MP/H Rules--Ovary: Rule M7 states bilateral epithelial tumors (8000-8799) are reportable as a single primary. Are bilateral germ cell tumors of the ovary (e.g., dysgerminoma (9060/3)) that occur simultaneously now reported as two primaries?
For cases diagnosed 2007 or later, rule M7 applies to ovarian epithelial tumors with ICD-O-3 histology codes between 8000 and 8799. Rule M7 does not apply to dysgerminoma which is coded to 9060. Go on to the next rule, M8 and abstract as multiple primaries, left and right.
Behavior--Bladder: What behavior code is used for a TURB path specimen diagnosis of "non-invasive urothelial carcinoma, no muscle found, depth of invasion cannot be assessed" when the clinician stages the case as Ta? See Discussion.
The SEER site specific coding module for bladder says, "If the only surgery performed is a TURB and if it is documented that depth of invasion cannot be measured because there is no muscle in the specimen, code the behavior as malignant and not in situ."
Assign behavior code 2 [in situ] based on the physician's stage Ta.
When no other information is available and the TNM designation is not available, use the instructions on page C-844 in Appendix C of the 2007 SEER manual as a default.
Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
Ambiguous Terminology/Date of Diagnosis: How would you code the diagnosis date when the body of an imaging report uses reportable ambiguous terminology while the final impression in that same report uses non-reportable ambiguous terminology? Would you code the diagnosis date to the date of the scan or to the subsequent biopsy date that confirmed a malignancy? See Discussion.
Within the body of a mammogram report, the radiologist stated, "diffuse inflammatory tissue throughout the rt breast w/ large rt axillary lymph nodes, consistent with an inflammatory carcinoma of rt breast." His final impression, however, said "extremely suspicious rt breast w/ extremely dense breast parenchyma and adenopathy in axilla, suggesting an inflammatory carcinoma." The patient then went on to have a biopsy, which was indeed positive for cancer.
Accept the reportable ambiguous terminology from the body of the mammogram. Record the date of the mammogram as the date of diagnosis.
The guidelines on page 4 of the 2007 SEER manual addressing discrepancies within the medical record can be applied to discrepancies within one report.
The instructions are:
If one section of the medical record(s) uses a reportable term such as
apparently and another section of the medical record(s) uses a term that is not on the reportable list, accept the reportable term and accession the case.
Flag: For cases diagnosed prior to 2001, how is the ICD-O-3 Conversion Flag set if the ICD-O-2 and ICD-O-3 histology and behavior fields are both directly coded, as registrars in this region are instructed to do when submitting late cases, and as a result no conversion is necessary? Is it to 0 [Morphology (Morph--Type&Behav ICD-O-3 originally coded in ICD-O-3)] or Blank [Not converted]?
Assign code 3 [converted with review].
In your scenario above, ICD-O-2 and ICD-O-3 are being independently coded which should yield the same result as converting the case and then reviewing it.
Otherwise, if there is an ICD-O-3 code which differs from the ICD-O-3 code based on the conversion criteria, it will trigger an edit.
Type of Multiple Tumors--Colon: How is this field coded for a case in which the patient is found to have two in situ polyps and an adenocarcinoma arising in a polyp all in the same segment of the colon? See Discussion.
Code 30 would not count the fact that these are polyps. Code 31 states "AND a frank adenocarcinoma." What would be the correct code?
Assign code 30 [In situ and invasive] in this case. Code 31 does not apply here because frank adenocarcinoma is not present.
EOD-Pathologic Extension--Prostate: When coding a prostate case with a date of diagnosis prior to 1995, is the EOD-Pathologic Extension-Prostate field left blank?
For tumors diagnosed prior to 1995, leave EOD-Pathologic Extension--Prostate field blank.
Code all EOD fields according to the EOD coding scheme in effect for that year of diagnosis.
Reportability/Histology: Is a case reportable if the Final Diagnosis in a pathology report indicates a non reportable diagnosis but the Diagnosis Comment on the same report indicates a non reportable diagnosis followed by a reportable diagnosis in parenthesis? See Discussion.
08/13/2007 polypectomy final diagnosis: tubulovillous adenoma with severe epithelial atypia. Dx Comment (on same path) ...atypia including focal cribriform glandular architecture (carcinoma in situ).
This case is reportable as carcinoma in situ. The histology code is 8263/2 [adenocarcinoma in situ in a tubulovillous adenoma].
According to our pathologist consultant, a "comment" in a path report is a part of the diagnosis - it often elaborates on or clarifies the diagnosis. Placing [carcinoma in situ] in the comment, even in parentheses, indicates that is the appropriate diagnosis for our purposes.
MP/H Rules/Multiple Primaries--Bladder: The new multiple primary rule M7 states that tumors diagnosed more than three years apart are multiple primaries. Does this apply to in situ bladder tumors that occur more than three years apart and to an in situ tumor that occurs three years after an invasive tumor?
For cases diagnosed 2007 or later, use the MP/H rules in order. Rule M6 comes before rule M7.
M6 states that bladder tumors with certain histologies are a single primary. It is a single primary regardless of timing if there is any combination of:
papillary carcinoma [8050]
transitional cell carcinoma [8120-8124]
papillary transitional cell carcinoma [8130-8131]
Rule M7 applies to bladder tumors with histologies other than those listed above. If you have such a case, rule M7 applies to in-situ tumors and to an in situ three years after an invasive.
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