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Report Produced: 04/27/2026 23:27 PM

Report Question ID Question Discussion Answer Year
20100025

MP/H Rules/Primary site--Kidney, Renal Pelvis: Should the primary site be changed to C689 [Urinary system, NOS] for a primary renal pelvis tumor after additional tumors are found months later in different urinary sites (e.g., bladder or ureter) and the MP/H Rules indicate these are all the same primary? See Discussion.

In a patient is diagnosed 1/29/08 with an invasive grade 3 of 3 papillary urothelial cell carcinoma arising in the depth of a calyx in mid portion of kidney, the primary site was coded C659 [Renal pelvis]. In 6/1/09 a TURBT showed three separate lesions on the right side of the bladder. The final diagnosis was high grade urothelial carcinoma in-situ with three tumors, the largest being 7mm. Per rule M8, the renal pelvis primary and subsequent bladder tumors are the same primary. Would the primary site be changed to C689 [Urinary system, NOS] when the bladder tumors were identified? Or is C689 only coded if more than one primary site is involved at diagnosis?

For cases diagnosed 2007 or later, Rule M8 applies. This is a single primary. The primary site was coded to C659 in 2008. Do not change the primary site code.

 2010
20100069 Primary site--Heme & Lymphoid Neoplasms: How is this field coded when a 5/26/10 colonoscopy reveals ulcers in the cecum, ascending, transverse, descending, and sigmoid colon and, the final diagnosis on the pathology report is post-transplant lymphoproliferative disorder [9971/3]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C189 [Colon, NOS] per Rule PH1.

Code the primary site to C189 [Colon, NOS] and not C188 [Colon, overlapping lesion] because there are multiple ulcers in different segments of the colon. The .8 code is used only for a single lesion that overlaps subsites.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010
20100073 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed on 4/7/10 by a bone marrow biopsy with myelodysplastic syndrome, refractory anemia (RAEB2) and on a 7/27/10 bone marrow biopsy with progression to acute myelogenous leukemia with 40% blasts (AML)?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Accession two primaries per Rule M10, the first is a chronic neoplasm RAEB2 [9983/3] and the second is an acute neoplasm AML, NOS [9861/3]. Rule M10 states abstract as multiple primaries when a neoplasm is originally diagnosed in a chronic phase (MDS RAEB2) and an acute disease (AML) is diagnosed more than 21 days later. This is the rule that fits your case.

There are several important pieces of information. There were two bone marrows biopsies; one confirmed the chronic disease and a second confirmed the acute disease. The dates of the bone marrows are more than 3 months apart. Because you have a chronic and an acute disease, Rules M8-M13 in the coding manual apply.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010
20100033

Histology--Heme & Lymphoid Neoplasms: How is this field coded for a case described as follicular lymphoma, grade 3a/3 [9698/3], with focal areas of diffuse large B cell lymphoma [9680/3] (approximately 10%)? Does the term "focal" have the same significance in Heme cases as it does for solid tumors? See Discussion.

Per rule PH11, "Code the primary site to the site of origin (lymph node region(s), tissue, or organ) and code the histology diffuse large B-cell lymphoma (DLBCL) (9680/3) when DLBCL and any other non-Hodgkin lymphoma are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow."

Should the focal diffuse large B cell lymphoma be ignored in this case and rule PH11 not be applied? To apply rule PH11, does the follicular lymphoma have to be NOS [9690/3] or does PH11 include all grades of follicular lymphoma [9695/3, 9691/3, 9698/3]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

First, you need to determine how many primaries are to be accessioned. Per Rule M4, abstract a single primary* when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location(s), such as the same lymph node or lymph node region(s), the same organ(s), and/or the same tissue(s).

Code the histology to 9680/3 [Diffuse large B cell lymphoma] per rule PH11 when DLBCL and any other non-Hodgkin lymphoma are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow. Follicular lymphoma (FL), which is a non-Hodgkin lymphoma, includes FL, NOS, FL grade 1, FL grade 2 and FL grade 3.

Focal, foci, and focus are not used in the hematopoietic rules, meaning that you DO NOT ignore histology terms described as focal, foci, or focus.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010
20100086 Multiple primaries/Primary site/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed with mycosis fungoides in February 2010 and in May 2010 is diagnosed with peripheral T-cell lymphoma consistent with CD 30+ large cell transformation of mycosis fungoides? See Discussion Patient was diagnosed with mycosis fungoides on 2/10/2010. On 5/11/2010 the patient underwent lymph node biopsies lymph nodes that were diagnosed as peripheral Tcell lymphoma consistent with CD 30+ large cell transformation of mycosis fungoides. There is no data on the ALK protein.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Accession two primaries per Rule M15 which instructs you to use the Multiple Primaries Calculator to determine the number of reportable primaries. The result is that mycosis fungoides [9700/3] and peripheral T-cell lymphoma [9702/3] represents two primaries.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

 2010
20100091 Reportability/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and how is histology coded when a patient has a history of chronic myelogenous leukemia diagnosed in 1997 and a "blast crisis with myeloid markers" of this disease in 2010? See Discussion. The patient was initially diagnosed with CML in 1997. In February 2010 the disease went into a "blast crisis with myeloid markers." The patient received induction chemotherapy and the disease went back into a chronic phase. To capture the 2010 diagnosis of a blast crisis, is the histology code 9875/3 [chronic myelogenous leukemia, BCR/ABL1 positive] or 9861/3 [acute myeloid leukemia, NOS] used?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Per Rule M2, there is a single primary. Code histology to 9863/3 [CML, BCR-ABL1 status unknown, Blastic phase (BP)]. The blast phase is not recorded as a new primary because this disease does NOT change histologies.

