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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20110094 | Surgery of Primary Site--Breast: Is a "nipple sparing mastectomy" coded to 30 [subcutaneous mastectomy] or 40 [total (simple) mastectomy] if the nipple/areolar complex was not removed but the pathology specimen indicates some breast skin was removed? See Discussion. |
In the past, the SEER Manual indicated that code 30 [subcutaneous mastectomies], which captured nipple-sparing mastectomies, would rarely be used because it was not typically performed as treatment for a malignancy. This note was removed from the 2010 SEER Manual, Appendix C. Code 30 which now states, "A subcutaneous mastectomy is the removal of breast tissue without the nipple and areolar complex or overlying skin." More "nipple-sparing mastectomies" are now being performed at certain facilities.
Should the Surgery of Primary Site field be coded to 30 when a nipple-sparing mastectomy with reconstruction is performed, even if there is skin removal? Or, does the skin removal indicate that this is not a subcutaneous mastectomy, and therefore code 43 [Total (simple) mastectomy with reconstruction, NOS] applies? |
Code Surgery of Primary Site to 30 [Subcutaneous mastectomy] for this case.
Assign code 30 when the nipple and areolar complex are NOT removed. Assign code 40 (or higher) when the nipple and areolar complex ARE removed. |
Breast | Surgery of Primary Site | 2011 |
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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). |
Breast | Surgery of Primary Site | 2017 |
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20051114 | Surgery of Primary Site--Colon: In the absence of detailed operative or pathology report descriptions of the specific segment(s) of the colon removed, should a hemicolectomy be coded if stated by the surgeon to be such? | Yes, code hemicolectomy as stated by the surgeon when there is no conflicting or additional information avaliable. | Colon | Surgery of Primary Site | 2005 | |
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20031022 | Surgery of Primary Site--Head & Neck: Is a composite resection performed for an oral cavity primary coded to 40 [Radical excision of tumor, NOS], 41 [Radical excision of tumor only], 42 [Combination of 41 with resection in continuity with mandibles (marginal, segmental, hemi-, or total resection], 43 [Combination of 41 with resection in continuity with maxilla (partial, subtotal, or total resection)]? See discussion. |
Example: Patient underwent composite resection of left soft palate, tonsillar fossa, medial pterygoid and lateral tongue for a primary of the retromolar trigone. There was no mention of an excision of the mandible; however, the procedure included the application of a mandibular reconstruction plate. |
Use surgery codes 40-43 for composite resection of an oral cavity primary. In the case example, code Site-Specific surgery as 42 [Combination of 41 WITH resection in continuity with mandible]. Even though excision of mandible was not mentioned, there was mention of a mandibular reconstruction plate. Since the retromolar trigone is ON the mandible, resection of the mandible is likely. | Head & Neck | Surgery of Primary Site | 2003 |
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20010012 | Surgery of Primary Site--Breast: What code is used to represent this field for a breast primary treated with a "bilateral mastectomy"? See discussion. |
Pt diagnosed with rt breast primary opted to be treated with rt modified radical mastectomy and lt simple mastectomy. Path revealed invasive ductal carcinoma on the rt and ductal carcinoma in situ on the lt. Path reported 14 axillary lymph nodes were found in the mastectomy specimen. |
There are two primaries. For cases diagnosed 1/1/2003 and after: For the rt breast, code Surgery of Primary Site to 51. The contralateral left breast malignancy is not involved with the right breast primary by either direct extension or metastasis. Codes 42 and 52 are used to capture prophylactic mastectomy of the opposite noncancerous breast. In this case, the opposite breast has cancer so these codes cannot be used. Code Scope of Regional Lymph Node Surgery to 5 and Surgical Procedure of Other Site to 0. For the lt breast, code Surgery of Primary Site to 41, Scope of Reg LN Surgery to 0, and Surgical Procedure of Other Site to 0. |
Breast | Surgery of Primary Site | 2001 |
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20091118 | Surgery of Primary Site--Corpus uteri: How are the surgery fields to be coded when patient undergoes hysterectomy and omentectomy for endometrial primary? See Discussion. | The example for instruction 6 in the 2007 SEER manual on page 179 (for surgery of primary site) states "code an en bloc removal when the patient has a hysterectomy and an omentectomy." There is no Site-Specific Surgery code for corpus uteri that combines hysterectomy with omentectomy. Is the information about removal of the omentum lost or is it documented under Surgical Procedure of Other Site? |
Use the most appropriate code in the "Surgery of Primary Site field." Do not code the omentectomy in "Surgical Procedure of Other Site" when it is performed with a hysterectomy for an endometrial primary. | Corpus uteri | Surgery of Primary Site | 2009 |
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20160014 | Surgery of primary site--Lung: Should microwave ablation be coded as treatment for lung cancer, and if so, how should it be coded? |
Code microwave tumor ablation as surgery. For lung, assign code 15.
This question was discussed by the technical advisory group – a small group of representatives from each standard setter which meets periodically. The group agreed on this consensus answer. |
Lung | Surgery of Primary Site | 2016 | |
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20150011 | Surgery Primary Site--Breast: Please clarify how to code both simple mastectomy with tissue expander and AlloDerm reconstruction, and simple mastectomy with tissue expander (NOS). See discussion. |
There are multiple SEER Notes in the Breast Surgery Codes of Appendix C instructing us to code tissue expanders as reconstruction but none address the type of reconstruction to be coded.
1. Is a tissue expander always equivalent to Implant reconstruction? 2. Is AlloDerm always equivalent to Tissue reconstruction? 3. Is the combination of AlloDerm and tissue expander always equivalent to Combined (tissue and implant) reconstruction? |
Do not code AlloDerm as either a tissue or implant reconstruction, it is a graft material that usually accompanies implant reconstruction. Placement of a tissue expander is an indication of planned reconstruction. Additional information is needed to determine whether the reconstruction involves tissue or implant.
1. A tissue expander is not always equivalent to Implant reconstruction 2. AlloDerm is not equivalent to tissue reconstruction 3. The combination of AlloDerm and tissue expander is not equivalent to combined (tissue and implant) reconstruction |
Breast | Surgery of Primary Site | 2015 |
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20061014 | Surgery of Primary Site--Lung: Is this field coded to 30 [Resection of lobe or lobectomy] or 33 [Lobectomy with mediastinal lymph node dissection] when a lobectomy specimen includes 2 AP window lymph nodes? See Discussion. | LUL lobectomy: 1.7cm apical tumor, DX=mod well diff subpleural SCC, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0. 1. No lymph node dissection or sampling was stated to be done 2. The lobectomy specimen contained the LNs 3. Scope of regional LN surgery is coded Would the surgery to primary site code 30 or 33? |
Code surgery of primary site to 30 [Resection of lobe or lobectomy]. According to the information provided, there was no lymph node dissection in this case. The 2 AP window nodes were obtained as part of the lobectomy specimen. | Lung | Surgery of Primary Site | 2006 |
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20140068 | Surgery of Primary Site--Corpus uteri: What is the correct surgery code to assign for dilation and curettage (D&C) for an in-situ endometrium (C541) primary? The code to use for the cervix uteri (C530-C539) is specified, but not for the corpus uteri (C540-C549). |
Assign code 20 for endometrial D&C for in situ cancer of endometrium. |
Corpus uteri | Surgery of Primary Site | 2014 |
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