MP/H Rules/Histology--Thyroid: Is a "papillary carcinoma of the thyroid" coded to 8260/3 [Papillary adenocarcinoma] per the ICD-O-3 because it lists "papillary carcinoma of the thyroid" as a synonym for that code or should it be coded to 8050 [Papillary carcinoma, NOS]?
For cases diagnosed 2007 or later, assign code 8260 [papilary carcinoma of the thyroid].
CS Extension--Prostate: Should CS Clinical Extension always be coded to 99 [Extension unknown] for prostatic adenocarcinoma found incidentally during surgery for another primary or at autopsy? See Discussion.
Patient had a cystoprostatectomy for bladder cancer. Pathology report states only 2 microscopic foci of prostate adenocarcinoma found on LEFT side of gland. Physician notes state patient has been followed for 4 years with a nodule in the RIGHT prostate and has refused biopsy despite rising PSA. There was no definite statement of suspected cancer.
Should CS Clinical Extension be coded 99 because prostate cancer wasn't clearly stated to have been suspected until cystoprostatectomy? Or could we code the right-sided "nodule" as clinically apparent (CS Extension 20), even though path found tumor only on the left (which is how we would code a standard prostate case)?
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 [Extension unknown]. This prostate cancer was not clinically evident; it cannot be clinically assessed based on the information provided.
Note: This is an unusual case. A DRE was performed and a nodule was palpated on the right that was not cancer. The other lobe is presumed to have been negative because it was not mentioned.
Histology--Corpus uteri: Because coding a pathology final diagnosis of "serous carcinoma" for an endometrial primary to 8441/3 triggers the site/histology error in the SEER Edits, should histology be coded to 8010/3 [Carcinoma, NOS] instead?
Assign histology code 8441 [serous carcinoma] and override the edit. Endometrium with serous carcinoma is NOT one of the "impossible" site / histology combinations.
Histology--Lymphoma: How is a "lymphocytic lymphoma of follicular center cell origin" coded?
For cases diagnosed prior to 1/1/2010:Assign code 9690 [Follicular lymphoma, NOS]. According to the WHO Classification of Lymphoid tumors, follicular lymphoma is a neoplasm of follicle center B cells which has at least a partially follicular pattern.
Assign code 9695 for follicular lymphoma grade 1, 9691 for follicular lymphoma grade 2, and 9698 for follicular lymphoma grade 3.
For cases diagnosed 1/1/10 and later, 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.
Reporting Source: If the only patient record available for a physician office biopsy is the pathology report identified from a freestanding laboratory, is reporting source coded to 3 [Laboratory Only (hospital-affiliated or independent)] or 4 [Physicians office/Private Medical Practitioner (LMD)]? See Discussion.
A case was identified through a pathology report from a freestanding lab. The doctor who submitted the specimen left the state. His records cannot be located. Because the patient had the specimen removed at a physician's office, not at a path lab, is Type of Reporting Source field coded to the physicians office?
Reporting Source is the source that provided the best information used to abstract the case.
For this case, assign code 3 [Laboratory Only (hospital-affiliated or independent)]. Reporting source should reflect the lab where this case was identified. The MD office added nothing to the case, not even a confirmation of malignancy.
CS Lymph Nodes--Kidney, renal pelvis: Under what circumstances would code 80 [Lymph nodes, NOS] be used to document the presence of positive lymph nodes? See Discussion.
The CS Schema for Kidney (Renal Parenchyma) states to use code 70 for Regional Lymph Nodes, NOS. The schema for for Renal Pelvis states to use code 50 for Regional Lymph Nodes, NOS. Both schemas have a Code 80, for Lymph Nodes, NOS that maps to N1 in both schemas.
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 80 can be used for positive lymph nodes when you are unable to determine if they are regional or distant. CS Lymph Nodes code 80 is provided for this situation in accordance with the downstaging rule.
Code 80 should be used very infrequently and only when there is no indication whether the involved lymph nodes are regional or distant.
MP/H Rules--Lung: Why the term "nodule" is not included as an equivalent term along with tumor, mass, lesion and neoplasm in the 2007 lung multiple primary rules?
Answer revised July 2008
For cases diagnosed 2007 or later:
For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.
This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.
MP/H Rules/Histology--Breast: Which report and diagnosis should be used to code the histology if an excisional biopsy that removes the majority of the tumor has a diagnosis of "carcinoma," and the subsequent lumpectomy diagnosis is "microscopic residual disease consistent with infiltrating duct carcinoma"?
For cases diagnosed 2007 or later, code histology for this case to 8010 [carcinoma]. The histology is coded from the pathology report with the most representative specimen (the most tumor tissue) even when the most representative specimen has a less specific histology.
MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?
For cases diagnosed 2007 or later:
Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.
Radiation Therapy: How is radiation coded when it is "recommended" but the patient dies before radiation is started? See Discussion.
Code 0 seems appropriate but then we would lose the fact that it had been recommended. All of the other modalities give an option for 'recommended but patient died prior to treatment.' Is there a reason this option is not given for radiation?
Code Radiation (Rx Summ--Radiation) to 0 [None; diagnosed at autopsy].
SEER does not collect the Reason For No Radiation field. However, those who abstract using software that captures this data item can identify these cases. Code 5 [radiation not administered because patient died] reflects this situation.
Radiation (Rx Summ-Radiation) is a SEER field. This field is derived from the data collected in Rad-Boost Rx Modality and Rad-Regional TX Modality. These fields do not include a choice for "radiation not given because the patient died prior to treatment." Therefore, this information cannot be coded in the Radiation field.