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Report Produced: 11/06/2025 20:28 PM

Report Question ID Question Discussion Answer Year
20031194

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. 2003
20031007 EOD Extension--Lung: Do we ignore pericardial effusion seen on a CXR if a subsequent lobectomy reveals only a localized tumor? See discussion. Note 6 in the lung EOD scheme instructs us to assume that a pleural effusion is negative if a resection is done. Does this also apply to a pericardial effusion? For example, if a pericardial effusion is seen on CXR, and a subsequent lobectomy reveals only a localized tumor, should the effusion be ignored? For cases diagnosed 1998-2003: Ignore pericardial effusion which is negative for tumor. Assume that a pericardial effusion is negative if a resection is done and the tumor is pathologically confirmed to be localized. 2003
20031062 Primary Site--Melanoma: How would this field be coded for a pleural effusion consistent with metastatic melanoma and "no skin lesions?" Code primary site as C44.9 [Skin, NOS]. ICD-O-3 does not list a suggested site code for 8720/3 because melanoma can arise in other parts of the body. However, C44.9 [Skin, NOS] is the default when the primary cannot be found. 2003
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
20031120

Primary site: How is this field coded for a malignant spindle cell neoplasm in a subcutaneous mass of the right knee? See Description.

The pathology report says: Right knee tumor:

A. discrete subcutaneous mass 3.5x5.2x1.4 cm malignant spindle cell neoplasm (see Comment)

B. A focus of subcutaneous malignant neoplasm is identified in the superior resection margin.

C.All other margins are clear.

The comment mentions that the specimen has been sent to Mayo Clinic and the Mayo clinic consult says, "we still believe that the diagnosis of spindle cell carcinoma is correct. Obviously the differential diagnosis involves melanoma and sarcoma also. The results of the immunoperoxidase stains strongly support the prior diagnosis of a carcinoma."

Code the site to C49.2 [Connective, subcutaneous and other soft tissues of lower limb and hip]. The site is a subcutaneous mass. C49 with 8032/3 will not be impossible following the next updates to the SEER edits.

 2003
20031032 Diagnostic Confirmation--Hematopoietic, NOS: How should diagnostic confirmation of Hematopoietic diseases be coded in the absence of positive bone marrow? See Description.

Case 1. Patient admitted 9-12-02 with diagnosis of essential thrombocythemia. Per the H&P, patient obviously has had this since January 2001. Per the clinical history: patient with elevated platelets. Path diagnosis of bone marrow biopsy done 9-20-02 showed mildly increased megakaryocytes. 10-31-02 clinical sign-out diagnosis was: essential thrombocythemia.

Case 2. Patient admitted for evaluation of erythrocytosis. Assessment: Increased hematocrit only. It is most likely that patient has polycythemia vera. I think it is reasonable to initiate phlebotomy treatment.

Code 1, Positive histology, includes diagnostic hematologic findings and peripheral blood smears when these are the basis for diagnosis.

When the clinician makes a specific diagnosis and the blood work is not diagnostic, code diagnostic confirmation as 8 [Clinical diagnosis only]. The clinician is putting together all evidence, including the blood work and using his/her professional experience to diagnose the case.

Case 1. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. Megakaryocytes are the immature form of thrombocytes, but mildly increased megakaryocytes are not diagnostic of essential thrombocythemia.

Case 2. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only].

 2003
20031025 Histology (Pre-2007): Is a small cell undifferentiated carcinoma coded to 8041/34 [small cell carcinoma undifferentiated] or to 8045/34 [combination small cell AND undifferentiated carcinoma] using terms from the 2 columns in Appendix 1 of Coding Complex Morphologic Diagnoses? See discussion. Per pathology report, diagnosis is small cell undifferentiated carcinoma in biopsies taken from the laryngeal surface of the epiglottis and left false vocal cord.

For tumors diagnosed prior to 2007:

Code histology as 8041/34 [small cell carcinoma, undifferentiated]. The diagnosis indicates that this is an undifferentiated small cell carcinoma, rather than a mixture of small cell carcinoma with undifferentiated 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
20031034

Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?"

For tumors diagnosed prior to 2007:

Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent.

1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260.

2) Code "chromophil renal cell carcinoma" to 8260.

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
20031191 EOD-Clinical Extension--Prostate: How is this field coded when biopsies of the prostatic apex are positive and the physician clinically stages the case as T1c?

For cases diagnosed 1998-2003:

Code clinical extension to 33 [arising in the prostatic apex] when a biopsy of the prostatic apex is positive for malignancy, with no further evidence of involvement. If biopsies of both the apex and another site within the prostate (for example right lobe) are positive and there is no mention that the malignancy arose in the apex, code extension to 34 [extending into the prostatic apex].

 2003
20031181

EOD-Extension--Kaposi Sarcoma: Is a "markedly enlarged spleen" involvement for cases of Kaposi Sarcoma?

For cases diagnosed 1998-2003: No. Splenomegaly is not synonymous with "extension to" or "involvement of" the spleen in Kaposi's sarcoma. Look for a definite statement of Kaposi's lesion(s) involving the spleen.

 2003