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.
Reportability/Behavior--Hematopoietic, NOS: Is a "myelodysplastic/myeloproliferative disease, unclassifiable" coded to 9975 with a behavior code of 3 as indicated in the WHO blue book on "Tumours of Haematopoietic and Lymphoid Tissues" or is it not abstracted because it has a behavior code of 1 which means the case is not reportable?
For cases diagnosed prior to 1/1/2010:Code MDS/MPD U to 9975/3 [Myelodysplastic/myeloproliferative disease, unclassifiable]. Change the behavior code to /3 according to ICD-O-3 Rule F. The case is reportable.
The WHO book is more recent and gives a specific code for this new hybrid category of the WHO/REAL classification.
For cases diagnosed 2010 forward, 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.
CS Extension--Bladder: How is extension coded if the bladder tumor involves the right ureter per cystoscopy but the TURB specimen demonstrates muscularis propria invasion?
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 extension based on the area of deepest invasion. According to the TNM Supplement, which was used as a resource in the development of CS, "Direct invasion of the distal ureter is classified by the depth of greatest invasion in any of the involved organs." Record the greatest extent of disease using both clinical and operative/pathologic assessment.
Histology (Pre-2007)--Lung: How is a poorly differentiated non-small cell carcinoma with "squamoid differentiation" coded?
For tumors diagnosed prior to 2007:
Squamoid and squamous are synonymous. Squamoid is non-standard terminology. It means "squamous like" and is a synonym of squamous.
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.
CS Site Specific Factor--Colon: If the patient has a polypectomy followed by definitive surgery, can a higher CEA reported after the polypectomy but before the colon resection be coded?
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.If the tumor was in the polyp, do not use the post-polypectomy CEA even if it is higher than CEA's prior to the polypectomy. In this situation, the polypectomy would be treatment.
Conversely, if this is a frank adenocarcinoma or the tumor was so invasive that the polyp removed only a portion, use the post-polypectomy CEA because the polypectomy would not be treatment in this situation.
CS Extension--Lung: If only a "single" cytology is performed on pericardial fluid and it is negative, can Note 6 B, which states that pleural effusion [code 72] is coded as malignant unless there are "multiple" negative cytologies, be used to infer that the pericardial fluid should also be coded as involvement?
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.
No, do not apply the instructions for pleural effusion to pericardial effusion. Do not code a pericardial effusion proven negative by cytology in CS Extension.
CS Extension/CS Mets: For primary sites within the peritoneum (abdominalpelvic walls) such as stomach, colon, does the presence of malignant ascites affect the coding of CS Extension or CS Mets?
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 Collaborative Staging system is governed by site-specific coding rules. Refer to each set of site rules rather than looking for a general answer for all sites in peritoneum. In particular, Ovary and Corpus allow malignant ascites to be coded in CS Extension, but not CS Mets at Dx. For each site, both CS Extension and CS Mets at Dx should be checked for the proper field to code malignant ascites.
Reportability--Lymphoma: Is a lymphoma diagnosed on a bone marrow biopsy reportable if the cytogenetics evaluation performed does not confirm the malignancy? See Discussion.
Bone marrow Bx: Marginal zone lymphoma/leukemia. The morphology of the lymphoma/leukemia cells and the immunophenotypic characteristics identified by flow cytometry are consistent with marginal zone lymphoma/leukemia.
Addendum Report: Cytogenetic evaluation revealed a 46,XY male karyotype. This is the normal male chromosome karyotype. Based on the limits of this methodology, no evidence of hematologic malignancy was observed in this specimen.
For cases diagnosed prior to 1/1/2010:
Yes, this case is reportable. The cytogenetic evaluation cited in the addendum report does not disprove the bone marrow biopsy diagnosis.
For cases diagnosed 2010 forward, 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.
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
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