Primary Site--Esophagus: What is the difference between C15.5 [Lower third of esophagus] and C15.2 [Abdominal esophagus]?
These descriptions represent the use of two different ways the esophagus can be divided anatomically. The two different systems used are illustrated in the SEER Self Instruction Manual for Tumor Registrars: Book 4. Assign the primary site code that describes the location of the tumor in the same way the tumor's location is described in the medical record.
Primary Site--Head & Neck (Middle ear): How do you code site for a skull based tumor consistent with a low grade papillary adenocarcinoma of "endolymphatic sac origin"?
Code Primary Site to C30.1 [Middle ear]. The endolymphatic sac is part of the inner ear labyrinth located with in the petrous portion of the temporal bone.
Primary Site--Head & Neck: What is the anatomical distinction among tonsillar fossa, tonsillar pillar, and tonsil NOS?
Operative findings describe a right tonsil three times the size of the left tonsil. Tonsil is dissected from the tonsillar fossa. There appeared to be no involvement of tumor below the tonsillar capsule.
The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.
Code C09.9 [Tonsil NOS] as the primary site for the case above.
Primary Site--Head & Neck: How is this field coded for a tongue primary described as "located on the lateral" or "left oral" tongue? See Discussion.
Case 1. Patient with squamous cell carcinoma, left oral tongue.
Case 2. Squamous cell carcinoma, left lateral tongue.
Case 3. Patient status post biopsy of lesion on tongue. Exam: healing left lateral tongue incision with sutures in place in underside of tongue.
Code Primary Site for cases 1 and 2 above to C023 [Anterior 2/3 of tongue, NOS]. Code lateral tongue without mention of dorsal or ventral surface to C023 [Anterior 2/3 of tongue, NOS].
Code Primary Site for case 3 to C022 [Ventral surface of tongue]. The underside of the tongue is specified as the site of the biopsy in case 3.
Primary Site--Head & Neck: What site code is used to represent the following head and neck primary where there is not a clear statement of primary site? See discussion.
6/29/02: PE: 2-3 cm mass in the posterior pharynx that seems to arise from the right side of back of tongue.
6/29/02 CT soft tissue of neck: 3 cm right sided oropharyngeal mass, possibly arising from right tongue mass. There is near occlusion of airway at this level.
7/3/02 Excision of oropharyngeal tumor: Palpated mass could clearly be felt coming off the right lateral tongue in approximately the mid portion of the tongue near the tonsillar base.
Code the Primary Site field to C02.9 [tongue, NOS], based on the information provided.
Primary Site--Hematopoietic, NOS: Are there any guidelines for the use of topography code C420 [blood] rather than C421 [bone marrow], or C424 [Hematopoietic system, NOS] for hematopoietic diseases other than Waldenstrom macroglobulinemia?
For cases diagnosed prior to 1/1/2010:There are no specific guidelines concerning code C420 versus C421 or C424, other than the suggested topography codes in ICD-O-3 (see Rule H). The Hematopoietic task force is in the early phases of developing guidelines for these diseases. This issue will be presented to the task force for their consideration.
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: Is the primary site coded to C779 or C421 for a bone marrow that is positive for B-cell acute lymphoblastic leukemia, the peripheral blood demonstrates leukemic involvement and the PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones? See Discussion.
1/11/13 Bone marrow bx: B-cell acute lymphoblastic leukemia. Flow cytometry of peripheral blood shows leukemia involvement.
PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones. The patient has an elevated WBC, anemia and thrombocytopenia.
The answer to SINQ 20120047 (which is no longer visible in the system) said to code B lymphoblastic leukemia/lymphoma to bone marrow for primary site if there is bone marrow involvement. The Heme/Lymph Manual Rule PH7 says to code bone marrow as the primary site if bone marrow is the only site involved.
Following the manual, the primary site would be C779. However, according to the answer to SINQ 20120047, the primary site would be C421. Which is correct?
Per the Heme DB, the histology B-cell acute lymphoblastic leukemia is synonymous with B lymphoblastic leukemia/lymphoma, NOS. Per Rule PH8, for a neoplasm that can manifest as either leukemia lymphoma or leukemia lymphoma, one is to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. The Note 4 instruction states it is necessary to go to Module 7 (Rules PH18-PH27) to code the more specific primary site. In this case, use Rule PH22 to code primary site to C779 [lymph nodes, NOS] for the case you describe.
In this case, there is involvement of abdominal lymph nodes, spleen, bone marrow and bone. There is no indication of the primary site. Per the Heme DB, the most frequent sites of involvement for the lymphoma are bone and lymph nodes. This is a Stage IV lymphoma.
The now inactivated SINQ 20120047, stated that based on the sites of involvement, this histology could be coded as either leukemia or lymphoma. If the only involvement is the bone marrow, the site is coded to C421 [bone marrow]. The involvement of peripheral blood does not change the primary site because such involvement is part of the leukemic process.
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.
Primary Site--Heme & Lymphoid Neoplasms: What is the primary site for a diffuse large B-cell lymphoma involving the testicles, stomach, rectum and bone marrow, when no lymph nodes are involved?
Per PH27, code the primary site to C809 [unknown]. Rule PH27 states one is to code the primary site to unknown [C809] when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR there is multiple organ involvement without any nodal involvement.
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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