Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?
Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.
First Course Treatment--Unknown & ill-defined site: We have a case with an unknown primary site and the patient had chemoembolization into the hepatic artery. We don't know how to code this treatment. See Discussion.
We were told to code as surgery (10) and chemo (01). However an unknown primary automatically gets a (98) surgery code & the chemo is coded (01) but we can't code as systemic therapy. This is an edit. Chemo coded but no date of systemic therapy.
Effective for cases coded prior to the change in policy made on January 9, 2008, code chemoembolization of a metastatic site as 1 [nonprimary surgical procedure performed] in Surgical Procedure of Other Site.
Surgery of Primary Site code 98 is assigned to all cases with an unknown primary.
In the case of a liver primary, it would be coded 10 [local tumor destruction, NOS] in Surgical Procedure of Primary Site.
Chemotherapy--Breast: In the absence of more specific information, is the insertion of a port-a-cath one month after mastectomy enough documentation to code chemotherapy to 88 [Recommended]?
Assign chemotherapy code 88 [Chemotherapy was recommended, but it is unknown if it was administered]. Be sure to confirm whether or not treatment was administered and update this code accordingly.
Reportability/Behavior--Colon: Is a final diagnosis of "mucosal carcinoid" of the colon reportable with a behavior code 2 [in situ] or 3 [invasive] if the microscopic description states that a "malignancy is not appreciated"? See Discussion.
2002 carcinoid case. Path final diagnosis: sigmoid colon polyp, bx-- sm mucosal carcinoid (1.5mm) w/crush artifact in a colonic polyp showing assoc inflammatory and hyperplastic changes. Micro: due to prominent crush artifact, histologic detail is compromised; however, significant atypia or malignancy is not appreciated.
Our state registry requests that this case be abstracted using the histology code 8240/3 because it is a mucosal carcinoid.
AJCC states TIS as being confined w/i basement membrane w/no extension through muscularis mucosae into submucosa. SEER-EOD codes as invasive: mucosa, lamina propria and muscularis mucosae. Our pathologist goes along with AJCC while we are having to code with SEER rules.
1) Assign /3 to mucosal carcinoid, unless stated to be in situ in the final diagnosis. ICD-O-3 is the reference for assigning the behavior code, not AJCC, EOD or CS.
2) The ICD-O-3 code for carcinoid of the sigmoid colon is C187 8240/3. This is reportable to SEER based on the final diagnosis above. Use the histology stated in the final diagnosis.
Reportability--Lung: Is sclerosing hemangioma of the lung with multiple regional lymph nodes metastases reportable?
No, it is not reportable. According to the WHO Classification of Lung Tumours, sclerosing hemangioma "behaves in a clinically benign fashion...Reported cases with hilar or mediastinal lymph node involvement do not have a worse prognosis."
Histology (Pre-2007)--Melanoma: How is a 2004 "malignant melanoma, nodular type, epithelioid cell type" coded?
For tumors diagnosed prior to 2007:
Assign code 8771 [Epithelioid cell melanoma]. Code the cell type when specified.
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.
Surgery of Primary Site--Prostate: How is the use of a Laserscope Niagara laser (modulated KTP-YAG laser beam (Niagara 122 prostate vaporization)) coded for prostate primaries? See Discussion.
The Laserscope Niagara laser performs an operation similar to the TURP, but there is virtually no bleeding and patients can sometimes go home the same day, most without a catheter. The laser is delivered through a fiber (the thickness of hair) into the cavity via an endoscope inserted through the urethra.
When performed as part of the first course of therapy, assign surgery code 15 [Laser ablation] to Niagara laser photovaporization of the prostate.
Behavior/Date of Diagnosis--Lung: If the term "Pancoast tumor, NOS" is malignant by definition, should the date of diagnosis be coded to the date of the clinical diagnosis when the clinical diagnosis is made prior to the histologic confirmation of the malignancy?
Yes, Pancoast tumor is by definition malignant. It is defined as a lung cancer in the uppermost segment of the lung that directly invades into the brachial plexus (nerve bundles) of the neck, causing pain. If a Pancoast tumor was identified on imaging prior to the biopsy, the date of diagnosis should be linked to the Pancoast tumor report.
Primary Site/Histology (Pre-2007)--Rectum: How are rectal biopsies with the histology of "poorly differentiated carcinoma with mixed basaloid and squamous features" coded if, per the SEER site/histology validation table, the histology 8094/3 [basosquamous carcinoma] histology cannot be coded to the rectum for the primary site?
For tumors diagnosed prior to 2007:
Code primary site C209 [rectum] and histology 8094/3 [basosquamous carcinoma]. As of 6/9/2003, this is no longer an impossible site/histology combination.
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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