Report | Question ID | Question | Discussion | Answer | Year |
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20031012 | EOD-Lymph Nodes/Extension: How does one code these fields if the clinical level of disease extension prior to neoadjuvant treatment is greater than demonstrated on pathology at time of resection? See discussion. | Breast case described clinically as a "breast mass and nodal metastases" which is treated with neoadjuvant chemotherapy and at surgery the lymph nodes are pathologically negative. | For cases diagnosed 1998-2003:
Use the combination of clinical and pathologic information to code EOD for primary site, extension and lymph nodes. Code the more extensive disease. If lymph nodes are positive clinically and not positive after neoadjuvant treatment, code lymph node involvement. If lymph nodes are negative clinically and positive on path, code lymph node involvement. When neoadjuvant treatment is administered because of a clinical statement of stage or involvement, code EOD based on this clinical information, even if later pathologic information would lead to a lesser EOD. General guideline number 6 (page 1 of SEER EOD-88 3rd ed.) points out that clinical information must be considered when coding EOD. However, do not code EOD based on clinical information disproved by pathologic findings in the absence of intervening treatment. The scenario above: The clinical involvement of the nodes justifies the neoadjuvant chemotherapy. Therefore, code EOD based on the clinical lymph node involvement. |
2003 |
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20031052 | 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. |
2003 |
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20031071 | EOD-Extension--Brain and CNS: How does one code this field for a brain primary with drop metastases and/or seeding? See Description. | In the past SEER has advised coding these cases to extension 60. However, SS2000 states to code these cases to distant.
1. Primary in the cerebrum, hypothalamic region, with drop mets to spinal cord. 2. Primary in the cerebellum with spinal cord drop mets. 3. Primary in the fourth ventricle, with drop mets along the spinal cord. |
For cases diagnosed 1998-2003: Assign extension code 85 [Metastasis] for drop metastases and/or seeding of the spinal cord from a brain primary. Assign code 85 to each of the three cases above. |
2003 |
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20031187 | Histology--Lymphoma: What code is used to represent the histology "monomorphic post-transplant lymphoproliferative disorder [diffuse large B-cell lymphoma]"? See Description. |
A 14 year old with a cadaver kidney transplant in 1994 for membranous glomerulonephritis presented in 6/26/03 with a right cervical LN with biopsy showing "lymph node involved by monomorphic post-transplant lymphoproliferative disorder (diffuse large B-cell lymphoma). Staging was done including a bone marrow which was negative, CSF negative. The oncologist on the case reduced the immunosuppression drugs with the final outcome being no sign of the lymphoma. | For cases diagnosed prior to 1/1/2010:Code 9680/36 [Diffuse large B-cell lymphoma]. This post-transplant lymphoproliferative disorder was diffuse large B-cell lymphoma. According to the World Health Organization, there are two types of post-transplant lymphoproliferative disorder. "Regular" post transplant lymphoproliferative disorder is not a neoplasm and is therefore not reportable to a cancer registry. The second type (sometimes called Hodgkin-like PTLD) is classified as a B-cell lymphoma, which means that it IS 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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20031094 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are coded and what code(s) is/are used to represent the histology "invasive ductal carcinoma with extensive spindle metaplastic change [metaplastic carcinoma] with a second, separate, tumor "invasive ductal carcinoma, moderately differentiated with extensive associated DCIS"? See Description. | The comment on the pathology report states, "due to the associated DCIS this smaller lesion is felt to most likely represent a synchronous second primary." Is this two primaries, one coded 8575/33 and the other coded 8500/32 or is this a single primary with a combination code -- 8523/33? | For tumors diagnosed prior to 2007:
Abstract as two breast primaries. Code to 8575/33 (metaplastic carcinoma) and 8500/32 (infiltrating duct carcinoma). There are two lesions with different histologic types. Do not use code 8523 to combine separate tumors with different histologies.
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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20031202 | Surgery of Primary Site--Head & Neck: How is this field coded for a surgery titled "Parotidectomy with facial nerve dissection"? See Description. | If the operative report is not titled "total parotidectomy," can we assume that less than total parotidectomy was done? Can we assume that "facial nerve dissection" and "facial nerve monitoring" are other ways of stating "facial nerve spared"? | Use the best information available to determine whether or not all of the parotid has been removed. It is important to read the entire operative report and review the content of the pathology report. The Op report will usually include wording about how much was removed, and this can be confirmed by the path report. Do not make assumptions about the extent of the surgery based solely on the title used on the operative report.
For cases diagnosed 1998-2003: Code 30 [less than total parotidectomy] can be used when the parotid is not totally removed, but the exact type of partial parotidectomy cannot be determined. "Facial nerve monitoring" and "Facial nerve dissection" are synonymous with "facial nerve sparing." |
2003 |
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20031051 | Histology (Pre-2007)/Sarcoma: What code is used to represent the histology "Ewing's Sarcoma/Primitive Neuroectodermal Tumor (PNET)"? See Description. | A comment on one path report states "some authors consider both Ewing's & PNET to be the same biologic entity given that they share the same translocation between chromosomes 11 & 22." The pathologists at our children's hospital agree with this statement and contend that the two should have the same histologic code. | For tumors diagnosed prior to 2007:
Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.
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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20031022 | Surgery of Primary Site--Head & Neck: Is a composite resection performed for an oral cavity primary coded to 40 [Radical excision of tumor, NOS], 41 [Radical excision of tumor only], 42 [Combination of 41 with resection in continuity with mandibles (marginal, segmental, hemi-, or total resection], 43 [Combination of 41 with resection in continuity with maxilla (partial, subtotal, or total resection)]? See discussion. |
Example: Patient underwent composite resection of left soft palate, tonsillar fossa, medial pterygoid and lateral tongue for a primary of the retromolar trigone. There was no mention of an excision of the mandible; however, the procedure included the application of a mandibular reconstruction plate. |
Use surgery codes 40-43 for composite resection of an oral cavity primary. In the case example, code Site-Specific surgery as 42 [Combination of 41 WITH resection in continuity with mandible]. Even though excision of mandible was not mentioned, there was mention of a mandibular reconstruction plate. Since the retromolar trigone is ON the mandible, resection of the mandible is likely. | 2003 |
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20031089 | Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description. | The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized." | For tumors diagnosed prior to 2007:
Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell carcinoma.
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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20031024 | Surgical Fields--Head & Neck: How does one code the removal of benign submandibular and sublingual glands performed during a neck dissection for a head and neck cancer? See discussion. | Should the removal be coded as incidental in the surgical Procedure if the Other Site field? Does it make a difference if the submandibular gland is removed en toto with lymph nodes or if the gland is submitted as a separate specimen? Does it make a difference if the glands are involved? | Removal of the lower salivary glands is part of a radical neck dissection and is not recorded in Surgery of Primary Site or Surgery of Other Site. Radical neck dissection is coded under "Scope of Regional Lymph Node Surgery." It does not matter whether or not the gland is submitted as a separate specimen. It does not matter whether or not the gland is involved. |
2003 |