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20190094 | Reportability/Heme & Lymphoid Neoplasms--Skin: Is elephantiasis nostras verrucosa (ENV) reportable as a lymphoma? See Discussion. |
The autopsy report indicated a diagnosis of: Skin: Hyperkeratosis and pseudoepitheliomatous hyperplasia as well as reactive angioendotheliomatosis indicating Elephantiasis Nostras Verrucosa. |
Elephantiasis nostras verrucosa (ENV) is not reportable. ENV is a rare form of chronic lymphedema caused by any number of conditions including neoplasms, trauma, radiation treatment, congestive heart failure, obesity, hypothyroidism, chronic venous stasis, and parasitic infection. |
2019 |
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20190084 | Histology/Heme & Lymphoid Neoplasms: Should the histology be coded to chronic myeloid leukemia (CML), BCR-ABL1-positive (9875/3) regardless of the quantitative analysis percentage of BCR-ABL1 that was detected? See Discussion. |
Example: Bone marrow biopsy diagnosis is chronic myelogenous leukemia, chronic phase, and the RT-PCR test result proved, BCR-ABL1 p210 (Major Breakpoint) - Detected, 3.3659%. Even though the p210 fusion transcript was less than 5%, it was detected. The presence of BCR-ABL1 does define whether or not patients are treated with tyrosine kinase therapies. Therefore, it seems likely that the presence of any BCR-ABL1 would be captured using the more specific histology code 9875/3, instead of the non-specific CML, NOS histology code 9863/3. Are there minimum threshold requirements for these quantitative studies in order to code the histology to the more specific type of CML? |
Code chronic myeloid leukemia (CML) BCR-ABL1-positive as 9875/3. According to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th edition, CML BCR-ABL1-positive is characterized by the chromosomal translocation t(9;22) which results in the formation of the Philadelphia (Ph) chromosome containing the BCR-ABL1 fusion gene. The diagnosis requires detection of the Ph chromosome and/or BCR-ABL1. If the mutation is detected, regardless of percentage, it is positive. Quantitative levels of BCR-ABL are used to monitor response to tyrosine kinase inhibitor therapy. |
2019 |
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20190075 | Sex: How should the sex field be coded for the newly allowable non-binary gender designation ? See Discussion. |
Washington State added to birth certificates, which allows people to have their certificates changed to this non-binary gender designation. Gender X is defined as a gender that is not exclusively male or female, including, but not limited to: intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, genderfluid, genderqueer, male-to-female, neutrois, nonbinary, pangender, third sex, transgender, transsexual, Two Spirit, and unspecified. |
Code Gender X as 9 when that is the only information available. Use text fields to document the details. Also refer to coding instruction #7. When gender is not known Assign code 1 when the primary site is C600 'C639 Assign code 2 when the primary site is C510 'C589 Assign code 9 for primary sites not included above |
2019 |
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20190005 | Primary Site--Bladder: Does instruction #4 in the Urinary Sites Solid Tumor Rules Instructions for Coding Primary Site apply to a mix of in situ and invasive urothelial tumors? Instruction #4: Code Urinary System NOS C689 when there are multiple non-contiguous tumors in multiple organs within the urinary system. See Discussion. |
Example: Patient has multiple biopsies with final diagnosis of in situ papillary urothelial carcinoma in the prostatic urethra and invasive papillary urothelial carcinoma in the bladder. How should primary site be coded in this type of mixed in situ and invasive situation? |
Code Urinary System NOS C689 for this case since there are two separate urinary sites involved. Apply instruction #4 when there is a mix of in situ and invasive urothelial tumors. |
2019 |
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20190002 | Histology/Behavior--Brain and CNS: How should Histology and Behavior be coded for a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) arising in the brain? |
Updated answer Assign code 9413/0. |
2019 | |
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20190015 | Update to current manual/EOD 2018--EOD Primary Tumor: Should Note 6 in Extent of Disease (EOD) Primary Tumor for the schemas Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma be revised to exclude pelvic sites? See Discussion. |
There is a discrepancy between Notes 3 and 6 in the schemas Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma for EOD Primary Tumor. Note 3 describes extension/discontinuous metastasis to the pelvic sites (code 450) and includes the sigmoid colon, rectosigmoid and rectum since these are all pelvic sites. However, Note 6 also includes rectosigmoid and sigmoid colon. Note 6 is describing extension/discontinuous metastasis to the abdominal sites (600-750), so it should include rectosigmoid or sigmoid colon (since those are pelvic sites). Note 6 indicates, Intestine, large (except rectum). In the previous Collaborative Stage, the corresponding note used to also include: except sigmoid colon, rectosigmoid and rectum. Did sigmoid colon and rectosigmoid get removed from the list here? That is, should Note 6 read, Intestine, large (except sigmoid colon, rectosigmoid, rectum)? Involvement of the sigmoid, rectosigmoid, or rectum via peritoneal seeding/metastasis is consistent with T2b disease and would correlate with code 450 (pelvic sites), not codes 600-750 (abdominal sites). Those codes only correlate with T3 and greater disease (i.e., peritoneal seeding/metastasis of the abdomen). |
