Report | Question ID | Question | Discussion | Answer | Year |
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20021026 | Surgery of Primary Site--Skin: Should Mohs surgery be code to 27 [Excisional biopsy] or 31 [Shave biopsy followed by a gross excision of the lesion]? See discussion. | Under surgery coding in the 5/22/01 SEER Abstractor/Coder Workshop book, page 20, it states that Mohs surgery should be coded as an excisional biopsy. The ACoS I&R dated 6/6/2001 states that it should be coded to 31. | For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 34 [Mohs surgery, NOS], 35 [Mohs with 1-cm margin or less] or 36 [Mohs with more than 1-cm margin]. | 2002 |
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20021133 | First Course Treatment--All Sites: The patient has undergone part of the planned first course of treatment when a metastatic deposit is identified. If the patient continues with the planned first course of treatment, should the modalities of treatment given after the metastatic deposit is discovered be included in the coding of the first course of cancer-directed treatment fields? |
Yes, those modalities should be counted as part of first course of cancer-directed treatment if the patient continues with the planned first course. For example, if patient has the originally planned type of surgery, radiation, or drug protocol, then code the given treatment as first course. Caution: It is not a change in the treatment plan if the drugs are changed but the action of the drugs remains the same. This is still first course. However, if the treatment is changed from a chemotherapy drug to a hormonal drug following the discovery of the mets, do not code the hormonal therapy as first course. |
2002 | |
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20021173 | Histology (Pre-2007): What code is used to represent a review of slides histology of "in situ squamous cell carcinoma and multiple detached fragments of atypical papillary squamous epithelium; highly suspicious for invasive carcinoma"? See discussion. | The original pathologist indicated a final diagnosis of moderately differentiated squamous cell carcinoma. The slides were sent for review to another facility. The reviewing pathologist rendered the diagnosis stated in the question section. | For tumors diagnosed prior to 2007:
Code the Histology field to 8070 [squamous cell carcinoma].
The review diagnosis was also squamous cell carcinoma. The expression "atypical papillary squamous epithelium" does not modify the cancer histology.
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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20020054 | Multiple Primaries (Pre-2007)--Ovary: Are mucinous cystic tumors of low malignant potential diagnosed in the left ovary in 12/2000 and in the right ovary in 7/2001 reportable as two primaries? See discussion. |
Page 14 of the SEER Program Code Manual, 3rd Edition, states that bilateral retinoblastomas and bilateral Wilms tumor are always single primaries whether simultaneous or not. Does this apply to bilateral ovarian tumors as well? |
For cases diagnosed 2001-2006: Borderline tumors are not reportable to SEER as of 2001. If you are collecting them in your registry, use the following procedure: Exception 1 in the SEER Program Code Manual, 3rd Edition, responds to the issue of processing ovarian tumors. Simultaneously occurring ovarian tumors with a single histology are coded as one primary. In the case you cite, the right ovary primary occurred 7 months after the left ovary primary. This is not simultaneous, so it would be counted as a second primary. 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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20021047 | Surgery of Primary Site--Bladder: Do we code "random bladder biopsies" as an excisional biopsy (27) or as no cancer directed surgery (00) even if the only involvement mentioned on the pathology reports is "focal carcinoma in situ"? | Code the Surgery of Primary Site field to 00 [None; no surgery of primary site] when only random biopsy procedures are performed on the bladder. | 2002 | |
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20021199 | Primary Site/Surgery of Primary Site--Lymphoma: What codes are used in these fields when both regional lymph nodes and an extra-nodal site are involved with lymphoma and there is not a clear statement from the clinician as to the primary site? See discussion. |
In our registry, we code the primary site for such cases to the extra-lymphatic site if there is one extra-nodal site involved with disease and the patient does not have disseminated involvement of multiple extra-nodal sites. Is this correct? Example: A patient with a submandibular lymphoma and involved nodes undergoes a salivary gland excision and a modified radical neck dissection yielding 100 nodes. |
For cases diagnosed prior to 1/1/2010:Code the Primary Site to C08.0 [submandibular gland] and use the surgery code schemes that apply to that site (Parotid and Other Unspecified Glands). Physiologically, lymphoma cells in regional lymph nodes do not "back-flow" into the extralymphatic organ to involve it secondarily. As a result, the primary site is usually the extralymphatic organ with regional lymph node involvement. Do not be afraid to code an extralymphatic site as primary when that site and its regional nodes are involved. If the lymph nodes are not regional to the extra-nodal involved site and the primary site cannot be determined, code the primary site to C77.9 [Lymph node, NOS]. 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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20020063 | EOD-Extension--Breast: How do we interpret "dermal lymphovascular space invasion" and "dermal lymphovascular invasion" for extension? See discussion. | A breast path report states tumor invades dermal lymphovascular spaces. Also, pathologists sometimes state "dermal lymphovascular invasion". Are both these terms synonymous with dermal lymphatic invasion? | For cases diagnosed 1998-2003:
Dermal lymphovascular invasion and tumor in dermal lymphatics would both be coded as dermal lymphatic invasion. |
2002 |
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20021012 | EOD-Extension--Lymphoma: How do you code stage and EOD for an extranodal lymphoma with bilateral involvement of a paired site? See discussion. |
For example, we frequently see cases of lymphoma occurring in bilateral orbits, or both lungs. This issue was discussed at a 1991 SEER meeting with the tentative answer being that lymphoma involving both organs of a paired site will be coded as stage I (e.g., both eyes or both lungs), as this would be contiguous disease. However, an extranodal lymphoma involving tissue of both limbs (e.g., soft tissue of both arms) will be coded as stage IV because this represents wide areas of involvement that have no connection. | For cases diagnosed 1998-2003:
Bilateral involvement of an extralymphatic paired organ is coded as involvement of a single extralymphatic organ or site for lymphomas. The EOD extension code would be at least 11 (Stage IE). Staging lymphomas of any site depends on whether one or more lymph node regions and/or extralymphatic organs are involved, and whether sites on one or both sides of the diaphragm are involved. |
2002 |
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20021115 | EOD-Lymph Nodes--Testis: In coding lymph node involvement for a testicular primary, should we use code 5 (Size not stated) when there is not a pathologic size of the lymph node provided? See discussion. | Should Note 1 in the testis EOD be changed to "Metastases in lymph nodes are now measured by the size of the lymph node as stated in pathology report"? The SEER EOD-88, 3rd Edition, states that "when size of regional lymph nodes is required, code from the pathology report." | For cases diagnosed 1998-2003:
For testis cases only, "metastasis in lymph nodes" is measured by the size of the lymph node or the lymph node mass. It is acceptable to code the size of this metastasis from a CT scan or other imaging when a pathology specimen is not available for testicular primaries. |
2002 |
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20021131 | EOD-Extension: If extension/metastasis is found within 4 months of diagnosis, but after first course of cancer-directed therapy has ended, should that involvement be excluded when coding the EOD-extension field? See discussion. | Example: Spinal drop metastasis was diagnosed within 4 months of the initial diagnosis of a localized astrocytoma, but after treatment with surgery and XRT was completed. | For cases diagnosed 1998-2003:
Do not include the spinal metastasis because it was diagnosed after the extent of disease was established. If metastasis was not present at diagnosis, and not discovered during the original metastatic work-up, it is progression of disease. |
2002 |