| Report | Question ID | Question | Discussion | Answer | Year |
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20031192 | EOD-Extension--Breast: How is this field coded when the diagnosis includes both invasive and in situ disease, and the pathology report stated the tumor size may or may not include the size of the in situ portion of the tumor? See Description. | Examples:
1. Invasive ductal carcinoma well differentiated, 1.2 cm, gross tumor size, ductal carcinoma in situ.
2. Gross tumor size 3.2 x 2.5 x 2.3 cm. well differentiated to moderately differentiated invasive ductal ca, accompanying component well differentiated ductal carcinoma in situ, solid, cribiform. |
For cases diagnosed 1998-2003: Use extension codes 16, 26, or 36 depending on extent of involvement. These codes indicate that invasive and in situ components are present, the size of the entire tumor is coded in Tumor Size, the size of the invasive component is not stated, and the proportions of in situ and invasive are not known. Both examples above measure the entire tumor including invasive and in situ components. Assign extension code 16, unless there is evidence of further involvement. |
2003 |
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20031010 | 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. | 2003 | |
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20031021 | Primary Site--Head & Neck: What is the anatomical distinction among tonsillar fossa, tonsillar pillar, and tonsil NOS? | Operative findings describe a right tonsil three times the size of the left tonsil. Tonsil is dissected from the tonsillar fossa. There appeared to be no involvement of tumor below the tonsillar capsule. | The tonsil lies in an indentation called the tonsillar fossa. The tonsillar fossa is bordered on either side by the tonsillar pillars. The tonsillar pillars are part of the supporting structure of the throat opening.
Code C09.9 [Tonsil NOS] as the primary site for the case above. |
2003 |
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20031112 | Primary Site/Histology (Pre-2007)--Unknown & ill-defined site: How are these fields coded for a markedly atypical high grade malignant neoplasm diagnosed by a fine needle aspiration of a large iliac mass, right buttock area? See Description. |
The diagnosis was made in Oct. 2002 by a CT guided fine needle aspiration of a large iliac mass, right buttock area. The cytology report says: a. positive for malignant cells, markedly atypical high grade malignant neoplasm. b. It is impossible to tell from this aspiration biopsy whether or not this represents a high grade sarcoma or a high grade carcinoma, but our consensus opinion is that this lesion is a high grade carcinoma. The combination of soft tissue topography and carcinoma morphology is Impossible by SEER edits. How should we code this? |
For tumors diagnosed prior to 2007: Code the site to C76.3 [Pelvis, NOS]. Code the histology to 8010/34 [Carcinoma, NOS, high grade]. Unless there is better information available regarding the site, assign C76.3. The information provided above does not indicate the exact site of the mass. Code the histology based on the consensus opinion stated above. 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. |
2003 |
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20031080 | Behavior Code/EOD-Extension--Bladder: How are these fields coded for a bladder tumor in which the pathologist states, "there is no definite invasion identified" but the urologist states the case as T1? See Description. | Patient presents with four bladder tumors, described as "each measuring close to 2 cm." A specimen was taken of only one of the tumors. The tops of the tumors were fulgurated, then vaporized methodically. No obvious tumor or residual was noted on re-inspection. Pathology revealed papillary urothelial carcinoma, high grade, with no definite invasion identified. Small segments of muscularis propria were present. A comment read..."it is difficult to determine if lamina propria invasion is present due to marked necrosis and tissue fragmentation." Urologist staged this as AJCC cT2a, but based on the pathology findings changed it to cT1. The urologist insists this is invasive. |
For cases diagnosed 1998-2003: Because of the damage to the specimen from cautery and the insistence of the urologist that the tumor was invasive, code extension for this case to 15 based on the physician's TNM category of T1.
A T1 is invasive--code the behavior /3. The urologist is confident it is invasive, and will likely treat the patient accordingly. |
2003 |
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20031035 | Reportability/Histology--Hematopoietic, NOS: Does the presence of sideroblasts on a bone marrow biopsy confirm a diagnosis of refractory anemia with sideroblasts? | Final path diagnosis of bone marrow biopsy:
I. Hypercellular marrow for age with trilinear hyperplasia. II. Decreased iron stores with decreased sideroblasts.
Comment: Although the overall picture is not diagnostic of a specific entity, it is most consistent with an early stage myelodysplastic syndrome which would best be considered refractory anemia at this point.
