Sequence Number--Central/Reportability--Heme &
Lymphoid Neoplasms: Is a hematolymphoid disease included in the sequencing if it
was not reportable at the time of diagnosis?
Do not include the disease in the sequencing if the
original hematolymphoid disease was not reportable at time of diagnosis.
The 2025 SEER Manual Sequence Number--Central
Coding Instruction 1.a advises: A ‘reportable’ primary refers to the
site/histology/behavior of the tumor and the years when reporting was required.
Review of the reportability requirements in effect during the diagnosis year
will be needed.
Race/Spanish Surname or Origin: How are Race 1 and Spanish
Surname or Origin coded for the following race/ethnicity statements: "INDIGENOUS-LATINO/A
OR INDIGENOUS-LATINX" and "FIRST NATIONS"? See Discussion.
One of the largest hospital systems in our area includes "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS" as dropdown items for patients to self-select for race/ethnicity. This hospital system serves 51 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. If "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" is the only item selected with no additional text info available, how should Race 1 and Spanish Surname or Origin be coded? If "FIRST NATIONS" is the only item selected without additional text info available, should Race 1 be coded as 03?
Assign code 01 (White) for Race 1 when described as Indigenous-Latino/a or Indigenous-Latinx. Indigenous-Latinx is an umbrella term for Indigenous migrants to the United States from Latin America including South and Central America, the Caribbean, and Mexico (for example, Maya, Mixteco, Purépecha, Taino, Zapoteco, etc.). Latin America is listed in Appendix D of the 2025 SEER Manual as White.
Assign code 6 (Spanish, NOS; Hispanic, NOS; Latino, NOS) for Spanish Surname or Origin for Indigenous-Latino/a or Indigenous-Latinx in the absence of more specific information. Code 6 description includes the statement, There is evidence, other than surname or birth surname (maiden name), that the person is Hispanic but he/she cannot be assigned to any of the categories 1-5.
Assign code 03 (American Indian or Alaska Native) when described as First Nations. First Nations usually refers to Indigenous peoples for ethnic groups who are the original or earliest known inhabitants of an area. The term ‘First Nations’ can be applied to individuals, but technically refers only to those who have Indian status under Canadian law as part of a recognized community. Within Canada, the term First Nations is generally used for Indigenous peoples other than Inuit and Métis. Outside Canada, the term can refer to Indigenous Australians, U.S. tribes within the Pacific Northwest, as well as supporters of the Cascadian independence movement.
Solid Tumor Rules/Histology--Fallopian Tube: How is histology coded for a high-grade serous carcinoma with admixed yolk sac tumor of the right fallopian tube? See Discussion.
There was a single right fallopian tube tumor with two distinct morphologies. The diagnosis comment states, “The combined morphologic and immunohistochemical features are best classified as primary fallopian tube high grade serous carcinoma with a somatically derived yolk sac tumor.”
Assign high-grade serous carcinoma of the fallopian tube (8461/3). There is currently no code to capture this rare mixed histology. Yolk sac tumors rarely occur in the fallopian tubes of postmenopausal patients and are associated with poor outcome. It is important to document the findings in the appropriate text field.
Diagnostic Confirmation--Heme & Lymphoid Neoplasms: How
is Diagnostic Confirmation coded for hematopoietic and lymphoid neoplasms (heme)
when immunophenotyping, genetics, etc. confirm the diagnosis.
Assign Code 3 (Positive histology PLUS positive immunophenotyping or genetic testing) for
1. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis), AND
Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme Database, AND
Testing
Confirms
the neoplasm OR
Identifies a more specific histology (not preceded by ambiguous terminology)
Peripheral blood smear followed by flow cytometry (most commonly done with CLL/SLL, 9823/3)
2. A not otherwise specified (NOS) histology diagnosed and not a provisional diagnosis, AND genetic/immunophenotyping was performed and positive
Refer to the current version of the Heme Manual for specific notes and examples when coding Diagnostic Confirmation.
Solid Tumor Rules/Histology/Behavior--Brain and CNS: How
are histology and behavior coded when the Integrated Diagnosis is
"Meningioma, WHO Grade 2," and the Histological Classification is
"Meningioma with elevated mitotic activity, hypercellularity, necrosis,
and sheeting architecture?" See Discussion.
We are increasingly seeing pathologists use this
terminology to describe WHO G2 meningiomas, but the histology term
"Atypical meningioma" is not being used, and a more specific "Histological
Classification" of other WHO Grade 2 meningiomas (i.e., chordoid or clear
cell meningioma) is not given. Can the combination of meningioma, WHO Grade 2
plus the histological classification listing multiple features of an atypical
meningioma be used to code morphology to 9539/1? Or is this just a meningioma,
NOS 9530/0 despite the WHO Grade 2 classification?
Code meningioma, NOS (9530/0) based on the integrated diagnosis
and histological classification. WHO Classification of Central Nervous System Tumors,
5th edition, states that brain invasion is a criterion for the
diagnosis of CNS WHO grade 2 meningioma, and there is no statement of brain
invasion, atypical meningioma, or other WHO grade 2 lesions. WHO has not
proposed behavior codes based on WHO grade alone.
Reportability--Liver: Is a 2023 cholangiocarcinoma case
with Liver Imaging Reporting And Data System (LI-RADS) M (LR-M) lesion on
imaging reportable?
Report LR-M unless there is information to the contrary.
The American College of Radiology defines LR-M as "probably or definitely
malignant, not necessarily hepatocellular carcinoma (HCC)."