Thank you for bringing this issue to our attention. Rectosigmoid and Sigmoid Colon belong in Note 3 and not Note 6 for the following EOD schemas: Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma. Rectosigmoid and sigmoid colon will be removed as separate listings from Note 6. The only mention in Note 6 will be: Intestine, large (except rectum, rectosigmoid, and sigmoid colon) This change will be made for the next update. |
2019 |
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20190106 | Tumor Size--Esophagus: Can information from the endoscopy procedure that implies a size of 3 cm for Tumor Size--Clinical be used for Esophagus? See Discussion. |
1-28-2018 CT Scan: 2.4 cm mass 2-15-2018 Endoscopy: Mass was present 22 to 25 cm. Biopsies were taken with cold forceps for histology; biopsy positive. |
For the case you describe, we would record the clinical tumor size stated on the CT report. The priority order for clinical tumor size is as follows. 1. Biopsy or operative (surgical exploration) report 2. Imaging 3. Physical exam We do not recommend coding tumor size based on an inferred tumor size from a description such as "Mass was present 22 to 25 cm." Look for an actual measurement of the mass, or a stated tumor size. Use text fields to record details. |
2019 |
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20190054 | Update to current manual/Solid Tumor Rules (2018)/Histology--Brain and CNS: Table 6 (Non-Malignant CNS Equivalent Terms and Definitions) lists as a subtype/variant of craniopharyngioma 9350/1. This is not a valid histology per the ICD-O-3 or the 2018 ICD-O-3 Update Table. Is this actually supposed to read, ? |
Adamantinomatous craniopharyngioma (9351/1) is a subtype of craniopharygioma. We will correct the Non-Malignant CNS Solid Tumor Rules in the next update. |
2019 | |
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20190034 | Reportability/Histology--Penis: Is a diagnosis of undifferentiated penile intraepithelial neoplasia (PeIN) reportable for cases diagnosed in any year? See Discussion. |
Example: An October 2017 glans penis biopsy final diagnosis was reported as: Undifferentiated (Warty-Basaloid) penile intraepithelial neoplasia. In January 2018, an additional penile glans biopsy final diagnosis was reported as: At least squamous cell carcinoma (SCC) in situ (HGPIN). Foreskin circumcision on the same pathology report shows SCC in situ. It is unclear whether the term undifferentiated is synonymous with high-grade for the purposes of determining penile intraepithelial neoplasia (PIN/PEIN) reportability and diagnosis date. |
Report undifferentiated penile intraepithelial neoplasia (PeIN) (8077/2). WHO Classification of Tumors of the Urinary System and Male Genital Organs, 4th edition, lists basaloid (undifferentiated) penile intraepithelial neoplasia and warty (Bowenoid) penile intraepithelial neoplasia as a variants of PeIN. |
2019 |
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20190036 | First Course of Treatment/Hormone Therapy--Breast: Is hormone therapy (HT) prescribed for invasive ductal carcinoma of the right breast coded as treatment for lobular carcinoma in situ (LCIS) of the left breast even though the treatment plan for the LCIS was documented as surveillance? See Discussion. |
Patient is diagnosed with invasive ductal carcinoma (IDC), right breast, receives HT, radiation therapy, and surgery. The same patient is diagnosed with LCIS, left breast one month later--recommend surveillance only (no surgery). Is the HT for the left breast coded at all? I think for COC/NCCN, we do not, but for SEER what would I do? Treatment in the SEER Manual 2018 states, "Code the treatment on each abstract when a patient has multiple primaries and the treatment given for one primary also affects/treats another primary." The example include bladder/prostate and ovarian/cervix. It also states, "Code the treatments only for the site that is affected when a patient has multiple primaries and the treatment affects only one of the primaries." The example includes colon/tonsil. Breast LCIS treatment appears complicated. Per NCCN guidelines, this condition no longer has recommendations, however it appears as though they still state that if a core biopsy is done and is LCIS, follow up should be ultrasound or surgical excision. Nowhere does it state hormone is recommended. |
Do not code the hormone treatment for the LCIS since it was clearly documented that the hormone treatment was given for the IDC and the treatment for the LCIS was documented as "surveillance." Use text fields to record the details on both abstracts. |
2019 |
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