Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C421 [bone marrow] or C770-C779 [lymph nodes] for an adult T-cell leukemia/lymphoma [9827/3] that presented with a positive bone marrow biopsy and involvement of lymph nodes and the lung?
Code the primary site to the involved lymph nodes [C770-C779]. Per Rule PH 8, it indicates you are to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. Note 2 further states that the bone marrow may or may not be involved. If the bone marrow is involved, code this information in the CS Extension field.
Per the Abstractor Notes section in the Heme DB, this is a systemic disease with widespread lymph node involvement as well as involvement of the peripheral blood. In addition, systemic involvement of extranodal sites (including lung) are often involved.
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.
Primary Site/Histology--Ovary: We are encountering a primary site, histologic type, and behavior combination edit based on the Cancer PathCHART (CPC) tables. Using the CPC*Search tool, C569 and 8441/3 is a valid combination. The diagnosis date is 01/13/2024. Should an over-ride be applied with this combination?
The CPC Validity Status of the site morphology combinations of C569/8441/3 and C569/8441/2 was revised from Valid to Unlikely with the latest release of the Version v24A Edits Metafile. As a result, this site and morphology combination will now require an over-ride flag to be set.
Code as 8461/3 (high-grade serous carcinoma) or 8460/3 (low-grade serous carcinoma) if at all possible. Use 8441/3 (serous carcinoma, NOS) only if it cannot be distinguished as low grade or high grade. The codes for high-grade serous carcinoma and low-grade serous carcinoma are relatively new. High-grade serous carcinoma and low-grade serous carcinoma are very different tumors and pathologists should state whether it is high grade or low grade. Please make every attempt to use the newer codes. If unable to determine high gade versus low grade, assign 8441/3 and override the edit.
The files on the CPC website are currently being updated, and CPC*Search will be updated to reflect the changes sometime this Fall.
Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007?
For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists
For cases diagnosed 2007-2014, 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.
EOD-Size of Primary Tumor: How is tumor size coded when there is a clinical tumor size, the excisional biopsy pathology report has a tumor size and the resection specimen has residual tumor, but there is no tumor size provided in the pathology report?
For cases diagnosed 1998-2003: Code the EOD-Size of Primary Tumor from the excisional biopsy. If there is some indication that a large amount of tumor was removed at the time of the resection, code the clinical size instead. When both an excisional biopsy and a resection show tumor, code the largest size of tumor reported.
CS Extension--Ovary: How are the following terms coded when they are described in the medical record without any other qualifying information? Seeding, talcum powder appearance, salting, miliary, and studding.
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.Seeding, talcum powder appearance, salting and studding are synonymous with implants. When the size of implants is not stated, but operative report and scans state "seeding," "talcum powder appearance," "salting," and "studding" the CS extension code choice will depend on the location of the seeding, talcum powder appearance, salting, or studding.
The word "miliary" is not documented as a synonym for implants.
The term miliary does not affect the CS extension code choice according to the current CS instructions.
Histology (Pre-2007)--Melanoma: How is histology coded if the final diagnosis is "melanoma" and only in the comment section of the pathology report is there an indication of "Type: Lentigo Maligna. Cell Type: Small Cell"?
For tumors diagnosed prior to 2007:
Code the histology as 8742 [lentigo maligna melanoma]. Code the specific histologic type, even if stated only in the comment section.
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.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined/Surgical Procedure of Other Site--Kaposi Sarcoma: How do you code these fields for a groin mass excision containing 4 lymph nodes for a Kaposi sarcoma case that presented with multiple skin lesions?
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields to 99 99 for Kaposi cases that present systemically and for those that present in more than one site (which includes cases with more than one skin subsite involved at diagnosis). There are no "regional" lymph nodes for such cases. This represents a majority of currently diagnosed Kaposi cases. However, for localized Kaposi cases, you can count the number of regional lymph nodes positive and examined if the primary site selected has a regional lymph node chain(s) associated with it (e.g., soft palate, hard palate, or a skin subsite).
For cases diagnosed 1/1/2003 and after: Code the groin mass excision in the Surgical Procedure of Other Site field to 1 [Non-primary surgical procedure performed; Non-primary surgical resection to other site(s), unknown if whether the site(s) is regional or distant].
An official website of the United States government
Home