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Report Produced: 02/21/2026 00:13 AM

Report Question ID Question Discussion Answer Year
20130013

Reportability--Heme & Lymphoid Neoplasms: Is Mast Cell Activation Syndrome (MCAS) reportable?

MCAS has been given an ICD-9 code of 202.60 by our medical record coders. In the Progress Notes, the physicians state this is not the same as systemic mastocytosis. There is no listing for MCAS in the Hematopoietic and Lymphoid Database.

Mast Cell Activation Syndrome (MCAS) is not a reportable neoplasm unless it is specifically stated to be a result of a mast cell proliferative disorder that is reportable.

Per our expert pathologist, MCAS is a relatively new term used for conditions in which patients experience the symptoms of mast cell mediators in the absence of an increase/proliferation of mast cells. The diagnosis of this group of disorders is based in part on a complex of symptoms and on the demonstration of no increase in mast cells. Some of these diseases are difficult to separate from mastocytosis (which is reportable). Currently, this group of disorders is not part of the systemic mastocytosis/mast cell leukemia/mast cell sarcoma spectrum.

 2013
20130080 Primary site/Histology--Heme & Lymphoid Neoplasms: How are the primary site and histology coded when a right neck mass and spinal mass both show B-cell lymphoma, favor Burkitt lymphoma? See Discussion.

2/5/11 Right neck swelling. Biopsy of mass B-cell lymphoma, favor Burkitt lymphoma.

7/5/11 Hemi-laminectomy, L2-L5 spinal mass: Malignant lymphoma, B-cell phenotype, favor Burkitt lymphoma.

Should the primary site be C779? Is the correct histology Burkitt lymphoma [9687/3] or malignant lymphoma, diffuse large B-cell [9680/3]?

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

Code the primary site to C779 [lymph nodes] per Rule PH22 and the histology to 9591/3 [B-cell lymphoma, NOS].

Code the primary site to C779 [lymph nodes, NOS] when lymphoma is present in an organ and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. The patient has involvement of a lumbar spine mass and cervical lymph nodes. Cervical lymph nodes are not regional to the lumbar area of the spine.

Do not use ambiguous terminology to code histology for hematopoietic neoplasms. "Favor" is ambiguous terminology. Therefore, the histology must be coded to B-cell lymphoma and not to diagnosis which is "favored" (Burkitt lymphoma). Remember that ambiguous terminology is only used to determine case reportability, not to code histology for hematopoietic neoplasms.

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.

2013
20130161 Primary Site--Heme & Lymphoid Neoplasms: Is the primary site coded to C779 or C421 for a bone marrow that is positive for B-cell acute lymphoblastic leukemia, the peripheral blood demonstrates leukemic involvement and the PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones? See Discussion.

1/11/13 Bone marrow bx: B-cell acute lymphoblastic leukemia. Flow cytometry of peripheral blood shows leukemia involvement.

PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones. The patient has an elevated WBC, anemia and thrombocytopenia.

The answer to SINQ 20120047 (which is no longer visible in the system) said to code B lymphoblastic leukemia/lymphoma to bone marrow for primary site if there is bone marrow involvement. The Heme/Lymph Manual Rule PH7 says to code bone marrow as the primary site if bone marrow is the only site involved.

Following the manual, the primary site would be C779. However, according to the answer to SINQ 20120047, the primary site would be C421. Which is correct?

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

Per the Heme DB, the histology B-cell acute lymphoblastic leukemia is synonymous with B lymphoblastic leukemia/lymphoma, NOS. Per Rule PH8, for a neoplasm that can manifest as either leukemia lymphoma or leukemia lymphoma, one is to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. The Note 4 instruction states it is necessary to go to Module 7 (Rules PH18-PH27) to code the more specific primary site. In this case, use Rule PH22 to code primary site to C779 [lymph nodes, NOS] for the case you describe.

In this case, there is involvement of abdominal lymph nodes, spleen, bone marrow and bone. There is no indication of the primary site. Per the Heme DB, the most frequent sites of involvement for the lymphoma are bone and lymph nodes. This is a Stage IV lymphoma.

The now inactivated SINQ 20120047, stated that based on the sites of involvement, this histology could be coded as either leukemia or lymphoma. If the only involvement is the bone marrow, the site is coded to C421 [bone marrow]. The involvement of peripheral blood does not change the primary site because such involvement is part of the leukemic 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.

2013
20130001

Reportability--Brain and CNS: Are hemangioma, NOS (9120/0), cavernous hemangioma (9121/0) or venous hemangioma (9122/0) reportable when they arise in the brain or CNS?

 

Hemangioma, NOS (9120/0) and cavernous hemangioma (9121/0) arising in the dura and parenchyma of the brain/CNS are reportable.

Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous hemangioma arising in the brain is blood vessel (C490). The combination of 9122/0 and C490 is not reportable. This is a venous abnormality. Previously called venous angiomas, these are currently referred to as a developmental venous anomalies (DVA).

2013
20130207 Multiple primaries--Heme & Lymphoid Neoplasms: Is a new primary reported for the diagnosis of plasmacytoma associated with a pathological fracture if it follows a diagnosis five years ago of multiple myeloma? See Discussion.

Multiple myeloma was diagnosed more than 5 years prior to admission. The patient underwent multimodality treatment.

Currently, the patient suffered a fracture. The pathology report diagnosis was "plasmacytoma." The discharge summary states, "multiple myeloma advanced with multiple lytic lesions".

Does this scenario represent a single primary dating back to the original diagnosis? Or does the diagnosis of plasmacytoma on the recent biopsy indicate a new primary because it was originally diagnosed as acute and reverts to a chronic neoplasm after treatment more than 21 days later?

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

Per the Abstractor Notes section, this case represents a single primary. Histology is coded to 9732/2 [multiple myeloma], which is now advanced.

Review the Abstractor Notes section in the Heme DB for multiple myeloma. It states that in multiple myeloma there is generalize bone marrow involvement. It further states that lytic bone lesions and bone tumor masses of plasma cells (plasmacytomas) are signs of advanced disease. According to the Discharge Summary, this patient had multiple lytic lesions and plasmacytoma which indicates advanced 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.

2013
20130047 Date of diagnosis--Heme & Lymphoid Neoplasms: What is the diagnosis date for a patient with a mild thrombocytosis diagnosed in 2008, that was subsequently treated with Anagrelide in 11/2010 following an increase in platelet count, and later in 3/2011 was found to have positive JAK2 study physician refers to as essential thrombocythemia? See Discussion. In 2008, patient diagnosed with mild thrombocytosis. The patient opted to be followed clinically with observation. In November 2010, a CBC showed an increased platelet count to 600,000. Anagrelide was started. The patient would never agree to a bone marrow biopsy. However, in 3/2011 a JAK2 study was performed and read as positive. Following the positive Jak2 study, physician stated the diagnosis was essential thrombocytosis and started the patient on a different drug.

Code the diagnosis date to 3/2011. It wasn't until 3/2011 that the physician documented a reportable diagnosis of essential thrombocytosis [9962/3].

Mild thrombocytosis is not reportable. Therefore, the case was not reportable in 2008. Although the patient was treated in 2010, there was no documentation of a reportable diagnosis.

2013
20130107 Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a diagnosis of polycythemia vera with myeloproliferative syndrome?

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

Code the histology to 9950/3 [polycythemia vera], the more specific histology, per Rule PH29. Myeloproliferative syndrome is a non-specific (NOS) histology and polycythemia vera is a specific type of myeloproliferative 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.

2013
20130155

Diagnostic confirmation--Heme & Lymphoid Neoplasms: How do we code diagnostic confirmation if the pathology report states the diagnosis of a skin biopsy is "low-grade B cell lymphoma, most compatible with marginal zone lymphoma," genetic data includes positive rearrangement for immunoglobulin heavy chain gene favor a diagnosis of "B cell lymphoma," and the physician's clinical diagnosis is "cutaneous marginal zone lymphoma"?

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

Code diagnostic confirmation to 3 [positive histology AND positive immunophenotyping studies (9590/3 - 9992/3)].

Immunoglobulin heavy and light chain genes rearranged is listed under Genetics Data in the Heme DB for 9699/3 [extranodal marginal zone lymphoma]. Given the documentation of this positive genetic finding and the positive bone marrow, code diagnostic confirmation to 3.

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.

2013
20130193 Sex: How is sex coded for a transsexual diagnosed with a testicular primary? See Discussion. The Physical Exam states patient is male. There is a note that the patient is transsexual. There is no indication that the orchiectomy was part of gender reassignment surgery. Code sex to 1 [male]. When the natal sex is known, code that over transsexual. 2013
20130068 Reportability--Heme & Lymphoid Neoplasms: Is polycythemia, NOS reportable? See Discussion. The physician states the patient has polycythemia. There is no confirmation of primary polycythemia nor is there mention of polycythemia vera. JAK2 was negative.

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

Polycythemia, NOS is not reportable. Polycythemia, NOS is not a synonym for polycythemia vera and, therefore, is not reportable. To be reportable the diagnosis must be polycythemia vera, or one of the other terms listed in the Alternate Names section of the Heme DB.

Polycythemia (also known as erythrocytosis) is a disease state in which the proportion of blood volume that is occupied by red blood cells increases. Blood volume proportions can be measured as a hematocrit level. It can be due to an increase in the mass of red blood cells ("absolute polycythemia"); or to a decrease in the volume of plasma ("relative polycythemia").

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.

2013