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.
Reportability--Heme & Lymphoid Neoplasms: Is Rosai-Dorfman's syndrome (histiocytosis) a reportable malignant condition?
Rosai-Dorfman disease is not reportable. Rosai-Dorfman disease is a rare non-neoplastic disease. This disease can mimic lymphoma and extranodal involvement is frequent.
Histology/Primary site--Heme & Lymphoid Neoplasms: How are these fields coded if a bone marrow biopsy demonstrates diffuse infiltration by B-cell lymphoma/leukemia which consists of medium-sized cells with Burkitt morphology and the flow cytometry has no evidence of leukemia or lymphoma?
This case should be accessioned as one primary. Per Rule PH26, code the primary site to bone marrow (C421) when lymphoma is present only in the bone marrow. (We assumed all available physical exams, scans, and other work-up were negative for lymph node, tissue, or organ involvement.) Histology is coded to 9680/3 [Diffuse large B-cell lymphoma (DLBCL)]. Under the Alternate Names section of the Heme DB, a synonym for DLBCL is B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma.
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--Colon: How is this field coded for an appendical primary when the appendix has ruptured and intrapentoneal fluid is positive?
For cases diagnosed 1998-2003: Code EOD extension as 85 [Metastasis]. Positive intraperitoneal fluid is equivalent to distant metastasis (implantation) for colon, including appendix, primaries.
Surgery of primary site--Lung: Should microwave ablation be coded as treatment for lung cancer, and if so, how should it be coded?
Code microwave tumor ablation as surgery. For lung, assign code 15.
This question was discussed by the technical advisory group – a small group of representatives from each standard setter which meets periodically. The group agreed on this consensus answer.
Date of Diagnosis--Colon: If a patient has a positive Cologuard test, is the date of diagnosis the date of the cologuard test or the date of the biopsy?
Do not use the date of a positive Cologuard test as the date of diagnosis.
Primary Site (Pre-2007)--Prostate/Prostatic Urethra: What code is used to represent primary site for an "adenocarcinoma with spindle cell differentiation" of the prostatic urethra?
For tumors diagnosed prior to 2007:
Code the Primary Site field to C61.9 [prostate] because the histology is adenocarcinoma.
When a malignancy is identified in the prostatic urethra, look at the histology to determine the primary site. If it is a transitional cell carcinoma, code the Primary Site field to C68.0 [urethra] and if it is an adenocarcinoma, code to C61.9 [prostate].
The EOD scheme is ultimately collapsed into the TNM scheme. The TNM system differentiates between adenocarcinoma of the prostate and transitional cell carcinoma of the urethra. Only adenocarcinoma of the prostate is staged by the prostate scheme. Transitional cell carcinoma of the prostatic urethra is coded to C68.0 [urethra] and staged with that scheme.
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.
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded if a sentinel lymph node biopsy reveals no malignancy but there is an aggregate of melanoma cells in the lumen of a large vein immediately adjacent to the lymph nodes?
This question was answered by the CoC:
Do not count this as regional metastatic disease since there is no evidence it is an established tumor. Stage this as a N0.
MP/H Rules/Histology--Prostate: If a patient is stated to have prostate "cancer" but a pathology report is not available nor is a specific histology stated in the medical record, can this histology be coded to 8140 [adenocarcinoma] instead of 8000/3 [cancer] because the vast majority of prostate cancers are adenocarcinomas?
For cases diagnosed 2007 and later, the correct histology code is 8000/3 [cancer]. The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Other Sites Histology rules because no specific rules have been developed for prostate primaries.
To determine the histology, start at the SINGLE TUMOR: INVASIVE ONLY module, rule H8. The rules are intended to be reviewed in consecutive order within a module. Code the histology documented by the physician when there is no pathology/cytology specimen or the pathology/cytology report is not available. Code the histology as 8000/3 [cancer] because that is the only available information. In the absence of a pathology report or any other histologic confirmation, code the histology based on the information available.
Reportability--Hematopoietic, NOS: Is "evolving" multiple myeloma reportable to SEER?
For cases diagnosed prior to 1/1/2010:No, it is not SEER reportable. The diagnosis of "evolving" multiple myeloma could represent a plasmacytoma, plasma cell dyscrasia or another lymphoproliferative disorder. Some of these histologies are SEER reportable, but some are not. Additional information would be needed to determine reportability. If you are unable to obtain more information, the case is non-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.
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