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Report Produced: 11/04/2024 21:25 PM

Report Question ID Question Discussion Answer Year
20051126 Histology (Pre-2007)--Ovary: What codes are used to represent "mixed papillary serous and clear cell carcinoma" and "papillary serous carcinoma with focal clear cell features" of the ovary?

For tumors diagnosed prior to 2007:

Assign code 8323 [Mixed cell adenocarcinoma] to "mixed papillary serous and clear cell carcinoma." This is histology coding rule 3 in the 2004 SEER manual under single tumor (page 86). There is no other code for this mixture.

Example 1: 8323

Example 2: 8461 (clear cell is not coded according to Rule 6, page 87, because it is not the majority of the tumor).

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.

 2005
20051140 CS Reg LN Pos/Exam--Breast: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Discussion.

A breast cancer patient had an FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases.

Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection.

Example 2: Patient received no neoadjuvant therapy.

This question is answered for EOD in SINQ 20031059. What is the answer for Collaborative Stage?

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.Include all nodes examined by the pathologist in Regional lymph nodes positive and Regional lymph nodes examined, unless there is disease progression. These fields are cumulative -- record the total number of regional nodes positive and examined during first course of treatment. Preoperative treatment does not affect the coding of these fields.

An FNA alone, positive for regional lymph node metastasis is coded as 95 for number positive and 95 for number examined.

For the case examples above, assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Code number of regional nodes positive as 01, number examined as 07 for both examples.

 2005
20051033 CS Site Specific Factor--Melanoma: What is the correct code for measured thickness in SSF 1 for a melanoma of the choroid without an enucleation? See Discussion. CS Site Specific Factor 1 for melanoma of the choroid codes "Measured Thickness (Depth), Breslow's Measurement." The note for this field states "Record actual measurement in millimeters from the pathology report." For melanoma of the eye, there is often only an eye exam report stating the thickness. Can PE thickness (clinical statement only) be coded for SSF 1 or is this field coded only from pathology? (i.e., all cases treated without enucleation would have this field coded to 999)

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.

Code SSF 1 999 [Unknown] when there is no enucleation, and therefore, no pathology report for a choroid melanoma.

 2005
20051007 CS Tumor Size--Breast: How is this field coded for a 1.5 cm clinically palpable tumor that appeared to be a cyst with a papilloma when the partial mastectomy Path Micro stated the lesion was an "intraductal papilloma with focal noninvasive papillary carcinoma"? See Discussion. Should the size be coded to 999 [unknown] because the noninvasive papillary carcinoma is described only as "focal" and is not measured and it is not known how much of the tumor is benign and how much is in situ. Or would the size be coded to the size of the palpable mass, 1.5 cm?

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.

Code CS tumor size as 999 [unknown]. Size of the focal noninvasive papillary carcinoma is not stated.

 2005
20051050 CS Tumor Size--Breast: Is the largest focus or the total area coded for tumor size in a patient presenting with "scattered foci of DCIS, largest focus measuring 0.6cm. DCIS spans a total area of 2.1cm."

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.

Code the size of the largest focus in CS tumor size. Code the tumor size for this case as 006 (6mm or 0.6cm).

 2005
20051011 CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?

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.

Code CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.

Code SSF 4 and 5 000 [Nodes clinically negative].

 2005
20051074 CS Extension/CS Lymph Nodes--Colon: What codes are used when large vessel invasion (V2 grossly evident) is stated to be present on a pathology report? See Discussion.

Example

Cecum, right hemicolectomy: poorly differentiated invasive adenocarcinoma of the cecum. Large vessel invasion (V2-grossly evident) is present. Microscopic description: The grossly described matted lymph node tissue shows an irregular nuclear contour and is classified as V2, grossly evident venous invasion based on staging criteria of the AJCC Cancer Staging Manual, 6th Edition.

Per note 2 in the coding scheme for CS-Extension, a nodule with irregular contour in the pericolic adipose tissue should be coded in CS-Extension to code 45. Is the large vessel invasion described in the path report the same process as a tumor nodule in pericolic fat? Should note 2 be used and CS-Extension coded to 45?

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.The description of large vessel invasion and irregular nuclear contour from the example above describes grossly matted LYMPH NODE tissue. Do not code this in the CS Extension field. Code the CS Lymph Nodes field appropriately based on the rest of the information for this case.

When large vessel invasion and irregular nuclear contour is used to describe a "tumor nodule," rather than a recognizable lymph node, code it in the CS extension field.

 2005
20051010 Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion. The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant?

Code the breast subsite from the pathology report (C501, central).

The priority order for coding subsite from conflicting reports is

1. Pathology report

2. Operative report

3. Physical examination

4. Mammogram, ultrasound

The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor.

 2005
20051072 Primary Site/CS Extension--Lymphoma: Should CS Extension be coded to 22 [Involvement of spleen PLUS lymph node(s) BELOW the diaphragm] or 32 [Involvement of spleen PLUS lymph node(s) on both sides of the diaphragm] for the biopsy proven lymphoma in a retroperitoneal mass and a CT of the chest with nodes described as "indeterminate" or "calcified"? See Discussion.

It was diagnosed on CT-guided biopsy of retroperitoneal mass: obtained access to the posterior aspect of the lesion adjacent to the left side of the spinal column at approx the level of the kidney.

CT Abdomen/Pelvis: Large low attenuation & smooth walled regions in hilum of the spleen & into the splenic parenchyma w/assoc smaller lesions in the spleen. Associated adenopathy on left side of aorta between the superior mesenteric artery & renal vein.

Body of report: Soft tissue mass 4.4 x 4.8 x 7cm adjacent to the left side of the aorta & spanning the distance betw superior mesenteric vein inferiorly to level of left renal vein, appears to be matted adenopathy.

CT Chest: indeterminate nodes in pretracheal region w/calcified nodes in infracarinal region, right perihilar region & calcifications in pulmonary parenchyma of right lung. Calcified nodes & other structures suggest healed granulomatous process. However, with the infarct/mass lesion in the spleen & left periaortic adenopathy, extension of this process to the mediastinum can't be excluded.

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.Code the primary site C772 [Intra-abdominal lymph nodes]. Assign CS extension code 22 [Involvement of spleen plus lymph nodes below diaphragm]. The description from the chest CT is not sufficient to code lymph node involvement above the diaphragm.

 2005
20051003 CS Tumor Size/CS Eval--Breast: How are these fields coded when there is a clinical size recorded but the tumor size is not specified on the pathology report associated with a subsequent resection? See Discussion. 4/8/04 excisional biopsy of 1.5 cm palpable mass. Path: gives a specimen size only and states that there is a nodular firm area that correlates with the clustered microcalcification on radiograph. No pathologic tumor size is given. Would the size be coded to the clinical size of 1.5 cm? The patient did have surgery but the only size available is a clinical one. Because the size is clinical, is the CS Eval field coded to 0 [No surgical resection done. Evaluation based on PE...]?

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.

Clinical size can be coded when the patient has had surgery. For the case above, code the tumor size as 015 [1.5 cm] using the clinical information. The CS Tumor Size/Extent Eval field refers to both tumor size and extension. In this case, record the eval field as 0 or 1 (which ever is appropriate). The tumor size sets the T category unless the resection shows skin or chest wall or dermal lymphatic involvement.

 2005