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.
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).
For cases diagnosed prior to 1/1/2010: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.
Histology (Pre-2007)--Lung: What code is used to represent the histology "mucin-producing bronchoalveolar carcinoma?" Is mucin-producing synonymous with mucinous?
For tumors diagnosed prior to 2007:
Code histology as 8253 [Bronchiolo-alveolar carcinoma, mucinous]. Mucin-producing bronchoalveolar carcinoma is best classified in ICD-O-3 as Bronchiolo-alveolar carcinoma, mucinous.
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.
EOD-Size of Primary Tumor: Can the term "filling defect" be used to code tumor size? See Description.
Site: Bladder
CT abd/pelvis: 4 cm filling defect of the bladder encasing jetstream of distal ureter. 2-3 cm lesion may be extension to bladder. KUB: 3-4 cm filling defect within bladder.
Cystoscopy: large bladder tumor with small tumor extending out of the large tumor.
OP Findings: Large tumor on right of bladder extending from bladder neck lateral and posterior
Pathology: TURB: High grade TCC, Grade III with focal lamina propria invasion.
For tumors diagnosed 1998-2003:
Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, just above a physical exam.
The term "filling defect" from a CT or KUB may be used to code tumor size for bladder in the absence of more reliable size information from path, operative or endoscopic reports.
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.
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.
Reportability--Appendix: Is an appendiceal carcinoid with one periappendiceal lymph node positive for metastatic carcinoid tumor reportable to SEER? See Discussion.
The patient had an appendectomy followed by a hemicolectomy. No residual carcinoid tumor was identified but there was one lymph node positive for metastatic carcinoid tumor.
Yes, this carcinoid is reportable to SEER. This carcinoid is malignant by virture of the lymph node metastasis. Code the behavior as /3.
EOD-Extension/EOD-Lymph Nodes--Cervix: How do you code these fields when the cancer extended to the pelvic wall and there are periaortic LN metastases?
For cases diagnosed 1998-2003:
Assign extension code 65 for contiguous (direct) extension of tumor from the cervix to the pelvic wall. Assign extension code 85 only if the pelvic wall is involved with discontinuous extension from the cervix; i.e., the cervical tumor spread indirectly (through lymph or vascular channels) to the pelvic wall. Code the pelvic wall involvement in the Extension field and the periaortic lymph node involvement in the Lymph Node field. When the computer does the algorithm, it will look at the periaortic lymph nodes and report the summary stage as distant and the TNM stage group as IV because periarotic nodes are M1. Do not code the periaortic lymph nodes in both fields. This is stage IV, distant disease, due to the periaortic lymph node involvement (EOD lymph nodes code 6).
Surgery of Primary Site--Lung: Is a core-out of the main bronchus coded in this field? See Description.
Patient with right lung cancer was not a surgical candidate because of extent of disease. Prior to receiving radiation, patient underwent bronchoscopy, which revealed obstruction from right main bronchial tumor. Core-out of the tumor was undertaken, and a specimen was sent for path evaluation. The physician stated that this was a palliative procedure to relieve obstruction.
Do not code bronchoscopy to clear the airway as surgery of primary site. When combined with laser therapy, cryosurgery, or other tumor destruction, or when combined with excision of tumor, code as surgery of primary site.
For cases diagnosed 1998-2003: Code surgery of primary site for the case described above to 23 [Excision, NOS]. Tissue was excised and sent to pathology.
An official website of the United States government
Home