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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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20031175 | First Course Therapy: Are radio immune labeled antibodies, such as Bexxar [Tositum--I-131] coded as immunotherapy, radiotherapy, or experimental therapy? |
Agents such as Bexxar or Zevalin are radioisotopes and coded as radiation. These agents destroy cancer cells with radiation. | 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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20031201 | Reportability/Terminology, NOS--Hematopoietic, NOS: Are the diagnoses "myelodysplastic syndrome," "myelodysplastic syndrome, thrombocytopenia" and "myelodysplastic syndrome, anemia" all reportable to SEER for diagnosis 2001 and later? | For cases diagnosed prior to 1/1/2010:"Myelodysplastic syndrome" (NOS) is reportable to SEER--ICD-O-3 code 9989/3. "Myelodysplastic syndrome, thrombocytopenia" is not reportable to SEER because "thrombocytopenia" is not reportable. "Myelodysplastic syndrome, anemia" is not reportable to SEER because "anemia" is 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. |
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20031053 | Reportability/History (Pre-2007)/Behavior Code--Ovary: Should the matrix principal in Rule F be applied to code a 2002 right ovary case to 8462/3 [Papillary serous borderline ovarian tumor] when peritoneal washings reveal the same histology? | For tumors diagnosed prior to 2007:
Do not apply the matrix principle in this case. This ovarian tumor is not reportable (behavior /1 per ICD-O-3). The peritoneal washings reveal the same histology (/1), rather than malignant cells. Based on the information provided, there is no evidence to support changing the behavior code.
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. |
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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. |
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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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20031079 | 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]. |
2003 |
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20031055 | Histology (Pre-2007)/Primary Site/Diagnostic Confirmation: How would these fields be coded for a diagnosis of cholangiocarcinoma based on clinical findings only? See Discussion. |
We have a case of reported "cholangiocarcinoma" of the liver diagnosed only by a CT of the abdomen. There is no pathologic confirmation. CT ABD: Heterogeneous liver mass suspicious for cholangiocarcinoma; mass causes right portal & right hepatic vein occlusion & right and left biliary duct dilatation.... Should this be coded to cholangiocarcinoma by radiology alone and should it be liver as primary site? |
For tumors diagnosed prior to 2007: Code according to the prevailing medical opinion in this case. If no further information can be obtained, code as cholangiocarcinoma of the intrahepatic bile duct. 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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20031145 | EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. | Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? | For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. | 2003 |