Reportability--Head & Neck: Would this be reportable and if so what histology would be coded? Soft tissue mass left cheek excision reveals Carcinoma Ex Pleomorphic Adenoma Non-Invasive with focal vascular invasion. Margins clear.
Carcinoma ex pleomorphic adenoma (Ca-ex-PA) is reportable. Assign 8941/3. The WHO classification of head and neck tumors defines Ca-ex-PA as an epithelial malignancy arising in a benign pleomorphic adenoma. Most of these originate in the parotid gland but can also arise in other salivary glands.
Grade--Liver: How should grade be coded for a liver lesion treated with radio frequency ablation (RFA) followed by a transplant showing moderately differentiated hepatocellular carcinoma? See discussion.
The SEER Manual emphasizes the importance of coding grade only prior to neoadjuvant treatment as systemic treatment and radiation can alter a tumor's grade. This patient did not have neoadjuvant chemotherapy or radiation, but did undergo a prior surgical procedure (RFA) in an attempt to destroy tumor tissue. The subsequent transplant showed residual moderately differentiated HCC.
For this case, record the grade specified even though it is after RFA. RFA is not systemic or radiation treatment and should not alter the grade.
MP/H Rules/Multiple primaries--Breast: Is the diagnosis of Paget disease two years after a diagnosis of infiltrating duct carcinoma of the same breast a new primary? See discussion.
A patient was diagnosed and treated in 2010 for infiltrating duct carcinoma of the left breast. There was no mention of Paget disease. Then in 2012, the same patient was diagnosed with Paget disease of the nipple of the left breast. Rule M9 seems to apply; so this is the same primary, correct? And the information about the Paget disease is simply never captured, correct?
Yes, Rule M9 makes this a single primary. You could revise the original histology code to 8541/3 on the assumption that Paget was present at the original diagnosis, but not yet identified.
Reportability--Heme & Lymphoid Neoplasms: Is this a reportable case and if so what codes would be used for the primary site and histology?
Lymph node flow cytometry and bone marrow biopsy revealed involvement by a low-grade B-cell lymphoproliferative disorder. Medical oncologist states monoclonal gammopathy, question marginal zone B cell lymphoma versus lymphoplasmacytic lymphoma/lymphoproliferative disorder.
Based on the information provided, this case is not reportable. Low grade B-cell lymphoproliferative disorder is not reportable, nor is monoclonal gammopathy. There is no definitive diagnosis for marginal zone or lymphoplasmacytic lymphoma. The terminology used includes "question" and "versus" which are not acceptable ambiguous terms for reportability. If possible, follow up with the physician regarding the definitive diagnosis.
Reportability--Heme & Lymphoid Neoplasms: Is a statement of "JAK-2 positive polycythemia" reportable? See discussion.
Polycythemia, NOS is not reportable. However, there is a statement in the Heme Manual Glossary for JAK2 that states, "When JAK2 is positive, the MPN is definitely reportable." Does a positive JAK 2 always mean there is a reportable myeloproliferative disorder or must there also be an associated statement of a reportable neoplasm (e.g., myeloproliferative disorder, polycythemia vera, or essential thrombocythemia)?
A positive JAK 2 does not always mean there is a reportable myeloproliferative disorder. There must also be an associated statement of a reportable neoplasm (e.g., myeloproliferative disorder, polycythemia vera, or essential thrombocythemia). The glossary entry will be clarified.
Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets.
Assign C139 for a primary originating in the parapharyngeal space. This space contains part of the parotid gland, adipose tissue, lymph nodes, nerves, arteries and veins.
Reportability/Histology--Heme & Lymphoid Neoplasms: Is primary erythrocytosis equivalent to primary polycythemia and thus reportable? See discussion.
Per the Heme Manual, Appendix F - Non-Reportable list for Heme Diseases, under Polycythemia, the Comment states that polycythemia is also known as erythrocytosis. Because polycythemia is equivalent to erythrocytosis, can we assume that "primary erythrocytosis" is equivalent to "primary polycythemia" and thus reportable as 9950/3 per the Heme DB? Or is the case nonreportable because the exact term of "primary erythrocytosis" is not listed as an alternate name for polycythemia vera, only "primary polycythemia" is listed?
Primary erythrocytosis is not equivalent to primary polycythemia and is not reportable. This will be clarified in a future revision. Thank you for point it out to us.
Surgery of Primary Site/Surgical Procedure of Other Sites--Endometrium: How are these fields coded for an endometrial primary when the patient undergoes a radical tumor cytoreduction including modified radical hysterectomy, BSO, omentectomy, resection of intra-abdominal and intrapelvic implants, and partial cystectomy? See discussion.
When other regional sites (besides the omentum) are removed with the primary site, how is Surgical Procedure of Other Site coded? There is no cytoreduction surgery code for endometrial primaries, and this patient does not appear to qualify for any of the specific pelvic exenteration codes.
Per SINQ 20091118, an omentectomy is not coded in the Surgical Procedure of Other Site field when it is performed with a hysterectomy.
In general, record surgery of sites/organs not covered in the surgery of primary site codes under surgery of other site. For this case, code the partial cystectomy under surgery of other site. As you point out, the omentectomy is not recorded under surgery of other site when performed with a hysterectomy for an endometrial primary.
Surgery of Primary Site--Bladder: Is any mention of cautery in the gross description of pathology for a TURBT specimen sufficient to code 22 (excisional biopsy with electrocautery), or does there need to be a statement in the operative report that electrocautery was performed? See discussion.
Often, pathology for TURBT with non-invasive papillary TCC includes a gross description with a variety of cautery descriptions. For example, "received are three cautery roughened gray-pale pink tissue fragments.” However, the operative report is documented as a "TURBT" with no further description of the procedure.
Assign code 22 when cautery is mentioned n the gross description of pathology for a TURBT specimen.
MP/H Rules/Multiple primaries--Bladder: Is this a single primary or multiple primaries? Transurethral resection of the bladder identifies two bladder tumors. Pathology states one is high grade papillary carcinoma (8130/3) and the other is lymphoepithelioma-like urothelial carcinoma (8082/3). Lymphoepithelioma-like is listed as a urothelial type in Table 1 but rule M6 does not include it in the list of histologies and we are not told to refer to Table 1. M8 refers to Table 1 but does not include multiple bladder tumors (C67_). Specify which rule would apply and why.
Rule M9 applies to this case. Abstract two primaries. M6 does not apply to this case because code 8082 is not one of the applicable histology codes for M6. This situation will be reviewed as we prepare the next version of the rules.
An official website of the United States government
Home