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Report Produced: 01/26/2023 19:40 PM

Report Question ID Question Discussion Answer (Ascending)
20091118 Surgery of Primary Site--Corpus uteri: How are the surgery fields to be coded when patient undergoes hysterectomy and omentectomy for endometrial primary? See Discussion.

The example for instruction 6 in the 2007 SEER manual on page 179 (for surgery of primary site) states "code an en bloc removal when the patient has a hysterectomy and an omentectomy." There is no Site-Specific Surgery code for corpus uteri that combines hysterectomy with omentectomy. Is the information about removal of the omentum lost or is it documented under Surgical Procedure of Other Site?

Use the most appropriate code in the "Surgery of Primary Site field." Do not code the omentectomy in "Surgical Procedure of Other Site" when it is performed with a hysterectomy for an endometrial primary.
20110093 Residence at dx: After living elsewhere (Florida) and traveling around the country in an RV with his spouse, is a patient considered a resident of this area for either primary if he was diagnosed with his first primary less than a month after arriving in the area and a second primary more than a year after parking his RV here? Use the patient's usual residence to determine residency. If the usual residence is not known or the information is not available, use the residence the patient specifies at the time of diagnosis. The SEER rules for determining "usual residence" match the rules used by the US Census Bureau.
20061108 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).
20110074 First course treatment/Date therapy initiated--Breast: How is the Date of Initiation of Hormone Therapy field coded when a patient undergoes "Tamoxifen blunting" to achieve better MRI imaging after a biopsy but prior to definitive surgery which is followed by adjuvant Tamoxifen therapy? See Discussion. Patients are prescribed two weeks of "Tamoxifen blunting" to achieve better MRI imaging after biopsy confirmation of an ER/PR positive breast carcinoma. The Tamoxifen is subsequently discontinued and the patient has definitive surgery. Following surgery, maintenance Tamoxifen is initiated. Which date should be recorded for the Date of Initiation of Hormone Therapy field? Is it the first date when Tamoxifen blunting started or the post-surgical date when maintenance Tamoxifen is initiated? Use the post-surgical start date of maintenance Tamoxifen to code the Date of Initiation of Hormone Therapy field. The actual hormone treatment begins after surgery when Tamoxifen blunting was performed. The low dose administered prior to surgery does not affect the cancer.
20091112 Grade-Breast: How is this field coded for a breast tumor described as "intermediate nuclear grade"? See Discussion.

Guidelines for selecting grade for breast primaries prioritize nuclear grade right after B&R grade. The conversion table displays only numeric values for nuclear grade. How is grade coded for tumors in which nuclear grade is described by terminology? Does it make a difference if the tumor is invasive or in situ?

Example 1: Ductal carcinoma, intermediate nuclear grade.

Example 2: Ductal carcinoma, high nuclear grade.

Example 3: Ductal carcinoma, moderate nuclear grade.

Example 4: DCIS, intermediate nuclear grade.

Use the table on page C-607 of the 2007 SEER manual. The terms "low," "intermediate," and "high" appear in the column labeled "BR Grade." Use this column to determine the appropriate grade code when grade is described using these terms. If the grade of an in situ tumor is described using these terms, use the table to determine the appropriate code for the grade field.
20140009 Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets. We recommend C490 for a primary originating in the parapharyngeal space. This space contains part of the parotid gland, adipose tissue, lymph nodes, nerves, arteries and veins.
20100061 MP/H Rules/Histology: The 2010 SEER Manual has omitted some useful information in the Histologic Type ICD-O-3 section, specifically the statement of "Do not revise or update the histology code based on subsequent recurrence(s)". Will this statement be added to the revisions of the MPH rules? See Discussion. Example: A 2005 diagnosis of left breast lobular carcinoma [8520/3], followed by a 2009 diagnosis of left breast ductal carcinoma [8500/3]. Rule M10 states this is a single primary, but there is no information in the Histology rules (Multiple Tumors Abstracted as a Single Primary) that the original histology should be retained, thus a person could potentially use these rules to change the original histology to 8522/3 [duct and lobular carcinoma] per rule H28. We will reinstate the instruction not to change the histology code based on recurrence in future versions of the histology coding instructions. However, this instruction may not be applicable to all anatomic sites. It will be reinstated on a site-by-site basis. You may also refer to the instructions on Page 7 of the 2010 SEER Manual under the heading "Changing Information on the Abstract."
20041018 Grade, Differentiation: Can grade be assigned based on a thin prep if there is no grade in the other pathology reports? See Discussion.


Vag & Cervical Thin-Prep: Adenocarcinoma, endometrial, high grade.

Resected Uterus and Left Adnexa: Endometrial papillary serous carcinoma arising in an endometrial polyp.

When it is the only source specifying the grade, code grade from the thin prep.
20051062 Surgery of Primary Site--Prostate: How is the use of a Laserscope Niagara laser (modulated KTP-YAG laser beam (Niagara 122 prostate vaporization)) coded for prostate primaries? See Discussion. The Laserscope Niagara laser performs an operation similar to the TURP, but there is virtually no bleeding and patients can sometimes go home the same day, most without a catheter. The laser is delivered through a fiber (the thickness of hair) into the cavity via an endoscope inserted through the urethra. When performed as part of the first course of therapy, assign surgery code 15 [Laser ablation] to Niagara laser photovaporization of the prostate.
20041099 First Course Treatment: If a patient makes a blanket refusal of all recommended therapy or refuses all treatment before any therapy was recommended, are only immunotherapy and hematologic/endocrine therapies to be coded as refused (code 87)? Or should all treatment modalities be coded as refused if a patient makes a blanket refusal? Or should none of the treatment modalities be coded as refused because we do not know what would have been recommended? See Discussion. Coding instructions for immunotherapy and for hematologic/endocrine procedures state that Code 87 is to be assigned if either of the following circumstances apply: 1) If the patient made a blanket refusal of all recommended treatment. 2) If the patient refused all treatment before any was recommended. These instructions are not included for other treatment modalities. When the patient refuses treatment, the first course of therapy is no treatment. Code all treatments as refused.