Report | Question ID | Question | Discussion | Answer | Year |
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20021100 | Primary Site: How do we code the primary site for a malignancy that occurs in parenchyma located in an ectopic site? See discussion. | 1. Patient presented with a subcutaneous nodule in right axilla. Pathologic impression by initial and reviewing pathologists is that the lesion represents a breast adenocarcinoma arising in ectopic mammary parenchyma. Subsequent breast biopsies were negative. 2. Patient presented with right branchial cleft cyst. The pathologist states the cyst is a primary thyroid adenocarcinoma arising in an ectopic focus of thyroid tissue. The subsequent total thyroidectomy is negative. |
Code the primary site to the location of the malignancy.
1. Code the Primary Site field to C76.1 [Axilla NOS]. 2. Code the Primary Site field to C10.4 [Branchial cleft]. |
2002 |
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20021210 | Date of Diagnosis/Histology (Pre-2007)--Breast: When there is a delay between the clinical diagnosis of a malignancy and the surgical resection of the primary site, can the resection be used to code the date of diagnosis, extension, size of the primary tumor, and histology? See discussion. | For example, mammogram March 28th states "certainly represents malignancy." Nothing else done until November 1st when pt presents w/skin retraction on PE and bone mets. A mastectomy November 6th shows "ductal ca w/dermal lymphatic invasion and tumor measuring 3.5 cm."
How is the date of diagnosis, extension, tumor size & histology coded for this case? |
For tumors diagnosed prior to 2007:
Code the Date of Diagnosis to March. Code the Histology field to 8500/3 [Infiltrating duct carcinoma]. Histology can be upgraded from a clinical histology to a pathological histology anytime.
For cases diagnosed 1998-2003, in coding extension, you need to assess whether there has been progression of disease or not. If progression of disease is verified, do not code extension using the surgical information from November. Code the extension and tumor size based on the mammogram and physical examination at the time of the mammogram, if available.
If no progression of disease is verified, use surgical information to code extension and tumor size.
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. |
2002 |
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20021021 | Reportability--Hematopoietic, NOS: Should we add the missing terms listed in the Abstracting and Coding Guide for the Hematopoietic Diseases to ICD-O-3 because these absent synonyms would not be identified during hematology casefinding? See discussion. | The Abstracting and Coding Guide for the Hematopoietic Diseases gives a preferred term for each code followed by a list of synonyms, not all of which are listed in the ICD-O-3. Two examples are: 1) 9962/3 [Essential Thrombocythemia] has 6 synonymous terms listed, but the last three of them are not in ICD-O-3. 2) 9930/3 [Myeloid Sarcoma] has the synonym "extramedullary myeloid tumor" which is not in ICD-O-3. | For cases diagnosed prior to 1/1/2010:Do not add these synonyms to ICD-O-3. The Abstracting and Coding Guide for the Hematopoietic Diseases lists synonyms for the preferred terms to assist in the classification of these other terms. In the absence of a specific code for the synonym, code to the preferred term. For casefinding, these terms would be grouped in a broader category of hematologic diseases under an ICD-9-CM or ICD-10 code and, therefore, will be identified during casefinding procedures using the disease index. 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. |
2002 |
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20021178 | Histology (Pre-2007): What code is used to represent the histology "poorly differentiated invasive transitional cell carcinoma with extensive squamous and focal glandular differentiation"? | For tumors diagnosed prior to 2007:
Code the Histology field to 8120/33 [transitional cell carcinoma, NOS, poorly differentiated]. The ICD-O-3 does not have a separate code for transitional cell carcinoma with squamous and/or glandular differentiation.
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. |
2002 | |
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20021159 | Histology (Pre-2007)--Breast: What code is used to represent the histology "mucinous carcinoma with Paget disease"? | For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [mucinous carcinoma]. This answer assumes the patient presented with a single tumor. There is no combination code that includes these two entities. According to the rules for Coding Complex Morphologic Diagnoses, it would appear that the case should be coded to 8540 [Paget disease] because it is the higher code. However, this combination of histologies represents an exception to that rule. The prognosis for mucinous carcinoma is worse than the prognosis for Paget disease. As a result, it would be more appropriate to the histology to mucinous 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. |
2002 | |
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20021141 | EOD-Extension--Lung: When only minimal information is available, such as scans and needle biopsies, should EOD extension be coded to localized or unknown? See discussion. | The patient was diagnosed with non-small carcinoma of the lung by needle biopsy of the right upper lobe Feb. 2, 2001. History revealed that CT performed prior to needle bx showed 2 right sided lung lesions and right hilar adenopathy. Chest x-ray following needle bx showed irregular opacity within the RML appears unchanged. Soft tissue prominence in the azygos region, possibly related LN enlargement. This is the only information available.
Should we code extension as 30 [localized, NOS]? |
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 99 [unknown] if no additional information is available for this case. Because the second lesion in the right lung could be malignant, the extension code might be 77 [separate tumor nodule(s) in different lobe]. With the possibility of a more extensive stage, the status of the hilar lymph nodes is also not clear. The abstracted information is insufficient to stage this case. |
2002 |
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20020060 | Terminology/EOD-Size of Primary Tumor--Lung: Can the term "opacity" be used to code the size of the primary lung tumor when it is given a size in an imaging study but the "opacity" is not referred to as being suspicious for cancer? See discussion. | Example: How do you code tumor size for a lung primary in which the patient had a CT of the chest that describes a "4 cm opacity in the RUL of the lung." A biopsy of the RUL lung is positive for carcinoma? Would your answer be different if the opacity was described as being "suspicious for carcinoma"? | For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 999 [Not stated] for the example given above. However, if the opacity was described as a "mass" or as "suspicious for cancer," the size could be coded to 040 [4 cm]. |
2002 |
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20021059 | Surgery of Primary Site--Soft Tissue: What code is used to represent this field when an excisional biopsy of a soft tissue sarcoma is followed two weeks later with a wide excision (re-excision)? | For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 26 [partial resection]. According to the CoC, "Excision" in the surgery codes refers to the lesion and "partial resection" refers to the organ. The biopsy is a local excision (code 25). The wide resection is code 26, presuming that more than just the remaining lesion was removed. | 2002 | |
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20021020 | First Course Treatment: 1) When is Decadron (Dexamethasone) coded as cancer treatment? 2) When Decadron is given to a patient with multiple myeloma, is it coded as treatment only if given in combination with chemotherapy? See discussion. |
SEER Book 8 states that Decadron is an important therapeutic agent for treatment of multiple myeloma. In the Abstracting and Coding Guide for the Hematopoietic Diseases, Decadron is a hormonal treatment for multiple myeloma "when given as part of a chemotherapy regimen". |
For cases diagnosed 1/1/2003 and after: 1. Code hormone therapy to 01. Code any therapy administered to treat cancer tissue that achieves its effect on cancer tissue through a change in the hormone balance in the hormone therapy field. Decadron is coded for leukemias, lymphomas and multiple myelomas primaries. It is coded for other sites only when stated to be cancer-directed treatment. 2. Code hormone therapy to 01. Decadron should be coded as hormone therapy for multiple myeloma when given alone or as part of a first course of treatment chemotherapy regimen. |
2002 |
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20021103 | Surgery of Primary Site/First Course Treatment--Liver: If disease progression is so rapid that the initial therapy plan is changed before patient receives any therapy, would "no therapy" be the first course? See discussion. | Patient was diagnosed with liver cancer on 8/23 and on 9/6 a hepatectomy was recommended. However, patient was hospitalized on 9/19 with ascites. Patient underwent embolization instead of a hepatectomy during that admission. | Code the "embolization" (or hepatic artery embolization, HAE) in Surgery of Primary Site. Assign code 10 [local tumor destruction, NOS]. The embolization is coded as first course of therapy for this case because it seems that this patient was not adequately staged until 9/19 -- there is no indication on this case of the stage of disease in August or early September. Furthermore, no treatment was started before the embolization. Therefore, the ascites is not "progression of disease" in this case -- it is taken into account as part of the initial stage of disease. This procedure was previously coded as other therapy, experimental. Code as surgery as of July 2005. |
2002 |