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Reportability/In Situ--Prostate: Was there a time period when PIN III was reportable to SEER?
Per the 2004 SEER Manual, page 2, Reportable Diagnoses, Exceptions, 1.b.iii "Prostatic intraepithelial neoplasia (PIN III) of the prostate (C619). (Collection stopped effective with cases diagnosed 1/1/2001 and later.)"
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: What codes are used to represent these fields when only a regional lymph node (positive) aspiration is performed?
For cases diagnosed 1998-2003:
With the exception of those sites/histologies that require 99 in these fields, code the Number of Regional Lymph Nodes Positive field to 97 [Positive nodes but number of positive nodes not specified]. Code the Number of Regional Lymph nodes Examined field to 95 [No regional Lymph nodes removed, but aspiration of regional Lymph nodes was performed].
Primary Site/Histology (Pre-2007)/EOD Fields/Surgery of Primary Site--Abdomen, NOS: What codes are used to represent these fields for a case with a resection of the rectosigmoid and adjacent tumor mass that demonstrated no tumor in the rectosigmoid but extramural to the colon there was an endometrioid adenocarcinoma arising in association with an area of endometriosis (possibly within the pericolic soft tissue or in an ovarian remnant)?
EOD-Lymph Nodes--Head & Neck: When a physician provides only "Stage IV" (i.e., an abbreviated stage) for a right posterior tongue primary with lateral extension into the oropharynx and hypopharynx, can you assume "palpable" level 2, 3 and 5 lymph nodes are involved?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 9 [Unknown], based on the information provided.
The physician's statement of an N category from a TNM may be used to determine lymph node involvement in the absence of other information. However, you cannot assume nodal involvement based on the incomplete staging information of "Stage IV" for a base of tongue primary. For this primary site, extension into the hypopharynx from this primary is equivalent to T4/Stage IV. Therefore you cannot assume the clinician's assessment of the case as Stage IV represents his assessment of lymph node involvement.
Surgery of Primary Site--Breast: How is this field coded when a re-excision follows a prior mastectomy?
Code the most extensive surgery in Surgery of Primary Site. This is a cumulative field. Assign the appropriate code including all surgeries of the primary site performed during the first course of treatment.
The correct code for mastectomy followed by re-excision will depend on the extent of the re-excision. For example, if the re-excision removed muscle, code radical mastectomy.
Histology--Heme & Lymphoid Neoplasms: How is this field coded when the final diagnosis for excisional biopsy of two cervical lymph nodes shows classical Hodgkin lymphoma, histologic subtype cannot be determined, but the COMMENT section of the report indicates there are features of both lymphocyte rich and nodular sclerosis subtypes?
Per Rule PH28, code histology to 9650/3 [Classical Hodgkin lymphoma]. This rule states to code the non-specific (NOS) histology when the diagnosis is one non-specific (NOS) histology and two or more specific histologies.
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. http://seer.cancer.gov/seertools/hemelymph.
Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case?
Code the primary site to C421 [bone marrow]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow.
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.
Reportability/Ambiguous Terminology/Date of Diagnosis: If a "suspicious" cytology is reportable only when a later positive biopsy or a physician's clinical impression of cancer supports the cytology findings, is the Date of Diagnosis field coded to the later confirmation date rather than to the date of the suspicious cytology? Is a suspicious "biopsy" handled the same way?
Cytology reported as "suspicious" is not reportable. If the physician confirms the suspicious cytology by making a clinical diagnosis of malignancy, the Date of Diagnosis field is coded to the date of the clinical diagnosis, which may or may not be same date the cytology was performed.
Without supporting clinical documentation, the case will remain non-reportable and will not be submitted to SEER. The supporting documentation can be a physician's statement that the patient has cancer, a scan or procedure that identifies cancer, or a positive biopsy.
Suspicious "biopsies" are reportable according to SEER's list of ambiguous terms. Suspicious "cytologies" without supporting clinical statements are not.
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