EOD-Clinical Extension/EOD-Lymph Nodes--Prostate: How do you code clinical extension and lymph nodes for path only prostate cases treated with a TURP? Would clinical extension be coded to unknown or localized, NOS?
For cases diagnosed 1998-2003: Code the EOD-Clinical Extension field to 30 [localized, NOS] and the EOD-Lymph Nodes field to 0 [no lymph node involvement]. Per Note 7: Use code 30 when there is insufficient information as to whether the tumor is clinically apparent or inapparent but the tumor is confined to the prostate. This is an example of a case where there is insufficient information as to whether the tumor is clinically apparent or inapparent. Assume the tumor is confined to the prostate.
The PH rules for coding lymphomas (Module 7) refer to a lymph node region as defined by the ICD-O-3. Per the Appendix C, , the ICD-O-3 lymph node region for "pelvic" is C775. In this case, there is one lymph node region involved (bilaterally). Per Rule PH20, code the specific lymph node region when multiple lymph nodes within the same lymph node region (as defined by the ICD-O-3) are involved, C775. Per Note 1 under Rule PH20, use this rule when there is bilateral involvement of lymph nodes.
This same table in Appendix C also provides information on how left and right pelvic lymph nodes are categorized by AJCC for purposes of coding stage. If the left and right pelvic lymph nodes are positive for lymphoma, it is involvement of two regions. The case is coded as Stage II.
Keep in mind that the ICD-O-3 definition of regions is used to code the primary site, while the AJCC definition of regions is used to code stage.
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)/Diagnostic Confirmation: Which histology code is preferred if the CBD brushing is positive for malignant cells, cytologically most consistent with ductal adenocarcinoma [8500/3], and the common hepatic artery lymph node biopsy has metastatic adenocarcinoma, consistent with cholangiocarcinoma [8160/3]?
For tumors diagnosed prior to 2007:
Assign histology code 8160 [Cholangiocarcinoma]. Code from the pathology specimen when available. In this case, the only pathology is from the lymph node specimen.
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-Extension/EOD-Lymph Nodes--Kaposi Sarcoma: What code is used to represent this field for a Kaposi sarcoma with no skin lesions but positive lymph node and bone marrow biopsies?
Code the EOD-Extension field to 13 [Visceral (e.g., pulmonary, gastrointestinal tract, spleen, other)], because of the positive bone marrow. Code the EOD-Lymph Nodes field to 3 [Both clinically enlarged palpable lymph nodes (adenopathy) and pathologically positive lymph nodes], for the pathologically positive node.
Note: Potential revision of the extension scheme will be referred to SEER Medical Advisory Group (SMAG).
Reportability--Heme & Lymphoid Neoplasms: Is this a reportable case and if so what codes would be used for the primary site and histology?
Lymph node flow cytometry and bone marrow biopsy revealed involvement by a low-grade B-cell lymphoproliferative disorder. Medical oncologist states monoclonal gammopathy, question marginal zone B cell lymphoma versus lymphoplasmacytic lymphoma/lymphoproliferative disorder.
Based on the information provided, this case is not reportable. Low grade B-cell lymphoproliferative disorder is not reportable, nor is monoclonal gammopathy. There is no definitive diagnosis for marginal zone or lymphoplasmacytic lymphoma. The terminology used includes "question" and "versus" which are not acceptable ambiguous terms for reportability. If possible, follow up with the physician regarding the definitive diagnosis.
EOD-Extension--Corpus Uteri: What code is used to represent this field for a corpus primary (sounding 8 cm or less in length) treated with radiation prior to a hysterectomy that pathologically showed superficial myometrial invasion? Is it possible that the invasion could have been more extensive prior to the radiation treatment?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 12 [Myometrium, inner half] which represents the extension you know. In this particular case, there was no clinical evidence of extension outside the corpus. As long as the surgery was not performed because of disease progression, use information from the surgery to code EOD extension.
Surgery of Primary Site/Surgery Codes, NOS--Pancreas: What exactly is an extended pancreatoduodenectomy? Must the entire pancreas be resected in order to use code 70? What minimal requirements must be met to use code 70? How should a Whipple with cholecystectomy, partial omentectomy, common hepatic excision, portal vein resection, and lymphadenectomy be coded?
According to our research, a pancreaticoduodenectomy (PD) includes an en bloc resection of the pancreatic head, the common bile duct, the gallbladder, the duodenum, the upper jejunum, the distal portion of the stomach and the adjacent lymph nodes. The extended PD procedure includes extended lymphadenectomy, extended organ resection, and extended vascular resection and reconstruction.
Code 70 could be assigned without the entire pancreas being resected.
A Whipple procedure removes the head of the pancreas, duodenum, stomach and gallbladder and part the common bile duct. The portal vein resection is probably part of the common bile duct excision. If the omentectomy was performed for treatment of this primary, record it in "Surgical Procedure of Other Site." Record the lymphadenectomy in the lymph node data items.
Histology (Pre-2007): What code is best used to represent a diagnosis of "metaplastic carcinoma, matrix producing type." The tumor shows poorly differentiated infiltrating duct carcinoma and myxoid, cartilaginous stroma.
For tumors diagnosed prior to 2007:
Code the histology to 8575 [metaplastic carcinoma, NOS]. According to the WHO Classification of Tumors of the Breast and Female Genital Organs, metaplastic carcinoma is a type of epithelial breast tumor. Matrix producing carcinoma is a synonym of metaplastic carcinoma. ICD-O-3 does not have a code for matrix producing carcinoma.
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.
Primary Site/EOD-Size of Primary Tumor--Lung: If the only lung mass described in CXR is a "hilar mass," is the primary site coded to C34.9 [Lung, NOS] or C34.0 [Main Bronchus; incl. Carina]? Also, can the size of the hilar mass be used to code the size of tumor field?
Because the only description available is "hilar mass," code primary site as C34.0.
For cases diagnosed 1998-2003: Use size of mass for EOD-Size of Primary Tumor.
Reportability--Carcinoid: Is a diagnosis of carcinoid heart disease, based solely on clinical information and no pathology, reportable?
Carcinoid heart disease is not reportable but this diagnosis indicates that the patient likely has a carcinoid tumor which may be reportable. Obtain further information.
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