Reportability--Heme & Lymphoid Neoplasms: Does the fact that the Hematopoietic Database states the ICD-O-3 code 9970/1 [Lymphoproliferative disorder/disease, NOS] mean that the ICD-O-3 books should be updated to indicate that as of 2010 the code 9970/1 [Lymphoproliferative disorder/disease, NOS] is no longer applicable?
Lymphoproliferative disorder/disease, NOS [9970/1] is not a reportable neoplasm. There are also new codes that define lymphoproliferative disorder/disease more specifically. If you do a "smart search" and enter only the word "lymphoproliferative" into the Heme DB, you will get a listing of all of the reportable and non-reportable terms. That enables you to look at your record and compare the words in the Heme DB to those in the record you are reviewing.
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.
Histology (Pre-2007)--Colon: Must a case be specifically labeled "familial adenomatous polyposis" or is the mere presence of numerous/multiple polyps sufficient for coding the histology to FAP?
For tumors diagnosed prior to 2007:
The presence of numerous/multiple polyps is not necessarily adenomatous polyposis coli. Adenomatous polyposis is an extreme condition usually characterized by the presence of hundreds of polyps and should be identified as such either clinically or pathologically.
Look for the term "Familial adenomatous polyposis," FAP or one of its synonyms:
Adenomatosis of the colon and rectum [ACR]
Familial adenomatous colon polyposis
Familial colonic polyposis
Multiple familial polyposis
In the absence of these terms, the following probably indicate a diagnosis of FAP:
Hundreds of adenomatous polyps throughout large intestines, and at times, throughout the digestive system
Development of polyps as early as ten years of age, but more commonly at puberty
History of colectomy
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--Melanoma: Please explain how a CTR is to interpret the guideline in the MP/H rules (Cutaneous Melanoma): Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. Is this to mean that evolving melanoma in situ is not reportable? Or should we follow the guidelines in SEER Question 20130022 that states the reportability terms for melanoma and melanoma in situ.
Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.
CS Extension--Head & Neck: If a 2 cm left tonsil primary extends to the lateral aspect of the soft palate, should extension be coded to 40 [Soft palate, inferior surface including uvula or soft palate NOS] or 42 [Soft palate, superior (nasopharyngeal) surface] for a tonsil primary?
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.
Extension code 40 is for extension from the tonsil to the back (lower) part of the soft palate, or soft palate, NOS. Code 42 is for extension to the front (higher, nasopharyngeal surface) part of the soft palate.
Inferior soft palate is the back (lower) part of the soft palate (C051). Superior soft palate is the front, (nasopharyngeal surface) of the soft palate (C113).
Histology (Pre-2007)--Ovary: Should the histology "endometroid adenocarcinoma arising in a serous fibroadenoma" be coded to 8380 [Endometroid adenocarcinoma, NOS] or 9014 [Malignant serous fibroadenoma]?
For tumors diagnosed prior to 2007:
The best code is 8381/3 [Endometroid adenofibroma, malignant]. According to our pathologist consultant: "Serous 'fibroadenoma' is not exactly standard terminology. I would guess the pathologist is looking at an adenofibroma with more fibro and less adeno and thus has changed the terminology around. The combination of the benign serous and malignant edometrioid is also a bit unusual. Each of the proposed codes is defendable, but I prefer endometrioid adenofibroma, 8381/3, because it puts the tumor in the adenofibroma category (less common) yet still identifies the malignant element (endometrioid), even though it does lose the serous. But anyone wanting to look at malignant adenofibromas would find the case, and we would carry it under the appropriate malignant component."
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 Site Specific Factor--Lymphoma: Can the registrar calculate the International Prognostic Index (IPI) score from information found in the H&P or on the back of a TNM form for the SSF 3 field if the physician does not document it in the medical record?
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.Record the IPI score in SSF3 when the score is documented in the medical record. If the score is not stated, do not calculate it.
All Surgical Fields/Radiation Sequence with Surgery--Unknown Primaries: What codes are used to represent these fields for an unknown primary treated with a radical neck dissection followed by radiation therapy?
For unknown primaries treated with a lymph node dissection and diagnosed 1/1/2003 and after, code:
1) Surgery to Primary Site: 98 [All unknown and ill-defined disease sites, WITH or WITHOUT surgical treatment].
2) Scope of Regional Lymph Node Surgery: 9 [Unknown or not applicable].
3) Surgical Procedure of Other Site: 1 [Surgery to other site(s) or node(s), NOS; unknown if regional or distant].
4) Radiation Sequence with Surgery: 3 [Radiation after surgery]. Any planned surgical treatment is used to code radiation/surgery sequence (per CoC I&R).
MP/H Rules/Multiple primaries--Breast: Is this the same primary per MP/H Rule M10? Ductal carcinoma of the left breast in 2013, treated with a lumpectomy. New tumor with ductal and lobular carcinoma in the same breast in 2016.
The 2016 diagnosis is the same primary. MP/H Rule M10 for breast cancer applies. Do not change the original histology code. Use text fields to document the later histologic type -- duct and lobular.
Diagnostic Confirmation--Leukemia: How is this field coded when the clinician confirms that the diagnosis of CML is based on a combination of the clinical picture and positive cytogenetic studies?
Assign code 1 [Positive histology]. For leukemia only, assign code 1 for positive hematologic findings including peripheral blood smears, CBCs and WBCs.
Cytogenetics studies would have been done on blood. Therefore, histology provided diagnostic confirmation as it would with smear, bone marrow, or other special study of blood cells.