Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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--Lung: If LUL mass "crosses the pleural surface" into the LLL, do we assume this represents extension to the pleura? See discussion.
9/22/93 Left upper lobe lobectomy: 3 x 3 cm mass in the periphery of the LUL near the LLL. Multiple enlarged nodes around the aortic arch and within the pulmonary fissure.
9/22/93 Pathology: Moderately differentiated Adenoca. The neoplasm does cross the pleural surface into the segment of the lower lobe. Lower margin of resection is free of neoplasm. Six lymph nodes negative for metastatic carcinoma. Tumor staged as T2N0M0 Stage Ib by physician.
Is tumor extension coded 10 [confined to one lung] or 40 [extension to pleura]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to pleura]. The tumor has penetrated (extended to) the pleura.
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.
Radiation: Is "consolidated" radiation therapy coded as part of first course therapy when there is no documentation of "planned treatment" and the radiation is done 4 months after the initiation of treatment?
Yes, "consolidation" treatment is part of a planned treatment regimen. A treatment regimen may consist of the four following phases:
EOD-Extension--Lung: Is bilateral pleural effusion coded as 72 [malignant pleural effusion] or 85 [metastasis]? See discussion.
Example:
10/30/98 CXR: Widespread malignancy, hilar, superior mediastinal masses, bilateral pleural effusions, fullness in soft tissue right neck.
11/01/98 CT chest/ABD: Extensive infiltrate mediastinum by radiolucent tumor mass that engulfs esophagus/trachea. Pleural effusion extends so low it apes ascites. Normal ABS/pelvis.
11/01/98 Pathology: FNA right supraclavicular lymph node: metastic oat cell ca. Sputum cytology reported to be negative.
For cases diagnosed 1998-2003, code the EOD-Extension field to 72 [malignant pleural effusion; pleural effusion, NOS].
Histology (Pre-2007): What code is used to represent the histology "papillary adenocarcinoma: mixed serous, endometrioid and mucinous subtypes"? See discussion.
Example: Fallopian tube right (salpingectomy): Primary adenocarcinoma: mixed serous, endometrioid, and mucinous subtypes
For tumors diagnosed prior to 2007:
For cases diagnosed on or after 1/1/98: Code the Histology field to 8323/3 [adenocarcinoma, mixed cell]. The case is coded using the mixed histology rule A in the Coding Complex Morph Dx's.
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.
Diagnostic Confirmation--Prostate: How do we code this field when there is an elevated PSA, no other work-up and there is a clinical diagnosis of adenocarcinoma?
Code the Diagnostic Confirmation field to 5 [positive laboratory test/marker study] to indicate the diagnosis is based upon an abnormal PSA tumor marker if the physician uses the PSA as a basis for diagnosing prostate cancer.
Multiple Primaries (Pre-2007)--Ovary/Endometrium: Is endometrioid adenocarcinoma occuring simultaneously in the left ovary and the endometrium one primary or two? See discussion.
Pathology Final Diagnosis:
Left Ovary: Moderately differentiated endometrioid adenocarcinoma squamous differentiation grade 2 (scale of 3)
Uterus: Moderately differentiated endometrioid adenocarcinoma with squamous differentiation, grade II (scale of III). Focal, very superficial invasion to inner third myometrium with extension to lower uterine segment. Endocervix, cervix, right ovary and fallopian tubes negative for tumor.
For tumors diagnosed prior to 2007:
Code the case you describe as two primaries. The endometrioid adenocarcinoma can arise in the endometrium without a concomitant ovarian 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.
Histology (Pre-2007)--Skin: Are "atypical melanocytic hyperplasia" and "severe melanotic dysplasia" synonyms for melanoma in situ?
For tumors diagnosed prior to 2007:
No. SEER determines its reportable list from the ICD-O-3. The above terms are listed as tumor-like lesions and conditions, but are not in situ or malignant.
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.
Multiple Primaries/Histology (Pre-2007)--Bladder: What code is used to represent the histology and how many primaries should be coded for a TURB specimen that demonstrates carcinoma in situ, Grade I to II papillary transitional cell carcinoma, and high grade transitional cell carcinoma? See discussion.
Pathology report:
A. Biopsy, bladder neck, @ 6:00: Carcinoma in situ
B. Biopsy, Bladder wall, lateral, left:
1. Papillary carcinoma (Grade I-II)
2. Loose fragments of high-grade transitional carcinoma
C. Biopsy, Bladder neck @ 5:00: Carcinoma in situ
D. Biopsy, Bladder neck @ 7:00: Cystitis Glandularis
E. Biospsy, Bladder wall, posterior: Papillary carcinoma (Grade I)
For tumors diagnosed prior to 2007:
Code this case as one primary and code the Histology and Grade, Differentiation fields to 8130/34 [papillary transitional cell carcinoma, high grade].
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.
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