Neoadjuvant Treatment/Date Therapy Initiated--Breast: If Tamoxifen has been used since 2000 for the treatment of hyperplasia, should it be coded as neoadjuvant treatment for a 2004 diagnosis of breast cancer?
Do not code tamoxifen given for hyperplasia as treatment for breast cancer. In this case, tamoxifen started four years before the breast cancer diagnosis -- not treatment for breast cancer.
Date of Diagnosis/Ambiguous Terminology--Lung: Would the date of a PET scan that states there is a mass in the lung which is "in the range of malignancy " be coded as the date of diagnosis or would the date of a subsequent bronchoscopy with biopsy be used for diagnosis date because it confirms a malignancy?
The date of diagnosis in this case is the date of the bronchoscopy with biopsy.
"In the range of malignancy" is not one of the ambiguous terms that are reportable. Please see the list of reportable ambiguous terms on page 3 of the 2004 SEER manual. Do not accession cases based on ambiguous terms not found on the reportable list.
CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability.
CS Extension/CS Mets at Dx--Peritoneum: How are these fields coded for extraovarian peritoneal carcinomas presenting with multiple peritoneal implants? See Discussion.
Patient presented with large omental cake and multiple peritoneal implants including implants on the rectosigmoid serosa and right ovary. Path revealed papillary serous adenocarcinoma consistent with peritoneal primary.
Per AJCC Manual, extraovarian peritoneal carcinoma is usually staged with the ovarian staging classification.
We understand that the CS Manual will eventually be revised to include staging for extraovarian peritoneal primaries. In the meantime, how do we use the existing CS scheme for peritoneum to code these cases?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code CS Extension 99 [unknown] and CS Mets at DX 99 [unknown].
The issue has been sent to the CS steering committee for resolution. This answer will be updated when the steering committee provides a resolution.
First Course Treatment--Hematopoietic, NOS: How are Decadron and Zometa coded when used in the treatment of multiple myeloma? See Discussion.
The 2004 SEER Program Manual instructions for coding hormone therapy do not provide any specific instructions for coding adrenocorticotrophic agents. Per Abstracting and Coding Guide for the Hematopoietic Diseases pg. 3, prednisone and decadron are coded as hormonal therapy (when given as part of a chemotherapy regimen). Does this mean that Decadron without chemo agents is not coded as treatment? In paging through the hematopoietic disease manual, one sees this instruction for other sites as well. Yet, for other diseases (e.g., Waldenstroms macroglobulinemia on page 18), prednisone is coded as hormone therapy (not necessarily as part of chemo regimen).
Code the decadron as hormonal treatment. Do not code the zometa--it is an ancillary agent.
In the August 2006 update of SEER*Rx, a note was added to decadron and other hormonal agents that they can be used to control white cell proliferation in lymphoma and multiple myeloma.
In general, decadron is used more commonly for supportive care and as an antiemetic than as hormone therapy.
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded for a melanoma primary when melanoma is identified in lymph nodes but no primary skin tumor is found? See Discussion.
Excisional biopsy of an inguinal lymph node revealed metastatic melanoma. Multiple skin biopsies did not reveal the primary site.
Subsequent lymph node dissection of superficial inguinal nodes showed microscopic focus of malignant melanoma in subcutaneous fat adjacent to previous procedure site. No evidence of metastatic melanoma in 7 lymph nodes. Dissection of external iliac lymph nodes showed no evidence of melanoma in 5 lymph nodes.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code CS Lymph Nodes 80 [Lymph nodes, NOS]. Code CS Mets at DX 00 [None]. Since it cannot be determined whether the lymph nodes are regional or distant, code CS Lymph Nodes to lymph nodes, NOS.
CS Site Specific Factor--Head & Neck: If a lymph node dissection of the neck reveals that 1/24 lymph nodes is positive and the positive 5.6 cm lymph node extends throughout levels II-IV, how are the SSF 3 (status of levels I-III lymph nodes) and SSF4 (status of levels IV-V lymph nodes) fields coded?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.According to the CS Steering Committee, code 999 for SSF 3 and SSF 4. In this case, do not make assumptions about which level of lymph nodes were involved.
First Course Treatment--Lymphoma: Should the use of proton pump inhibitors be coded as treatment for lymphoma primaries in patients with H Pylori?
No, do not code proton pump inhibitors as treatment. These are used for gastric acid suppression. Proton pump inhibitors are used to treat symptoms, not the lymphoma itself.
CS Site Specific Factor--Prostate: How is SSF 6 coded for this site when there is only one Gleason number documented and the number is less than 5 (e.g., Gleasons 3)?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code 999 [unknown or no information]. Note 1 was revised in September 2006 to clarify this situation.
Note 1 states "If only one number is given and it is less than or equal to 5, code the total score to 999, unknown or no
Reportability--Anus: Is a final diagnosis on a pathology report of "squamous cell carcinoma of the anus, NOS" assumed to be a skin of anus primary or a primary of the anus?
Squamous cell carcinoma of the anus is reportable unless known or stated to be skin of anus.
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