cholangiocarcinoma]. Code from the pathology specimen when available. In this case, the only pathology is from the lymph node specimen.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules. |
N/A | Diagnostic confirmation, Histology | 2005 | |
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20140005 | Primary site--Testis: In the absence of a specific statement that the patient's testicle(s) are descended, should the primary site for a testicular tumor be coded as C621 (Descended Testis) when the mass is palpable on physical exam or demonstrated on scrotal ultrasound? See discussion. | It seems the non-specific Testis, NOS (C629) code is being over used. Many testis cases have no documentation of the patient's testicular descention. However, testicular tumors in adults are frequently detected by palpation or scrotal ultrasound. An undescended testis (a testis absent from the normal scrotal position) would be non-palpable or not amenable to imaging via a scrotal ultrasound. | Unless the testicle is stated to be undescended, it is reasonable to code C621 for primary site. Reserve C629 for cases with minimal or conflicting information. | N/A | Primary site | 2014 |
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20021162 | Chemotherapy: Should radiosensitizing chemotherapy agents (i.e., drugs typically coded as treatment for cancer) be coded as treatment when they are given in combination with radiation therapy with the intention of enhancing that treatment? See discussion. |
Per our consultant, these drugs are given at a lower dose than that typically given to treat cancer patients. |
Do not code radiosensitizers and radioprotectants as cancer-directed therapy. Drugs typically classified as chemotherapy agents would be "ancillary drugs" for the purpose of coding cancer-directed therapy because the drugs are given at a much lower dosage than that typically given to treat cancer patients. Per Book 8, ancillary drugs are not to be coded as cancer-directed therapy. Radiosensitizers and radioprotectants do not work directly on the cancer and are not coded under any of the systemic therapy fields. |
N/A | Chemotherapy | 2002 |
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20240022 | Solid Tumor Rules/Histology: When should the designation of “poorly differentiated” be used to further specify histology for carcinoma, NOS (8010) as undifferentiated carcinoma (8020)? See Discussion. |
The term “poorly differentiated carcinoma (NOS)” is listed as related to “undifferentiated carcinoma (NOS)” in the ICD-O 3.2. It is also listed in the Solid Tumor Rules for Urinary Table 2 (Urinary subtypes), Other Sites Table 16 (uterine corpus primaries) and Table 19 (vulvar primaries). Are these the only sites in which one should code “poorly differentiated carcinoma (NOS)” as 8020 (undifferentiated carcinoma)? How is histology coded if the only microscopic confirmation is from a metastatic site showing “poorly differentiated carcinoma” (NOS) or “invasive carcinoma, poorly differentiated” (NOS)? Example 1: Primary pancreatic cancer diagnosed on imaging and confirmed with liver mets core biopsy showing “poorly differentiated carcinoma.” Immunostaining pattern was non-specific. No further workup or treatment was planned. Other Sites - Table 11 (Pancreas Histologies) includes undifferentiated carcinoma (8020/3) as a valid histology; however, the synonyms/subtypes/variants do not mention poorly differentiated carcinoma. How should histology be coded for this case? Example 2: Hemicolectomy with cecal tumor final diagnosis of “invasive carcinoma, poorly differentiated” and synoptic summary listing “Histologic type: Invasive carcinoma. Histologic grade: G3 of 4: poorly differentiated.” Colorectal Table 1 (Specific Histologies and Subtypes/Variants) includes undifferentiated adenocarcinoma/carcinoma 8020 as a subtype of adenocarcinoma NOS. There is no mention of poorly differentiated in this context. How should histology be coded for this case? |
Assign code 8020/3 when the histologic type specifically includes the term of poorly differentiated, dedifferentiated, undifferentiated, or anaplastic undifferentiated carcinoma along with carcinoma as terms vary depending on the primary site. When the term poorly differentiated is included in the grade section only of the pathology report or only mentions poorly differentiated carcinoma without further substantiation from a pathology report as in examples 1 and 2, do not use code 8020/3. The histology code 8020/3 and terms may be used for selected primary sites as included in the Solid Tumor Rules, WHO Classification of Tumors series (latest versions), and the Site/Morphology Validation List including Nasal cavity Nasopharynx Salivary glands Urinary sites Colon, rectosigmoid, rectum Esophagus Stomach Gallbladder and extrahepatic bile duct Pancreas Thyroid Ovary Uterine corpus Vagina Uterine cervix (also referred to as unclassifiable in WHO Classification of Female Genital Tumors, 5th ed.) For sites other than those listed, if the diagnosis is poorly differentiated carcinoma, code 8010/3 and poorly differentiated in the grade field. |
N/A | Histology | 2024 |
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20160051 | Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block? |
Yes, assign diagnostic confirmation code 2 for diagnosis based on smears and cell block from CT guided FNA. This reply pertains to solid tumors. |
N/A | Diagnostic confirmation | 2016 |
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