EOD/Surgery of Primary Site--Melanoma: If a melanoma primary site is other than skin, vulva, penis, or scrotum should these fields be coded using melanoma schemes? See discussion.
Should a melanoma of the cervix be coded using the melanoma or the cervix schemes for these fields?
For cases diagnosed 1998-2003: Use the EOD and surgery code schemes for cervix uteri. The EOD scheme for melanoma excludes melanoma of the cervix uteri. The surgery code scheme for skin excludes cervix uteri.
EOD-Extension--Corpus Uteri: How is this field coded for a stage III A endometrial primary with positive pelvic washings, involvement of the omental serosa, and negative lymph nodes?
For cases diagnosed 1998-2003: Code EOD-extension as 85 [Metastasis]. According to our TNM consultant, Omental metastasis is M1, Stage IVB [EOD 85].
Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description.
We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall.
Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla".
Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9.
According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung].
EOD-Patholgic Review of Number of Regional Lymph Nodes Examined: How is this field coded when there is no lymph node count in the final pathology diagnosis and the gross description states "four possible lymph nodes are dissected"? See Description.
Patient with kidney cancer underwent nephrectomy and lymph node removal. Final path diagnosis was Lymph nodes, pericaval biopsy, lymph nodes with no evidence of carcinoma. Per Gross description: Received in formalin as pericaval lymph node is 2.5 cm piece of fibrofatty tissue, from which four possible lymph nodes are dissected.
For cases diagnosed 1998-2003: Code the number of regional lymph nodes examined as 04. This is as accurate as possible for this situation.
Ambiguous terminology/EOD-Extension: Is the term "within" a term of involvement in coding extent of disease? See Description.
For example: a kidney tumor is described as "completely encased within the renal capsule with no extension into perirenal fat." Does this mean the renal capsule has been invaded (extension code 20) or that the tumor is totally contained within an area surrounded by the renal capsule (extension code 10)?
For cases diagnosed 1998-2003: The term "within" is not one of the listed ambiguous terms for EOD. Determine extent of involvement from the context in which "within" appears.
In the example, "Encased" is an ambiguous term meaning not involved. Code extension for the example to 10 [Invasive cancer confined to kidney cortex and/or medulla].
EOD-Size of Primary Tumor--Prostate: Is this field coded to the size of a hypoechoic mass identified on a TRUS when there is no tumor size from the prostatectomy specimen?
For cases diagnosed 1998-2003: Ultrasound measurement of a malignancy can be used to code EOD-Size of Primary Tumor. Information on tumor size taken from imaging/radiographic techniques has low priority, just above physical examination.
EOD-Lymph Nodes--Lung: Are positive "neck nodes" coded to 7 [Distant lymph nodes, other than above (including cervical lymph nodes)] in this field because we do not have a specific lymph node chain named or are they coded to 6 [Contra lateral hilar or mediastinal (incl. bilateral); supraclavicular (transverse cervical), ipsilateral or contralateral; scalene, ipsilateral or contralateral] because this code represents the lowest possible code for involved neck nodes?
For cases diagnosed 1998-2003: Code EOD-Lymph Nodes as 7 [Distant lymph nodes, other than above (incl. cervical neck nodes)]. Lymph nodes in the "neck" are distant, rather than regional, for lung.
EOD-Lymph Nodes--Colon: Are "multiple submucosal lymphoid collections infiltrated with tumor" or "lymphoid areas" coded as lymph node involvement, similar to the way nodules in the pericolic fat are coded? See Description.
For an adenocarcinoma in the colon, under the "lymph node" section of the final path diagnosis it states "multiple submucosal lymphoid collections infiltrated with tumor" in addition to "one of two involved lymph nodes." The micro description states "There are multiple small lymphoid areas with tumor. A definite node excised from the mesentery shows...replacement of stroma and an additional very small node shows no tumor."
For cases diagnosed 1998-2003: No, do not code tumor infiltration of lymphoid collections or lymphoid areas as lymph node involvement.
However, code lymph node involvement for this case as 3 [mesenteric, NOS] because a mesenteric node is involved.
Regarding tumor infiltration of lymphoid collections or lymphoid areas from our pathologist consultant: Unless the anatomy of lymph node is evident (sinuses, trabeculae, primary and secondary follicles) these aren't lymph nodes and should not be coded as such. Unless there is evidence to the contrary in the path report, I would suggest that this be considered intramural spread, not lymph node spread.
Histology (Pre-2007)--Cervix: Is 8384/3 [adenocarcinoma, endocervical type] a specific histology type that must be stated or does it apply to any adenocarcinoma arising in the endocervical? Should the ICD-O-3 histology code of 8384/3 [Adenocarcinoma, endocervical type] be used for final diagnoses of "adenocarcinoma of the endocervix" or "adenocarcinoma of the cervix"?
For tumors diagnosed prior to 2007:
Histology code 8384 is for adenocarcinoma of endocervical type. This specific type (endocervical) must be part of the diagnosis in order to assign code 8384. This histology code is not to be used for Adenocarcinoma, NOS of the endocervix or cervix.
Adenocarcinoma of endocervical type can be diagnosed in other tissues and if so it will be stated as endocervical type. Adenoca of the endocervix would be coded to plain Adenoca.
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.
An official website of the United States government
Home