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Report Produced: 11/24/2024 18:40 PM

Report Question ID Question Discussion Answer Year
20010110 Grade, Differentiation--All Sites: Should we take the grade from a TNM staging form over a grade stated in a pathology report when the grade mentioned on the TNM staging form is a higher grade (e.g., Pathology report diagnosis is moderately differentiated adenocarcinoma, Gleason's 3+3=6, but the physician checked "poorly differentiated" on the TNM form)? Code the Grade, Differentiation field to 2 [moderatley differentiated]. Code from the pathology report over the TNM staging form. If you do not have access to the path report, use the grade from the TNM form. 2001
20010104 Date of Diagnosis--Lung: Based on Note 7 in the lung EOD, should the Date of Diagnosis field be coded to an earlier CT scan date with a reported diagnosis of "RUL mass with mediastinal lymphadenopathy" or to the later biopsy date with a reported diagnosis of small cell carcinoma? See discussion. Note 7 states that "mediastinal lymphadenopathy" indicates involved lymph nodes for lung primaries. Should the date of diagnosis be back-dated to the date of the scan?

For cases diagnosed 1998-2003:

No, code the Date of Diagnosis field to the later biopsy date. Note 7 is intended for use in coding the EOD-Extension field, not the Date of Diagnosis field. The earlier scan has a diagnosis of RUL "mass" not a "malignancy" so the fact that there is mediastinal lymphadenopathy mentioned in that scan is not used to help determine date of diagnosis.

 2001
20010003 Histology (Pre-2007)--Prostate: What code is used to represent the histology "prostatic duct carcinoma"? See discussion. Should the histology be coded to duct carcinoma [8500/3] or endometrioid carcinoma [8380/3]? Prostatic duct carcinoma is defined as endometrioid carcinoma; however, sometimes the pathology report describes the histology as being only "prostatic duct carcinoma."

For tumors diagnosed prior to 2007:

If there is no mention of endometrioid carcinoma in the microscopic description, code the Histology field to 8500/3 [duct carcinoma]. If "endometrioid carcinoma" is mentioned in either the final diagnosis or in the microscopic description, code the Histology field to 8380/3 [endometrioid 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.

 2001
20010097 Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with abundant mucin production"? See discussion.

If the diagnosis is adenocarcinoma with a mucinous focus, we code as 8140/3. However, when there is abundant mucin production, do we use 8480/3?

See SINQ #20010075: "The tumor must contain at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology. "

For tumors diagnosed prior to 2007:

Code the Histology field to 8481/3 [mucin-producing adenocarcinoma] if the diagnosis states "adenoca with abundant mucin production". Assume that the term "abundant" represents a term that implies > 50% of the tumor is mucin producing.

When a pathologist makes a diagnosis of mucin-producing adenocarcinoma, the pathologist has determined that more than 50% of the tumor is mucin-producing, so it is unnecessary for the abstractor/coder to look for additional supporting documentation.

If the pathologist states adenocarcinoma "with mucin production," look for a statement about the percentage or amount of mucin production, such as "abundant" or other wording indicating extensive mucin production. If such a statement or wording is present, code 8481/3 [mucin-producing adenocarcinoma]. If not present, code 8140/3 [adenocarcinoma, 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.

2001
20010075 Histology (Pre-2007): What code is used to represent the histology "adenocarcinoma with a mucinous focus"? See discussion. Could 8480/3 [mucinous adenocarcinoma] be used to code histology?

For tumors diagnosed prior to 2007:

Code the Histology field to 8140/3 [adenocarcinoma, NOS]. "Focus" does not indicate the majority of tumor per rule C2 on page 2 of the Coding Complex Morph Dx's. The tumor must be at least 50% mucinous, mucin producing, or signet ring to be coded to the specific histology.

We code to the more specific term if there are no qualifying or modifying terms such as: focally, focus, predominantly. If any qualifying words are used, the C1 rule applies, which is to code to the majority of tumor.

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.

 2001
20010100 Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field when the phenotype is combined B cell and T cell?

For cases diagnosed prior to 1/1/2010:Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. There is no combination code for B cell and T cell. There is also no hierarchy established for choosing one code over the other. Therefore coding such a case as a pure B cell or a pure T cell would misrepresent the phenotype.

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.

 2001
20010145 EOD-Extension: There is a one to many relationship between T values in TNM staging and SEER EOD-Extension values (one T value can be coded to many extension values). For most situations, we can typically code EOD-Extension to the lowest value in the range available for that T value per the SEER guidelines. But, what happens if another tumor feature, such as tumor size, was involved in the assignment of a T value? See discussion. Example: Physician stages lung tumor as T2. The lowest extension code, 20, doesn't precisely fit the guidelines for a T2 tumor because the T2 stage may be based on the size of the tumor, which doesn't have anything to do with the EOD-Extension field. Should EOD-Extension be coded to 30 rather than 20?

The criteria for AJCC stage T2 consists of both size and tumor extension values. Size of tumor is recorded in the EOD-Size of Primary Tumor field. If you determine that size is the physician's sole criteria for assigning a T2 value, code an EOD-Extension value that reflects more specific information than 30 [localized, NOS]. Code to 10 or 25, depending on the case.

If the tumor size is not provided, and there is only a clinician statement that describes the lung tumor as a stage T2, code EOD-Extension to 20, the numerically lowest equivalent EOD-Extension code for the lung T2 category.

 2001
20010084 EOD-Size of Primary Tumor: Can you code the known size of the residual tumor in a further resected specimen if the size of the tumor in a prior excisional biopsy is unknown? See discussion. Excisional biopsy is done prior to admission and the tumor size is unknown. Pt is admitted for a mastectomy and the residual tumor size is 5 mm.

For cases diagnosed between 1998-2003:

Code the EOD-Size of Primary Tumor field to 999 [unknown]. The majority of the tumor would have been removed during excisional biopsy and it is possible that the tumor could have been quite large.

 2001
20010025 Surgery of Primary Site--Prostate: What treatment code is used to represent prostate carcinoma treated with "high intensity focused ultrasound" (HIFU)?

For cases diagnosed 1998 and later:

Code the Surgery of Primary Site field to 17 [Other method of local tumor destruction]. HIFU uses focused energy to destroy tissue. It is classified as a surgical procedure.

 2001
20010135 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.

 2001