CS Lymph Nodes--Breast: What code should be used for the the following? There is no mention of LNS clinically; the patient has neoadjuvant therapy; and the LNS are matted pathologically.
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.Use the information from the pathologic evaluation to code CS Lymph nodes.
In the nodes evaluation field, assign code 6 [Regional lymph nodes removed for examination with pre-surgical systemic treatment or radiation and lymph node evaluation based on pathologic evidence]. See CS Lymph Nodes note 4.
Reportability--Brain and CNS: Is schwannoma of the extracranial part of a cranial nerve reportable? Some cranial nerves, like facial nerve, have intracranial and extracranial branches.
An extracranial schwannoma is not reportable. The schwannoma must arise on the intracranial part of the nerve to be reportable.
Behavior--Prostate: What is the correct behavior of intraductal carcinoma from a prostate biopsy with a Gleason score 4+4=8. While highly aggressive, but not suggestive of invasion, coding behavior as /2 seems inappropriate.
WHO classifies intraductal carcinoma of the prostate 8500/2. According to WHO, "the hallmark of intraductal carcinoma of the prostate is a proliferation of prostate carcinoma cells that is within and may significantly expand the native prostatic ducts and acini, with the basal cell layer at least partially preserved." Further, differentiation between intraductal carcinoma and infiltrating high-grade carcinoma of the prostate may require basal cell stains. Under Prognosis, WHO states: " intraductal carcinoma of the prostate on prostate biopsies is often associated with high-grade cancer (with a mean Gleason score of 8) ."
So while it may seem counter-intuitive, assign behavior code /2 when the diagnosis is intraductal carcinoma of the prostate.
Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C779 or C809 when a patient is diagnosed at another facility with mantle cell lymphoma and the staging bone marrow biopsy performed at this facility is negative? There is no available information concerning where the lymphoma originated.
Per PH Rule22, code the primary site to C779 [lymph nodes, NOS].
Rule PH22 is a default rule for lymphomas that is used when there is no other information regarding the primary site and the Heme DB does not indicate a primary site under its Primary Site(s) section. Rule PH27, code the primary site to unknown [C809], does not apply. Only use C809 [unknown] as the primary site when there is no evidence of lymphoma in lymph nodes AND the physician documents that the lymphoma originates in an organ(s).
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.
Neoadjuvant Treatment/Date Therapy Initiated--Breast: If Tamoxifen has been used since 2000 for the treatment of hyperplasia, should it be coded as neoadjuvant treatment for a 2004 diagnosis of breast cancer?
Do not code tamoxifen given for hyperplasia as treatment for breast cancer. In this case, tamoxifen started four years before the breast cancer diagnosis -- not treatment for breast cancer.
Reportability--Heme & Lymphoid Neoplasms: Is EBV-positive hemophagocytic lymphohistiocytosis (HLH) reportable when diagnosed in a 5 year old child and resulted in death in less than two months?
Hemophagocytic lymphohistiocytosis (HLH) is not a reportable disease because it is not listed in the Heme DB.
Per our expert pathologist consultant, "HLH is a lymphocyte driven hemophagocytic syndrome which may be either genetically based or caused by over-activated lymphoid cells, often in response to a viral infection. It is an abnormal immune response and is not considered a malignant disease, and is, therefore, not reportable. It is not synonymous with EBV-positive T-cell lymphoproliferative disease of childhood (9724/3)."
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.
Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?
Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.
Reportability--Brain and CNS: Is a skull tumor schwannoma an intracranial reportable benign tumor if the physician states it arose in the occipital nerve?
No. These schwannomas are not intracranial and therefore, are not reportable to SEER. The occipital nerve is not one of the 12 intracranial nerves (i.e., Abducens, Auditory (vestibulocochlear), Facial, Glossopharyngeal, Hypoglossal, Oculomotor, Olfactory, Optic, Spinal Accessory, Trigeminal, Trochlear, and Vagus).
Reportability--Hematopoietic, NOS: Is a "Myelodysplasia, refractory macrocytic anemia with multilineage dysplasia" reportable?
For cases diagnosed prior to 1/1/2010:Yes, myelodysplasia, refractory macrocytic anemia with multilineage dysplasia is reportable. This is a type of refractory anemia. Refractory anemia is reportable.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Primary site--Heme & Lymphoid Neoplasms: How do you code primary site for a case of "leukemia cutis" when the bone marrow exam is negative for involvement with leukemia?
Code the primary site to C421 [bone marrow] per Rule PH30 which states to use the to determine the primary site and histology when rules PH1-PH29 do apply. Leukemia cutis is the term for a leukemic infiltration of the epidermis, the dermis or the subcutis. This infiltration is easily identified as cutaneous lesions, but the primary site is still bone marrow. This is a type of "metastasis" or spread of the leukemia cells. The "conventional" definition for leukemia cutis is the infiltration of skin from a bone marrow primary. See the Hematopoietic & Lymphoid Neoplasm Coding Manual Glossary.
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.
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