MP/H Rules/Histology--Colon: If a tubulovillous (TV) adenoma is in situ and other polyp(s) have an invasive component, does the in situ TV adenoma still have priority and should rule H18 be applied?
For cases diagnosed 2007 or later, always give precedence to coding the invasive. Rule H18 applies UNLESS the adenocarcinoma in the TV is in situ and the others are invasive. In this case, code the histology of the invasive adenocarcinoma.
This clarification will be added when the MP/H manual is revised.
Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: Is the prostatic urethra a new primary for a case with a history of recurrent noninvasive bladder cancer that was subsequently diagnosed with transitional cell carcinoma in situ of the prostatic urethra and had a subsequent clinical diagnosis of "refractory bladder carcinoma"?
For tumors diagnosed prior to 2007:
If the histology of the bladder primary is "transitional cell carcinoma" or "papillary transitional cell carcinoma," do not code the prostatic urethra as a new primary. This is probably a case of intraluminal (mucosal) spread of the original tumor, rather than separate primaries. The clinical diagnosis supports this view.
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/Grade, Differentiation: Does the term "grade 0" refer to differentiation or does its use as a modifying phrase in the final diagnosis of "grade 0 immature teratoma" impact reportability?
Regarding the term "grade 0" for an immature teratoma, determine whether the pathologist is using that term to describe the primary tumor or its implants. The term can be used to describe both situations.
An immature teratoma (IT) may have grade 0 (benign) implants. Grade 0 implants may affect the prognosis and treatment, but the primary tumor (IT) would still be malignant and therefore reportable. If grade 0 pertains to the primary tumor (as opposed to implants) it is benign, and therefore not reportable.
Histology--Breast: Please confirm the morphology code for a diagnosis of "encapsulated papillary carcinoma" of the breast. Several articles on the internet lead me to believe it is the same as an intracystic carcinoma, code 8504/2 (our case shows no evidence of invasion).
You are correct in coding 8504/2 for this case. Per the 4th Edition WHO Tumors of the Breast, encapsulated papillary carcinoma (EPC) of the breast is synonymous with intracystic or encysted papillary carcinoma. It is a variant of ductal carcinoma in situ (DCIS).
First Course Treatment--Thyroid: Is hormone replacement following total thyroidectomy coded as first course treatment for all thyroid cases?
Code Hormone therapy as 01 [Hormone therapy administered as first course therapy] when thyroid replacement therapy is part of the first course of treatment for follicular or papillary thyroid cancer following thyroidectomy.
Thyroid hormone replacement therapy has a treatment effect on differentiated (follicular and papillary) carcinomas of the thyroid. This treatment effect is not seen for most medullary and undifferentiated thyroid cancers.
Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246?
Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma.
Hematologic Transplant and Endocrine Procedures--Breast: Is a bone marrow transplant first course of cancer-directed therapy for breast cancer? If yes, are time guidelines relating to the first "remission" the same as for those used in leukemia primaries?
For cases diagnosed 1/1/2003 and after: A bone marrow transplant can be first course of therapy for cases in which there has been no progression of disease between the initial therapy (e.g., surgery, radiation, chemotherapy) and the bone marrow transplant. Code Hematologic Transplant and Endocrine Procedures field to 10-12 or 40 (depending on the type of bone marrow transplant performed).
Do not use leukemia treatment time guidelines when coding breast cancer treatment.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field for a lymph node biopsy that reveals "well differentiated lymphocytic lymphoma" and a bone marrow biopsy that reveals "chronic lymphocytic leukemia/well differentiated lymphocytic lymphoma"?
For cases diagnosed prior to 1/1/2010:
Code the Grade, Differentiation field to 1 [Grade 1] for both of these cases because there is no mention of T-cell, B-cell, null cell, or NK cell involvement. Both cases have a pathologic description of well differentiated, not the descriptors "high grade," "low grade," or "intermediate grade" which must be ignored when coding grade for lymphomas.
For lymphomas, you cannot code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field because these terms refer to categories in the Working Formulation and not to histologic grade. However, you can code terms such as "well differentiated", "moderately differentiated" and "poorly differentiated" for lymphoma histologies.
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.
MP/H Rules/Histology--Skin: How is the histology coded for a "malignant baso-melanocytic tumor" arising in the skin of right shoulder?
Code the histology as melanoma, NOS [8720/3].
This is a malignant skin tumor with both melanoma and basal cell carcinoma histologies. There is no ICD-O-3 code for this entity. Per our subject matter expert, code the histology to 8720/3 [melanoma, NOS] and document the diagnosis of malignant baso-melanocytic tumor in a text field because melanoma is reportable to SEER and basal cell carcinoma is not.
Histology/Grade, Differentiation--Lymphoma/Leukemia: Do you agree with coding a diagnosis of Nasal NK/T cell lymphoma to 9719/38?
For cases diagnosed prior to 1/1/2010:Yes. Code the Grade, Differentiation field to 8 [NK cell] rather than 5 [T-cell]. Code the Histologic Type to 9719/38 [NK/T-cell lymphoma, nasal and nasal-type with Cell indicator of NK (8)].
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.