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Report Produced: 02/19/2026 23:56 PM

Report Question ID Question Discussion Answer Year
20031142 Other Therapy/Immunotherapy--Hematopoietic, NOS: How should erythropoietin be coded for leukemia or other hematopoietic diseases? Do not code Erythropoietin as treatment, it is used as an ancillary drug for leukemias or other hematopoietic diseases. Record information about erythropoietin in the text field. 2003
20031087 EOD-Extension--Lymphoma/Brain and CNS: How is this field coded for a primary brain lymphoma that is described as multi-focal? For cases diagnosed 1998-2003: Since brain is the only site involved in this example, assign code 11 [Localized involvement of a single extralymphatic organ or site]. 2003
20031184

Surgery of Primary Site--Breast: How is this field coded when a patient has a reduction mammoplasty (for macromastia) and within the pathology specimen there is an incidental finding of carcinoma?

Code this reduction mammoplasty to the code which best fits the amount of tissue removed. Read the operative report carefully. Code as a partial mastectomy, skin- nipple- areola-sparing mastectomy, or total (simple) mastectomy. Use text fields to record the details.

 2003
20031127 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: Would the simultaneously occurring histologies of "high grade ductal carcinoma in situ with micro invasion" and "keratinizing squamous cell carcinoma" be coded as two primaries or as a single primary when the pathologist is not clear whether two separate tumor masses exist?

For tumors diagnosed prior to 2007:

Code as two primaries, assuming the tumors are separate and the margins are clear/negative. Code 8071/3 [Invasive squamous cell ca, keratinizing] and 8500/3 [Ductal carcinoma, "microinvasive"].

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.

 2003
20031025 Histology (Pre-2007): Is a small cell undifferentiated carcinoma coded to 8041/34 [small cell carcinoma undifferentiated] or to 8045/34 [combination small cell AND undifferentiated carcinoma] using terms from the 2 columns in Appendix 1 of Coding Complex Morphologic Diagnoses? See discussion. Per pathology report, diagnosis is small cell undifferentiated carcinoma in biopsies taken from the laryngeal surface of the epiglottis and left false vocal cord.

For tumors diagnosed prior to 2007:

Code histology as 8041/34 [small cell carcinoma, undifferentiated]. The diagnosis indicates that this is an undifferentiated small cell carcinoma, rather than a mixture of small cell carcinoma with undifferentiated 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.

 2003
20031173

First Course Treatment/Hormone Therapy--Thyroid: Is hormone replacement therapy such as levothyroxine (Synthroid) for thyroid carcinoma coded as first course of treatment? See Discussion.

Examples:

Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. Fine needle aspirate suggested carcinoma. Patient's medications included Cytomel and Synthroid.

Patient was given levothyroxine after thyroidectomy for medullary thyroid carcinoma.

Updated December 2025

Do not code levothyroxine given to treat hypothyroidism or as cancer treatment for medullary carcinoma when given as replacement therapy and not as thyroid stimulating hormone (TSH) suppression therapy. Thyroid hormone therapy is generally coded as treatment for follicular, papillary, and oncocytic thyroid carcinomas.

 2003
20031075 EOD-Extension--Colon: How should this field be coded for "adenocarcinoma penetrating through bowel wall into adjacent adipose tissue? For cases diagnosed 1998-2003: The difference between EOD-extension codes 40 and 45 is the level of the fat involved. Code 40 is subserosal fat immediately adjacent to the muscular wall of the colon inside the serosa/visceral peritoneum. Code 45 is pericolic fat in areas where there is a serosal surface or in the retroperitoneal areas of the ascending and descending colon where there is no serosa. Code 42 was added for use when it is not possible to determine whether subserosal fat or pericolic fat is involved. Code 42 should be used only when there is a reference to 'fat' (NOS) The answer for the case example above depends on the location of the primary and whether the fat referred to is within or outside the entire thickness of the colon wall. If no additional information is available, use code 42 [Fat, NOS]. 2003
20031101 Primary Site/Behavior Code/EOD-Extension: How would these fields be coded for "squamous cell carcinoma in situ involving papilloma -- locally aggressive but not technically invasive" found in the sphenoid sinus, soft tissue of the skull base and brain? See Description.

The managing physician has staged this pathologically as T4 N0 M0 squamous cell carcinoma of the ethmoid sinuses. The final pathology report says " Sinus, sphenoid, resection: papillary neoplasm most consistent with inverted papilloma with squamous cell carcinoma in situ, 7 cm in greatest extent, focus of probable superficial invasion (see comment).

Soft tissue, skull base, excision: involved by papillary neoplasm with squamous cell carcinoma in situ (see comment). Brain, extradural, intercranial biopsy: involved by papilloma with squamous cell carcinoma in situ. COMMENT:

This is a predominantly exophytic neoplasm with infolding of the tumor epithelium and in situ extension into submucosal glands. There are only focal areas suspicious for invasive squamous cell carcinoma, with probable invasion (<2mm) in one section....The histologic features are most consistent with an inverted papilloma with carcinoma in situ." When asked to comfirm if the diagnosis were in situ or superficially invasive, the pathologist responded "Squamous cell carcinoma in situ involving a papilloma. Locally aggressive but not technically invasive."

Code site to C31.3 [sphenoid sinus]. Code the site based on the final pathology report diagnosis. In the case example, the site attributed to the managing physician appears to be an error.

Code behavior to 3 [malignant, primary site]. The SEER list of terms meaning involvement may be used to help determine behavior. The terms used by the pathologist are "probable" superficial invasion and "suspicious" for invasive squamous cell carcinoma with "probable" invasion. Interpret as invasive.

For cases diagnosed 1998-2003: Code extension to 70 [Brain] because this tumor involves the brain.

 2003
20031152 Ambiguous Terminology/Histology (Pre-2007): How do we code histology when there is a difference between the histology mentioned on a suspicious cytology and the clinical diagnosis by the treating physician? See Description. An FNA of pancreas is stated as "highly atypical cells present, suspicious for pancreatic ductal carcinoma." The attending physician states the patient has pancreatic carcinoma. Can histology be coded 8500/3 [infiltrating duct carcinoma, NOS] or should it be 8010/3 [carcinoma, NOS]?

For tumors diagnosed prior to 2007:

Code the histology from a suspicious cytology when this histology is supported by the clinical diagnosis.

Code the example above to 8010/3 [Carcinoma, NOS].

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.

 2003
20031124 Multiple Primaries (Pre-2007)--Breast: Synchronous invasive right breast tumors. Ductal carcinoma, NOS in UIQ and Ductal carcinoma, tubular type in LOQ. Are these two primaries or a single primary coded to 8523/3?

For tumors diagnosed prior to 2007:

Code as two primaries, one 8500/3 [Infiltrating duct carcinoma] and one 8211/3 [Tubular carcinoma].

Apply the multiple primary rules first. These are synchronous right breast tumors with different histologies. Therefore, they are separate primaries according to rule 5.a on page 12 of the SEER Program Code Manual. ICD-O-3 histology code 8523/3 is NOT to be used to combine histologies from separate primaries; it is used for mixed histologies in a single primary.

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.

 2003