Radiation Therapy: How is radiation coded when it is "recommended" but the patient dies before radiation is started? See Discussion.
Code 0 seems appropriate but then we would lose the fact that it had been recommended. All of the other modalities give an option for 'recommended but patient died prior to treatment.' Is there a reason this option is not given for radiation?
Code Radiation (Rx Summ--Radiation) to 0 [None; diagnosed at autopsy].
SEER does not collect the Reason For No Radiation field. However, those who abstract using software that captures this data item can identify these cases. Code 5 [radiation not administered because patient died] reflects this situation.
Radiation (Rx Summ-Radiation) is a SEER field. This field is derived from the data collected in Rad-Boost Rx Modality and Rad-Regional TX Modality. These fields do not include a choice for "radiation not given because the patient died prior to treatment." Therefore, this information cannot be coded in the Radiation field.
Ambiguous Terminology/Date of Diagnosis: How would you code the diagnosis date when the body of an imaging report uses reportable ambiguous terminology while the final impression in that same report uses non-reportable ambiguous terminology? Would you code the diagnosis date to the date of the scan or to the subsequent biopsy date that confirmed a malignancy? See Discussion.
Within the body of a mammogram report, the radiologist stated, "diffuse inflammatory tissue throughout the rt breast w/ large rt axillary lymph nodes, consistent with an inflammatory carcinoma of rt breast." His final impression, however, said "extremely suspicious rt breast w/ extremely dense breast parenchyma and adenopathy in axilla, suggesting an inflammatory carcinoma." The patient then went on to have a biopsy, which was indeed positive for cancer.
Accept the reportable ambiguous terminology from the body of the mammogram. Record the date of the mammogram as the date of diagnosis.
The guidelines on page 4 of the 2007 SEER manual addressing discrepancies within the medical record can be applied to discrepancies within one report.
The instructions are:
If one section of the medical record(s) uses a reportable term such as
apparently and another section of the medical record(s) uses a term that is not on the reportable list, accept the reportable term and accession the case.
Reportability--Brain and CNS: Are schwannomas of the spinal cord reportable when they are intradural? See Discussion.
The CNS guidelines basically indicate that schwannomas must all come from peripheral nerves and thus are not reportable when they are on the spinal cord. However, the COC Inquiry 18174 & 18068 states that schwannomas occasionally will develop inside the dura (intradural) on the spinal cord and would be reportable.
According to an expert consultant, schwannomas must be derived from Schwann cells which are not a part of the CNS. All schwannomas come from peripheral nerves. Benign and borderline tumors of the peripheral nerves (C47_), including peripheral nerves along the spinal cord, are not reportable.
MP/H Rules--Bladder: Does rule M6 mean that any combination of tumors with the histologies 8050, 8120-8124, or 8130-8131 are the same primary regardless of the amount of time between tumor occurrences? See Discussion.
Many interpret Rule M7 to mean when separate occurrences of TCC of the bladder are diagnosed more than 3 years apart, it is reportable as a second primary. However, doesn't Rule M6 mean that if the histology is any combination of 8050, 8120-8124 or 8130-8131 for tumors diagnosed more than 3 years apart, they are reported as a single primary?
For cases diagnosed 2007 or later:
Papillary, transitional cell and/or papillary transitional cell carcinomas of the bladder are a single primary using Rule M6. Rule M6 includes diagnoses within 3 years of each other AND diagnoses more than three years apart for the histologies listed. If rule M6 applies to your case, stop. Do not continue on to Rule M7.
Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007?
For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists
For cases diagnosed 2007-2014, 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.
MP/H Rules/Histology--Breast: Which report and diagnosis should be used to code the histology if an excisional biopsy that removes the majority of the tumor has a diagnosis of "carcinoma," and the subsequent lumpectomy diagnosis is "microscopic residual disease consistent with infiltrating duct carcinoma"?
For cases diagnosed 2007 or later, code histology for this case to 8010 [carcinoma]. The histology is coded from the pathology report with the most representative specimen (the most tumor tissue) even when the most representative specimen has a less specific histology.
Reportability/Diagnostic Confirmation: If a diagnosis based solely on positive flow cytometry is reportable even if a bone marrow biopsy is negative, how is diagnostic confirmation coded?
For cases diagnosed prior to 2010
The case is reportable if a recognized medical practitioner says the patient has cancer.
A flow cytometry alone is not diagnostic but it may be supported by either a positive bone marrow or a clinician's statement. If the clinicians statement is based only on flow cytometry, code diagnostic confirmation to 8 [Clinical diagnosis only].
Multiplicity Counter/Type of Multiple Tumors--Breast: How are these data items coded for a single breast primary composed of both in situ and invasive disease when measurements are provided for both the invasive and in insitu components? See Discussion.
Breast cancer, invasive duct carcinoma with DCIS, 1.3 cm, DCIS 3.7 cm. "The in situ carcinoma is very extensive in this lumpectomy. It is present contiguously from sides 1A through 1L sparing only the final 8 mm of medial margin. In situ and invasive carcinoma are prominently present along almost the entire superior margin." Is the mult counter 02 with Type of mult tumor 30, or one tumor?
Because there are individual measurements for each of these tumors, code the multiplicity counter 02 [Two tumors present]. Code Type of Multiple Tumor as 30 [In situ and invasive].
MP/H Rules--Ovary: Rule M7 states bilateral epithelial tumors (8000-8799) are reportable as a single primary. Are bilateral germ cell tumors of the ovary (e.g., dysgerminoma (9060/3)) that occur simultaneously now reported as two primaries?
For cases diagnosed 2007 or later, rule M7 applies to ovarian epithelial tumors with ICD-O-3 histology codes between 8000 and 8799. Rule M7 does not apply to dysgerminoma which is coded to 9060. Go on to the next rule, M8 and abstract as multiple primaries, left and right.
Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"?
For cases diagnosed prior to 1/1/2010:
The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source.
See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas.
For cases diagnosed 1/1/10 and later, 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.