CS Lymph Nodes--Breast: Clarify the use of code 25 [Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm)] vs code 60 [Axillary/regional lymph node(s), NOS; Lymph nodes NOS] when surgically removed lymph nodes are positive but the size of the metastasis is not stated. See Discussion.
Note 2 in CS manual states: "If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2mm and code LNs as positive in this field. Use code 60 in the absence of other information about regional nodes."
1. If the LNs are known to be axillary LNs, note 2 seems to imply the size can be assumed to be greater than 0.2mm. Would you code 25 or 60?
2. Both codes 25 and 60 map to N1, node involvement. Do they each mean something else in the evaluation process?
3. What would constitute "absence of other information"?
4. Is the use of 60 over 25 specific to SEER registries or all users?
5. Abstractors are trained to assume LNs are mobile if there is no contrary information. Is this appropriate?
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.
Assign CS Lymph Nodes code 25 for breast when there are positive axillary nodes without internal mammary nodes. Code 25 is used in a couple of situations: a. when you know the lymph nodes are clinically movable and only the axillary nodes are involved; b. when you know the size of the metastasis in an axillary lymph node is more than a micrometastasis (i.e., > 2 mm). Code 60 can be used for any regional lymph node (internal mammary, infra- or supraclavicular, as well as axillary. So you can code to 25 if you have "regular" metastases in axillary lymph nodes only. If you don't know whether the mets are micro or regular, use code 60. Assign code 60 when there are positive regional nodes not further described.
1. Assign code 25 for positive axillary lymph nodes.
2. Codes 25 and 60 may map to N1, N1a, N2a or N3a depending on the coding of SSF3.
3. Assign code 60 when there is not enough information to assign a code from 13 to 50.
4. CS instructions are the same for all users. There are no CS instructions specific to SEER registries.
5. Yes, assume lymph nodes are moveable (not matted, not fixed) when there is no information to the contrary.
Histology (Pre-2007): Is histology for an anorectal biopsy of "Cloacogenic carcinoma (squamous cell carcinoma with basaloid features)" coded to 8124/3 [Cloacogenic carcinoma] or 8083/3 [Basaloid squamous cell carcinoma]?
For tumors diagnosed prior to 2007:
Code histology to 8124/3 [Cloacogenic carcinoma]. These are squamous cell carcinomas of basaloid type that are found in the cloacogenic (transitional) zone of the anal canal.
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.
Marital Status: Is marital status coded to 2 [married] if the patient is legally married to a same-sex spouse (e.g., patient has a Canadian spouse and in Canada, same-sex marriages are legal)?
Code marital status for same-sex persons based on the legal status. For the case example above, assign code 2 [married].
Surgery of Primary Site--Lung: Is this field coded to 30 [Resection of lobe or lobectomy] or 33 [Lobectomy with mediastinal lymph node dissection] when a lobectomy specimen includes 2 AP window lymph nodes? See Discussion.
LUL lobectomy: 1.7cm apical tumor, DX=mod well diff subpleural SCC, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0.
1. No lymph node dissection or sampling was stated to be done
2. The lobectomy specimen contained the LNs
3. Scope of regional LN surgery is coded
Would the surgery to primary site code 30 or 33?
Code surgery of primary site to 30 [Resection of lobe or lobectomy]. According to the information provided, there was no lymph node dissection in this case. The 2 AP window nodes were obtained as part of the lobectomy specimen.
CS Extension--Bladder: Can the physician TNM be viewed as a clarifying statement when it provides information not documented elsewhere in medical record as in the example of a pathology report for bladder primary that demonstrates extension into bladder muscle, NOS but the physician documented TNM notes a more definitive T code for depth of muscle invasion? See Discussion.
In the Collaborative Stage manual in general instructions this guideline exists:
"The extent of disease may be described only in terms of T (tumor), N (node), and M (metastasis) characteristics. In such cases, assign the code in the appropriate field that corresponds to the TNM information. If there is a discrepancy between documentation in the medical record and the physician's assignment of TNM, the documentation takes precedence..." (Similar to language to use SEER information over TNM).
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.Yes, you may code CS extension using the physician assigned "T" when it provides information not found elsewhere in the medical record.
CS Extension--Head & Neck (Larynx): If a patient with cancer of the larynx is described as experiencing hoarseness, is that sufficient information to code "vocal cord fixation" or does that phrase need to be used?
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.
Do not code vocal cord fixation when the only information available is "hoarseness." Vocal cord fixation must be documented on endoscopy. Hoarseness is a common presenting symptom of laryngeal malignancy.
Chemotherapy: If a physician does not document the reason chemotherapy was given concurrently with radiation therapy, should it be assumed to have been used as a radiosensitizer or radioprotectant and then, per SEER chemotherapy coding instruction 2, ignore coding the chemo agent as treatment?
Do not assume that a chemo agent given with radiation therapy is a radiosensitizer. Seek additional information.
Compare the dose given to the dose normally given for treatment. When chemotherapeutic agents are used as radiosensitizers or radioprotectants, they are given at a much lower dose.
Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion.
This scenario occurs frequently and our QC staff is divided on which code to use.
03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs.
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate).
Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
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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