Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient with a several month history of refractory anemia with excess blasts (RAEB), that may or may not have been treated, who now presents with a bone marrow biopsy that is compatible with acute myeloid leukemia?
Per Rule M10, abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis. Two primaries should be accessioned for this case: refractory anemia with excess blasts (RAEB) [9983/3] (a chronic neoplasm), and acute myeloid leukemia [9861/3] (an acute neoplasm).
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
EOD-Extension--Mycosis Fungoides: Explain the difference between extension codes 25 [% of body surface not stated, no tumors] and 30 [skin involvement, NOS; extent not stated, no tumors. Localized, NOS]?
For cases diagnosed 1998-2003:
For mycosis fungoides: Use code 25 when skin involvement is present but only a general location/site is mentioned (i.e., face, legs, torso, arms).
Use code 30 when there is skin involvement but there is no mention of location/site.
CS Extension--Lung: If only a "single" cytology is performed on pericardial fluid and it is negative, can Note 6 B, which states that pleural effusion [code 72] is coded as malignant unless there are "multiple" negative cytologies, be used to infer that the pericardial fluid should also be coded as involvement?
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.
No, do not apply the instructions for pleural effusion to pericardial effusion. Do not code a pericardial effusion proven negative by cytology in CS Extension.
Reportability--Heme & Lymphoid Neoplasms: Is "myeloproliferative syndrome, NOS" synonymous with "myeloproliferative syndrome" and "myeloproliferative disease" and, therefore, reportable under the new hematopoietic rules?
Myeloproliferative syndrome and the myeloproliferative diseases were used in the past to describe myeloproliferative neoplasms. For cases diagnosed 2010 and forward, although the term "myeloproliferative syndrome" is not currently used to describe this disease, the synonyms "myeloproliferative syndrome" and "myeloproliferative disease" were added to the database for myelodysplastic/myeloproliferative neoplasm, unclassified [9975/3].
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Multiple Primaries (Pre-2007)/Recurrence--Cervix: How many primaries should be abstracted if a patient had a diagnosis in 1998 of adenocarcinoma in situ of the cervix treated with a total hysterectomy and a July 2004 vaginal mass biopsy with a diagnosis of invasive adenocarcinoma that is consistent with an endocervical primary?
For tumors diagnosed prior to 2007:
Abstract the July 2004 diagnosis as a new endocervical primary. Abstract an invasive cancer in the same site more than two months after an in situ cancer as a new primary. Residual cervical tissue is present following a hysterectomy.
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.
Reportability--Heme & Lymphoid Neoplasms: Is a case reportable in which the pathology report is negative for plasmacytoma but a subsequent physician's clinical diagnosis is plasmacytoma?
This case is reportable if the patient was treated for plasmacytoma. When the physician calls the case plasmacytoma and treats the patient accordingly, report the case.
See Case Reportability Instructions #6: Report the case when there is a clinical diagnosis (physician's statement) of a reportable hematopoietic or lymphoid neoplasm.
Note 1: The clinical diagnosis may be a final diagnosis found within the medical record or recorded on a scan (CT, MRI for example)
Note 2: Report the case even if the diagnostic tests are equivocal. A number of hematopoietic neoplasms are "diagnoses of exclusion" in which the diagnostic tests are equivocal and the physician makes the clinical diagnosis based on the equivocal tests and the clinical picture. See the Heme DB for definitive diagnostic methods for the specific neoplasm being abstracted.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Reporting Source: Is an ER patient who is diagnosed on peripheral smear with an acute leukemia coded as an outpatient if the patient died while in the process of being admitted for treatment or is the patient coded as a death certificate case?
Code reporting source as 1 [Hospital Inpatient/Outpatient or Clinic] for the case above. This case will be abstracted using information from the outpatient/ER record (and the death certificate).
EOD-Clinical Extension--Prostate: Should this field be coded to 15 [Tumor identified by needle biopsy for elevated PSA] or 30 [Localized, NOS] when the only information is from a biopsy positive pathology report that includes the clinical history of "PSA elevated, DRE negative," with no mention of an ultrasound being performed?
For cases diagnosed 1998-2003: For this scenario, assign code 15 if an ultrasound was not performed, performed and negative, or when it is unknown whether or not an ultrasound was performed. Assign code 30 only if an ultrasound was performed and there is no documentation stating that it was negative or positive.
Please refer to the Prostate EOD Coding Guidelines for all of the instructions pertaining to the coding of prostate EOD.
First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment?
If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence.