Report | Question ID | Question | Discussion | Answer | Year |
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20020049 | EOD-Extension--Breast: Should clinically mentioned "thickening" of the breast be ignored if the pathology report does not mention thickening or skin involvement? See discussion. | For cases diagnosed 1998-2003: Can clinical "thickening" of the breast be coded to 20-28 extension code when there is no mention of the thickening or skin involvement in the pathology report? How do we code cases when pathology reports don't support the clinical finding of skin involvement. | For cases diagnosed 1998-2003: Do not use code 20-28 when there is no preoperative treatment and the pathology report does not confirm skin invasion. The clinical diagnosis of skin involvement was not supported by the pathology report. | 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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20021147 | Other Cancer Directed Therapy--Hematopoietic, NOS: Is "aspirin" treatment for primary polycythemia? See discussion. |
Aspirin is listed as treatment for "thrombocythemia" in the Abstracting and Coding Guide for the Hematopoietic Diseases but not for "primary polycythemia." |
Do not code aspirin as treatment for primary polycythemia (polycythemia vera). |
2002 |
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20021105 | Grade, Differentiation: Do we code to the highest grade even when no grade is given at the time of initial diagnosis, but a grade is obtained on tissue removed after non-surgical treatment has occurred? See discussion. | 1. In 2000 a pleural fluid aspirate had no grade. Pt treated with chemo. In 2000 a BSO diagnosed high grade papillary serous adenocarcinoma of the ovary. 2. In 1993 a prostate bx had no grade. Pt treated. In 2001 prostate bx revealed a Gleason's 4+3. |
Code the grade at the time of initial diagnosis (if the specimen is from the primary site) or to the grade identified as part of a first course of cancer-directed surgery to the primary site. When different grades are specified for tissue pathologically reviewed from the primary site before and after treatment, code the higher grade. This is true even if the higher grade is obtained while the pt is still undergoing first course of cancer-directed therapy. 1. Code the Grade to 4 [high grade], if the grade information from the BSO specimen represents the grade associated with primary site surgical specimen. Even though the grade was obtained after first course of cancer-directed therapy started, it was obtained during first course of cancer-directed therapy. 2. Code the Grade to 9 [Cell type not determined, not stated or not applicable]. Grade was obtained well after the first course of cancer-directed therapy ended. |
2002 |
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20021187 | Reportability: When a hospital pathologist sends the slides from an original biopsy to two or more outside reviewers and the reviewers differ on whether or not the case is reportable, is the case SEER reportable? Does the decision to treat the patient have any bearing on whether the case would be reportable? |
Typically, the final diagnosis of the reviewing pathologist is the one used to determine whether the case is SEER reportable. If two or more reviewing pathologists disagree as to whether the case should be reportable, determine reportability based on the following priority order: 1) If the patient is treated for cancer, the case is reportable. 2) If the patient is not treated for cancer, use the amended diagnosis on the original pathology report if the hospital pathologist used the reviewing pathologists' opinions in establishing his new diagnosis. 3) If there is not an amended diagnosis for the original hospital pathology report, use the clinician's opinion regarding what the diagnosis is to determine whether the case is reportable. |
2002 | |
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20021175 | Histology (Pre-2007): What code is used to represent the histology if the final diagnosis between an electron microscopy report and the immunocytochemistry (ICC) differs and both histologies are specific (e.g., one report states papillary carcinoma and the other states squamous cell carcinoma)? | For tumors diagnosed prior to 2007:
There is no established hierarchy between electron microscopy and ICC findings. Contact the pathologists involved in these types of cases to determine the final histologic diagnosis.
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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20021171 | Date Therapy Initiated: How would you estimate the date treatment began for a patient who was treated elsewhere and seen only on an outpatient basis at the current facility? See discussion. | July 19th: Retromolar trigone primary was diagnosed. August 8th note states, "Pt is not a surgical candidate due to multiple medical co-morbidities." Sept 19th note states, "Per Tumor Board, pt has been undergoing radiation for her head and neck cancer." The exact starting date for radiation is not specified.
In the SEER Program Code Manual it states that "In the absence of an exact date of treatment, the date of admission for that hospitalization during which the first cancer directed therapy was begun is an acceptable entry." |
If possible, review the radiation treatment summary and outpatient records at the treating facility. If the date treatment began is not stated, look for the completion date and number of treatments, and calculate the first date of treatment.
If the date radiation started cannot be found or calculated, code the month as 09 for the example provided. The determination was made in August NOT to treat with surgery. We know that there was treatment in September. |
2002 |
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20020059 | Grade, Differentiation: Can a FIGO grade be coded in this field or is the FIGO grading system to be used only for EOD/Stage coding? |
This answer pertains to cases prior to 2014. For cases diagnosed 2014 and forward, see http://seer.cancer.gov/tools/grade/
Do not use FIGO grade to code differentiation.
FIGO grade is something completely different from FIGO stage. FIGO stage is used to code EOD. FIGO grade is based on the percentage of non-squamous (i.e., solid) portions of the tumor and corresponds roughly to a three grade differentiation system: grade I, well differentiated (=<5% solid component); grade II, moderately differentiated (>5 - 50% solid); and grade III, poorly differentiated (> 50% solid). SEER is evaluating whether the ICD-O-3 6th digit differentiation codes (four grade categories) accurately represent the FIGO grade. For the time being, do not code FIGO grade.
For a diagnosis that includes commonly used differentiation term with a FIGO grade, such as "Moderately differentiated, FIGO grade II," disregard the FIGO grade and code the Grade, Differentiation field according to the term "Moderately differentiated." |
2002 | |
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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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20021087 | Multiple Primaries (Pre-2007)--Head & Neck: How many primaries are represented when a1998 invasive squamous cell carcinoma of the true vocal cord is followed by a 1999 diagnosis of in situ squamous cell carcinoma of the true vocal cord (called "recurrent" by the clinician), and in 2001 there is another invasive squamous cell carcinoma of the true vocal cord (no statement of recurrence)? Would your answer be any different if no statement of "recurrent" had been made in 1999? | For tumors diagnosed prior to 2007:
Code this case as two primaries, an invasive true vocal cord primary in 1998 and another invasive true vocal cord primary in 2001.
If there had been no statement of recurrence for the 1999 in situ diagnosis and the 1999 diagnosis was more than two months following the 1998 diagnosis, this case would be coded as three primaries.
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 |