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].
CS Site Specific Factor--Prostate: Does perineural invasion affect the coding of SSF3, pathologic extension? See Description.
"Adenoca scattered over a 2.5 cm region bilaterally toward the apex. Perineural invasion is identified, including within the right apex." Does this mean that there is extension into the apex?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.For cases diagnosed 2004 and forward:
Presence or absence of perineural invasion does not affect pathologic extension. Most likely perineural invasion is still localized. It means that there is tumor found along the track of the nerves in the prostate. Where the nerves enter the prostate, the capsule is thinner than in other areas; thus pathologists make note of the potential for extracapsular extension.
The CAP Cancer Protocol for Prostate states that perineural invasion "has been associated with a high risk of extraprostatic extension...although the exact prognostic significance remains to be determined."
Based on the available information, code the case example to 023 [Involves both lobes].
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].
Reportability/Terminology, NOS--Hematopoietic, NOS: Is "smoldering" multiple myeloma reportable to SEER?
For cases diagnosed prior to 1/1/2010:Yes, "smoldering" multiple myeloma is reportable to SEER as multiple myeloma [9732/3].
According to our pathologist consultant, "smoldering" multiple myeloma would certainly refer to a diagnosed process. Smoldering means the process is progressing, but perhaps slowly, or even at a slower pace than might be expected.
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.
Surgery of Primary Site--Skin: When would one use codes 30-33 for this field on a skin primary?
Surgery of Primary Site codes 30-33 under "skin" are used for various types of biopsies followed by a gross excision of the lesion. The two procedures (biopsy and gross excision) may be performed on different days, at different facilities, by different physicians as long as both procedures are performed during the first course of treatment.
Answer applies to both pre-2002 and 2003+ surgury code definitions.
Primary site--Unknown & ill-defined site/Kidney: How should this field be coded when humeral metastases are compatible with renal cell carcinoma pathologically, no kidney lesion is found clinically and the physician's signout diagnosis is "no primary found, as of now unknown"? See Description.
Path states "biopsy of humerus, mets sarcomatoid carcinoma consistent with renal cell carcinoma." Material was sent to Mayo Clinic for consult & they state "with focus of clear cells, agree that a likely primary is renal cell carcinoma." Abdominal CT showed no abnormality in kidneys. When the registrar abstracted the case she spoke to the managing physician who told her that "no specific site was found and it was, as of now, unknown." This was stated about three months after dx. Can we code as a renal primary based on pathologic information or should we code unknown based on CT and physician's statement?
Code this case to C64.9 [Kidney, NOS].
ICD-O-3 rule H states that the topography code attached to a morphology term may be used when the topographic site is not given in the diagnosis. Topography code C64.9 is attached to morphology code 8312/3 [Renal cell carcinoma] in ICD-O-3.
Surgery of Primary Site--Skin: How should this field be coded for a re-excision or wide excision of a skin primary when the margins are NOS?
For cases diagnosed 2003 and later:
Assign surgery codes 45, 46 and 47 only when the margins are documented to be more than 1cm. Use the most appropriate code from 30-36 if re-excision or wide excision followed a biopsy. Use a code from the 20's series if the procedure is called a "biopsy."
EOD-Size of Primary Tumor: How is tumor size coded when there is a clinical tumor size, the excisional biopsy pathology report has a tumor size and the resection specimen has residual tumor, but there is no tumor size provided in the pathology report?
For cases diagnosed 1998-2003: Code the EOD-Size of Primary Tumor from the excisional biopsy. If there is some indication that a large amount of tumor was removed at the time of the resection, code the clinical size instead. When both an excisional biopsy and a resection show tumor, code the largest size of tumor reported.
Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description.
Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?
Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias.
Primary Site/Histology--CLL/SLL: How should these fields be coded when the pathological diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma is made on bone marrow biopsy only but scans show lymphadenopathy? See Description.
What histology would we give these two examples?
1. Bone marrow bx: CLL/SLL. CT chest/abdomen: Mediastinal and retroperitoneal adenopathy.
2. Bone marrow bx: CLL/SLL. CT chest/abdomen: Mediastinal and retroperitoneal adenopathy suspicious for lymphoma.
For cases diagnosed prior to 1/1/2010:If a lymph node or other solid tissue is involved initially, code to SLL. For lymphoma, any mention of lymph nodes is indicative of involvement. Involvement does not have to be proven pathologically in order to code to Small Lymphocytic Lymphoma (SLL). Code both of the examples to SLL.
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.
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