Date of Diagnosis/Histology (Pre-2007)/Behavior--Melanoma: How are these fields coded when the first shave biopsy finds "what appears to be the top of a melanoma" and a subsequent shave biopsy finds "features consistent with lentigo maligna?"
For tumors diagnosed prior to 2007:
Evaluate each case using all available information, including all pathology reports. Use the date of the first biopsy because it did identify the melanoma. The second biopsy confirmed the histologic type.
According to WHO's Histological Typing of Skin Tumors, lentigo maligna melanoma is similar to lentigo maligna, but has dermal invasion by atypical melanocytes.
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.
Terms of involvement--Lung: Is "intense uptake" described on a PET scan an indication of involvement? See Description.
We are seeing increasing use of PET scans as diagnostic tools for cancer. PET scans use different terminology than the ambiguous terms listed in the EOD manual. Could we please have guidelines for interpreting PET scans?
Example: Patient with right lung cancer. PET scan showed intense uptake in the mediastinum and in the hilum. Can we code "intense uptake" as involvement of mediastinal and hilar lymph nodes?
Do not interpret "intense uptake" as involvement. Look for a statement of involvement or other terminology, such as "highly suspicious," "strongly suspicious for" malignancy, involvement, etc.
Reportability--Ovary: Is a Stage IIIC serous borderline tumor (micropapillary type) of the ovary diagnosed in 2003 reportable?
Serous borderline tumor of the ovary diagnosed in 2003 is not reportable to SEER. The behavior code is /1 in ICD-O-3. The high stage does not make this borderline tumor reportable.
Surgery of Primary Site--Head & Neck: Is the removal of the left tonsil during a bilateral tonsillectomy for a right tonsil primary coded in the surgery of the primary site field to 27 [Excisional bx], 30 [Pharyngectomy, NOS], 31 [Limited/partial pharyngectomy; tonsillectomy; bilateral tonsillectomy], or to code 2 under the Surgical Procedure of Other Site field? See discussion.
Our notes document a 1/99 SEER e-mail stating that tonsillectomy/tonsillectomy with wide excision would be code to 31. Is this still correct? Some of our coders felt that code 27 or 30 would be more appropriate.
Is the removal of the contralateral tonsil incidental removal or do we code it under Surgery of Other Regional Site, Distant Site, or Distant Lymph Nodes? If it is coded, would 5 be the correct code?
Assign code 31 [Limited/partial pharyngectomy; tonsillectomy, bilateral tonsillectomy]. Do not code removal of the contralateral tonsil under Surgical Procedure of Other Site. Surgery to remove regional tissue with the primary site during the same procedure is coded in the Surgery of Primary Site field.
First Course Treatment--Thyroid: Is hormone replacement following total thyroidectomy coded as first course treatment for all thyroid cases?
Code Hormone therapy as 01 [Hormone therapy administered as first course therapy] when thyroid replacement therapy is part of the first course of treatment for follicular or papillary thyroid cancer following thyroidectomy.
Thyroid hormone replacement therapy has a treatment effect on differentiated (follicular and papillary) carcinomas of the thyroid. This treatment effect is not seen for most medullary and undifferentiated thyroid cancers.
Histology (Pre-2007)/Grading--Head & Neck: Can terms that commonly modify histologic types or grades be used if they are only expressed in the microscopic portion of the pathology report? See Description.
Final path diagnosis on a biopsy of the base of tongue is squamous carcinoma. The micro portion of the path report states the following: Multiple fragments of abnormal epithelium with a complex growth pattern. Many of the cells are small and poorly differentiated, interspersed with areas of well-differentiated keratinized epithelium. This is consistent with squamous cell carcinoma in situ with areas of invasive carcinoma. Do we code histology to 8070/3 or 8071/3?
For tumors diagnosed prior to 2007:
Yes, code using terms from the microscopic description if there is a definitive statement of a more specific histologic type.
Code the case example as 8070/33 [Squamous cell carcinoma, NOS, poorly differentiated]. The microscopic description adds grade information, but does not make a definitive statement of a more specific histologic type. "Keratinized epithelium" is not the same as keratinizing squamous cell carcinoma (8071/3). The mention of "areas of well-differentiated keratinized epithelium" refers to "normal" tissue within the specimen, in contrast to a type of neoplastic tissue.
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.
Surgery of Primary Site--Head & Neck: Will you clarify the use of code 20 [local tumor excision, NOS] versus code 27 [excisional biopsy] when there is no clinical description of a tumor and the pathology report describes more than one specimen from surgery performed on the vocal cords? See discussion.
Specimen A is labeled vocal cord biopsy. Specimen B is labeled left true vocal cord nodule. For specimen B the gross portion of the pathology report describes a .5 cm tissue portion. Is the term "nodule" enough information to code this as an excision? Can we code site specific surgery to code 20 or 27?
Code 20 [local tumor excision, NOS] based on information from the size and description of the specimen.
Reason No Cancer-Directed Surgery--Hematopoietic, NOS: Is this field always coded to 1 [not performed, not part of first course] for leukemias & other hematopoietic diseases?
For cases diagnosed 2003 and later: For sites where "Surgery of the primary site" is coded 00 or 98 (hematopoietic included), Reason for No Surgery of Primary Site should be coded as 1 [Surgery of the primary site not performed because it was not part of the planned first course of treatment]. On rare occasions, there may be surgery to the primary site for a hematopoietic disease, such as an excisional biopsy of a myeloid sarcoma. Refer to the "Abstracting and Coding Guide for the Hematopoietic Diseases" for cell-type-specific treatment information.
Surgery of Primary Site--Breast: How is this field coded when a patient has a reduction mammoplasty (for macromastia) and within the pathology specimen there is an incidental finding of carcinoma?
Code this reduction mammoplasty to the code which best fits the amount of tissue removed. Read the operative report carefully. Code as a partial mastectomy, skin- nipple- areola-sparing mastectomy, or total (simple) mastectomy. Use text fields to record the details.
EOD-Size of Primary Tumor--Breast: How would this field be coded, using the revised and expanded breast code, for a lesion described as "1.3 cm infiltrating ductal carcinoma, associated DCIS?"
For cases diagnosed 1998-2003: Code size of primary tumor as 013. The phrasing suggests that the infiltrating ductal carcinoma measures 1.3 cm. DCIS is also present, but no size mentioned.
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