Multiplicity Counter/Ambiguous terminology: How should these fields be coded for cases with an unknown date of diagnosis?
If the date of diagnosis is unknown, it is likely that you have little information for this case. Both multiplicity counter and ambiguous terminology fields would probably be coded as unknown. However, if information on the number of tumors and the diagnostic confirmation are available, code these fields as specified in the manual.
Reportability--Gallbladder: Is Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia reportable? The primary site is gallbladder.
Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia is not reportable. The WHO assigns a behavior of 0 to these neoplasms.
CS Site Specific Factor 1--Colon: If the registrar did not support the CEA code recorded with the appropriate text documentation, should the central registry accept the registrars coding or change the value to 999?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Accept your registrars' codes at your discretion. It is encouraged, but not required, to enter text for CS data elements. These cases do not automatically default to code 999.
Multiplicity Counter--Breast: How should the multiplicity counter be coded for a 3.8 cm infiltrating duct carcinoma with two "satellite nodules" measuring 5 mm and 7mm that are not described as either metastases or multiple foci?
Include these nodules in the multiplicity counter because they are measured and are part of the final diagnosis on the pathology report.
Radiation Therapy: Would tomotherapy, described as targeted IMRT, be coded as external beam?
Code tomotherapy as 1 [Beam radiation].
Tomotherapy is external beam radiation therapy. It is a type of IMRT. Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled x-ray accelerators to deliver radiation. Tomotherapy is a CT image guided IMRT.
EOD/Prostate Pathologic Extension--Prostate: Is a pathology report from a prostate biopsy/transurethral resection of the prostate that states "with intraductal spread" extraprostatic/extracapsular extension or localized?
Code as a localized, intracapsular tumor as ductal carcinoma in situ does not invade. Intraductal spread is describing the neoplasm spreading through the acinar/ductal cells in the prostate specimen. It is an in-situ type of spread and not invasive but almost always presents with an invasive tumor.
First Course Treatment--Liver: Given that agents can be used that are not chemotherapy drugs, how should treatment be coded for a procedure called a "chemoembolization" when the agent used is not documented?
This issue was discussed among the national standard setters and per the SEER website this issue has been resolved as follows: When "chemoembolization" is done but the agents used are not chemotherapy drugs, then treatment should be coded as "Other Therapy." See http://seer.cancer.gov/tools/codingmanuals/embolization.html
Surgery of Primary Site/Reconstruction-First Course--Breast: If the plan is to "reconstruct" the breast 6 months after an ipsilateral modified radical mastectomy, is the time span a problem or should it be coded in the Surgery of Primary Site field because it was planned?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 55 [Modified radical mastectomy WITHOUT removal of uninvolved contralateral breast, Implant]. The time span is not a problem as long as the reconstruction was planned as first course, which is indicated by tissue expander insertion at the time of the original surgery.
Reportability: Are malignant tumors of genital skin reportable? On page 1 of the 2004 SEER Manual, Reportable Diagnoses, 1.b.i. Exceptions: malignant and invasive histologies not required by SEER - Skin. There is no longer a note that states that lesions ARE reportable for skin of the genital sites. Has SEER discontinued the collection of malignant skin tumors of the genital sites OR is the manual in error?
The histologies listed in the exception on page 1 are NOT reportable when the topography code is C440-C449. The manual specifically lists the topography codes in 1.b.1. Diagnoses with the listed histologies ARE reportable when the topography code is NOT C440-C449. Genital skin sites are not coded C440-C449 so a note is not needed.
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