EOD-Extension--Small Intestine: How do we interpret a pathology description of "extending through serosa and forming masses in the periserosal tissue" for a jejunum primary?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 55 [Invasion of/through serosa and adjacent connective tissue]. The description states the tumor extended through the serosa into periserosal tissue. The periserosal tissue in this case refers to adjacent connective tissue lying exterior to the intestinal wall and not the (sub)serosal tissue that lies exterior to the muscularis but inferior to the serosa. Analyze each case individually since pathologists are not consistent when using the above terminology.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: How are these fields coded if radiation to the primary site and/or regional lymph nodes is performed prior to surgery?
For cases diagnosed 1998-2003:
Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields per the information in the pathology report(s). Radiation to the primary site would not affect the status of the lymph node involvement. Radiation to the regional lymph node region may or may not affect the pathologic status of the lymph nodes. However, for these fields code the best information available about the status of the lymph nodes which is reflected in the pathology report(s).
EOD-Size of Primary Tumor--Melanoma: How do you code tumor size for a melanoma diagnosed by a positive lymph node biopsy when the primary site is coded C44.9 because no primary site was identified? See discussion.
Should the size be 000 because no primary was found or 999 for unknown?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 000 [No mass; no tumor found] when primary site is coded to C449.
Reason for No Cancer-Directed Surgery--Lung: How do you code this field for a lung primary that presents with metastasis to the bone and brain in which the oncologist's treatment plan includes only radiation and chemotherapy?
Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-Directed Surgery Not Recommended].
Diagnostic Confirmation--Testis: How do you code this field when a testicular mass is confirmed to be cancer on physical exam and testicular antigen, but the orchiectomy specimen was negative and yet the final signout diagnosis on the medical record was "testicular cancer"?
Code the Diagnostic Confirmation field to 5 [Positive laboratory test/marker study] because the disease was confirmed both clinically and by a positive marker. Code 8 [Clinical diagnosis only] is used when the diagnosis is based on information other than that coded in 5, 6, or 7 [positive lab test/marker study, visualization, and radiography or other imaging techniques]. Code 8 is rarely used.
Grade, Differentiation--Bladder: Some pathologists use a two component grade system for bladder carcinomas - either low grade or high grade. Should we continue to code these per SEER rules as grades 2 [low grade] and 4 [high grade]? See discussion.
The AFIP website states that this low grade classification corresponds to grade 1/3, while the high grade corresponds to both grade 2/3 and grade 3/3. Using the 3-grade conversion, this would also classify the low grade as grade 2, but would leave the high grade as a toss-up between grade 3 and grade 4.
Continue to code Grade, Differentiation as specified in the SEER Program Code Manual: "Low grade" is coded to 2 and "high grade" is coded to 4.
Grade, Differentiation--All Sites: If the grade given for the primary site is from a provisional diagnosis and the grade given for a metastatic site is from a final diagnosis, should we follow the SEER rule that says to code the grade as stated in the final diagnosis (e.g., Provisional diagnosis: High grade papillary serous carcinoma of ovary. Final dx: poorly differentiated adenocarcinoma in a caval lymph node)?
Code the Grade, Differentiation field to 4 [High grade] from the examination of the ovary (primary site). Do not code grade from a metastatic site.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field for a lymph node biopsy that reveals "well differentiated lymphocytic lymphoma" and a bone marrow biopsy that reveals "chronic lymphocytic leukemia/well differentiated lymphocytic lymphoma"?
For cases diagnosed prior to 1/1/2010:
Code the Grade, Differentiation field to 1 [Grade 1] for both of these cases because there is no mention of T-cell, B-cell, null cell, or NK cell involvement. Both cases have a pathologic description of well differentiated, not the descriptors "high grade," "low grade," or "intermediate grade" which must be ignored when coding grade for lymphomas.
For lymphomas, you cannot code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field because these terms refer to categories in the Working Formulation and not to histologic grade. However, you can code terms such as "well differentiated", "moderately differentiated" and "poorly differentiated" for lymphoma histologies.
For cases diagnosed 2010 forward, 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.
Histology (Pre-2007)--Breast: What code is used to represent the histology of "invasive ductal carcinoma and in situ ductal carcinoma, cribriform type"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/3 [ductal carcinoma] unless the combination is ductal and lobular.
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.
Histology--CLL/SLL: If a tissue diagnosis of "small lymphocytic lymphoma" is made six months after an initial blood diagnosis of "chronic lymphocytic leukemia" should the histology be updated from 9823/3 to 9670/3?
For cases diagnosed prior to 1/1/2010:Do not change the histology to small lymphocytic lymphoma (9670/3). The chronic lymphocytic leukemia has advanced/progressed and disseminated into other tissues from the blood during the last six months. If the patient presents with disease in the blood and/or bone marrow only, code to CLL. If a lymph node or other solid tissue is involved initially, code to SLL. For the case cited, the tissue involvement occurred six months after the initial diagnosis and the histology code is not changed to reflect the progression of disease.
For cases diagnosed 2010 forward, 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.
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