Code 9875 [Chronic myelogenous leukemia, BCR-ABL1 positive] does not apply to the 2010 diagnosis because BCR/ABL status unknown. Code 9861/3 [Acute myeloid leukemia, NOS] also does not apply because the diagnosis was not acute.

It is not clear which chronic myelogenous leukemia (CML) this patient has. Each CML is unique in that it has a blast phase without the histology itself changing. See the Abstractor Notes section in the Heme DB under any of the chronic myelogenous leukemias for a further explanation of this disease process.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010
20100042

Reportability--Heme & Lymphoid Neoplasms: Given that there appears to be many differences in the reportability of these case types pre- and post-2010 (e.g., [refractory] thrombocytopenia), is there a list available that gives the reportability dates for these diseases? See Discussion.

For cases diagnosed prior to 2010 "thrombocytopenia" was not reportable. According to the Heme Database, the term "refractory thrombocytopenia" is now reportable for cases diagnosed 1/1/10 and later. It would be helpful to have a list of diagnosis date requirements for the different hematopoietic diseases.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Thrombocytopenia (NOS) is not reportable per Appendix F. However, the term "refractory thrombocytopenia" [9992/3] is reportable for cases diagnosed 2010 or later.

There has been no change in the reportability for thrombocytopenia. The hematopoietic "help" system lists all of the synonyms, variants, and abbreviations for diseases.

See the Hematopoietic & Lymphoid Neoplasm Coding Manual for changes in reportability associated with these cases.

 

  • Appendices D1a and D1b provide all of the new histology terms and codes.

  • Appendix D2 lists the newly reportable conditions.

    • Terms and codes in Appendix D are effective 01/01/10 and later. Refractory thrombocytopenia is included in D1a and D1b. The notes for D1a and D1b provide explanation and reiterate the dates these terms are effective.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2010
    		20100089 Primary site--Heme & Lymphoid Neoplasms: How is primary site coded when lymphoma is initially found in both lymph nodes and bone marrow, the pathology report is unavailable, and the physician only states that both areas are involved? See Discussion. For many consultations and/or class 2 cases, the pathology report is not available to help determine the primary site. Should the primary site be automatically coded to C421 over C77_ when both are involved? The Abstractor Notes state the primary site can be either bone marrow or lymph nodes. The physician states only that both are involved.

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Because both the bone marrow and LN are involved, code the primary site to C779 [lymph nodes, NOS] per Rule PH22. You are to code specific nodes if a specific region is specified; however, if no region is specified, code to lymph node, NOS [C779]). When you are having problems coding primary site, go to Module 7 Primary Site Rules for Lymphomas Only. See Rule PH26. It states that you code the primary site to bone marrow when ONLY the bone marrow is involved.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2010
    		20100096 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a 9/30/10 biopsy diagnoses follicular lymphoma, grade 1 and the patient is subsequently diagnosed on a 10/11/10 biopsy with large B-cell lymphoma which is stated to be a transformation of the prior lymphoma?

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Per Rule M11, this case is to be accessioned as two primaries; follicular lymphoma, grade 1 [9695/3] and diffuse large B-cell lymphoma (DLBCL) [9680/3]. The case represents a chronic neoplasm (follicular lymphoma, grade) and an acute neoplasm (diffuse large B-cell lymphoma) diagnosed within 21 days of one another and there is documentation of two biopsies, one confirming the chronic disease and the other confirming the acute disease.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2010
    		20110138

    First course treatment--Heme & Lymphoid Neoplasms: What is first course of treatment when a patient received multiple different chemotherapy regimens before a complete remission for diffuse large B-cell lymphoma was achieved?

    The patient was initially treated with involved field radiation and R-CHOP. The patient still had residual disease and the treatment was changed to RICE. Following RICE, there was still residual disease and the patient underwent another unspecified chemotherapy treatment. The patient was then transferred to a transplant center for pre-transplant chemotherapy and a bone marrow transplant. The patient achieved a complete response after transplant.

    Should the R-CHOP and radiation be the first course treatment in a case like this, or would first course treatment include all chemotherapy and the transplant?

    For hard-to-treat diseases such as DLBCL, the treatment plan outlined prior to treatment beginning may indicate, "The first course of treatment will be radiation and R-CHOP. If the R-CHOP does not achieve remission, we will use RICE." In other words, the first course treatment plan includes a second round of chemotherapy if the patient has not achieved a complete response after the R-CHOP and radiation. If the treatment plan was documented like this for the patient, the first course treatment includes R-CHOP, involved field radiation and RICE.

    However, if there is no initial treatment plan in the medical record, all treatment provided after the date when "residual disease" or "failed to achieve remission" is documented in the medical record is either second or a subsequent course of therapy.

    		 2011