In this case the percentage of sideroblasts is not stated. Would the path diagnosis of "decreased sideroblasts" along with the path comment of "refractory anemia" indicate that this case should be coded to 9982/3 [Refractory anemia with sideroblasts]? |
For cases diagnosed prior to 1/1/2010:
For the hematologic diseases, do not accession the case unless there is a definite positive diagnosis. A positive diagnosis, such as "Refractory anemia" must be stated in order to code that diagnosis. Other words associated with the positive diagnosis, such as "sideroblasts" are NOT to be used alone to assume a diagnosis.
Decreased sideroblasts does not make a diagnosis of Refractory anemia with sideroblasts. The sideroblasts for 9982/3 [Refractory anemia with sideroblasts] are characteristic in rings, and are INCREASED to make the diagnosis.
Based on the information provided, this case is not reportable. The final path diagnosis is not a reportable disease. The comment further states that the overall picture is not diagnostic of a specific entity. Therefore, it should not be reported at this point.
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. |
2003 |
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20031029 | 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. |
2003 |
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20031031 | Reportability/Histology--Hematopoietic, NOS: What histology code is used for a patient diagnosed with "myelodysplasia" prior to 2001, if a bone marrow biopsy in 2002 is consistent with myelodysplastic syndrome with refractory anemia with bilineage dysplasia with excess blasts and the final impression is "myelodysplastic syndrome slowly evolving toward acute leukemia?" |
Patient was admitted in July 15, 2002. Per the H&P, patient was diagnosed 5 years ago with myelodysplasia. Patient had bone marrow biopsy about 5 years ago and then again on 6-10-02. Patient has become transfusion dependent since mid-March. Bone marrow on 6-10-02 was consistent with myelodysplastic syndrome with refractory anemia with bilineage dysplasia with excessive blasts. Impression: Myelodysplastic syndrome slowly evolving toward acute leukemia. Plan: start chemo. 7-16-02 bone marrow biopsy showed acute myeloid leukemia. Can we assume that the myelodysplasia diagnosed 5 years ago was refractory anemia and therefore, patient's first reportable diagnosis would be the AML? Or is the 6-10-02 bone marrow biopsy showing refractory anemia to be the first reportable diagnosis because the term "myelodysplasia" is non-specific? |
For cases diagnosed prior to 1/1/2010: Based on the information provided, the diagnosis date is June 2002. The diagnosis is 9895/3, acute myeloid leukemia with multilineage dysplasia (AML with prior myelodysplastic syndrome). According to the SEER table of hematopoietic diseases, refractory anemia and myelodysplastic syndrome followed by AML is one primary. Prior to 2001, a diagnosis of myelodysplasia was not reportable. 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. |
2003 |
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20031036 | Histology--Hematopoietic, NOS: When both the path and clinical diagnoses simultaneously reflect reportable diagnoses but one is a worse form of the same disease process, which diagnosis do we code? See Description. | Would this case be coded to RAEB or AML? Bone marrow diagnosis: Hypercellular marrow with profound trilinieage dyspoietic changes. Comment: the features are consistent with RAEB. Clinical diagnosis five days later states: Myelodysplastic syndrome, early acute myelocytic leukemia (likely AML). | When several diagnoses are made as part of the diagnostic process within two months, code the one with the worst prognosis. Code the case example as acute myelocytic leukemia. 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. |
2003 |
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20031086 | EOD-Clinical Extension--Prostate: Must all three criteria be met (an elevated PSA; documentation that the physical exam was negative; and, if a TRUS was done, there is documentation that the findings were negative) in order to code this field to 15 [Tumor identified by needle by elevated PSA]? | For cases diagnosed 1998-2003:
Refer to the Prostate EOD Coding Guidelines, Final version distributed to SEER Registries 6/20/2001.
Prostate clinical EOD extension code 15 is used when all three criteria are met as listed on page 3 of the Prostate EOD Coding Guidelines. Meeting 1 or 2 of the 3 criteria is not sufficient for code 15. PE must be done and documented as negative. TRUS may or may not be done, but if done, must be documented as negative. PSA must either be elevated or there is no documentation about the PSA.
Codes 20 and 23-24 would be used with positive physical exam or positive TRUS.
Use codes 30-34 when there is no documentation that the physical exam was negative, or no documentation that the TRUS was negative, or when the prostatic apex is involved. |
2003 |
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