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Report Produced: 03/26/2023 07:46 AM

Report Question ID Question Discussion (Descending) Answer
20031036 Histology--Hematopoietic, NOS: When both the path and clinical diagnoses simultaneously reflect reportable diagnoses but one is a worse form of the same disease process, which diagnosis do we code? See Description. Would this case be coded to RAEB or AML? Bone marrow diagnosis: Hypercellular marrow with profound trilinieage dyspoietic changes. Comment: the features are consistent with RAEB. Clinical diagnosis five days later states: Myelodysplastic syndrome, early acute myelocytic leukemia (likely AML).

For cases diagnosed prior to 1/1/2010:When several diagnoses are made as part of the diagnostic process within two months, code the one with the worst prognosis.

Code the case example as acute myelocytic leukemia.

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.

20010095 EOD-Extension--Lung: Are "aortico-pulmonary window", "paratracheal space", and "subcarina" coded in the EOD extension field or in the EOD lymph node involvement field? See discussion. Would a lung tumor that extends into the AP window be synonymous with extension into the mediastinum? If so, would this also apply to extension to subcarina, paratracheal space, and other such terms corresponding to areas listed in the mediastinal lymph node field under code 2?

For cases diagnosed between 1998-2003:

Extension into the aortico-pulmonary window, would be coded in the EOD-Extension field as 70 [mediastinal extension]. If the tumor extends into the paratracheal space, subcarina, or other areas listed under the code 2 in lymph nodes, code the EOD-Extension field to 70 to capture this type of involvement.

20071114 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.


EOD-Size of Primary Tumor: Should a 2.0 cm ulcerated mass be coded to 020 or 999 for tumor size? See discussion.

With regard to tumor size, how would SEER interpret "2.0 cm ulcerated mass"? Should this be interpreted as an ulcer, or is it a gross description of the appearance of a mass and therefore acceptable to code tumor size to it?

For cases diagnosed 1998-2003:

If this ulcerated mass is pathologically confirmed to be malignant, code the EOD-Size of Primary Tumor field to 020 [2.0 cm] based on the size of this mass in the absence of a more precise tumor size description.

20100062 MP/H Rules/Histology--Lung: How is histology coded when there is a lung biopsy compatible with non-small cell carcinoma and regional lymph node biopsies compatible with adenocarcinoma? See Discussion. Which histology has priority when the pathology specimens reveal different histologies in the primary site and the regional lymph node? Do we assume the lung biopsy is the most representative tumor specimen because it is from the primary site and code to 8046 [non-small cell carcinoma] or should we use rule H5 and code to 8140 [adenocarcinoma, NOS] because adenocarcinoma is a more specific histology than non-small cell carcinoma? For cases diagnosed 2007 or later, code histology based on a pathology report from the primary site whenever possible. Code histology to 8046/3 [non-small cell carcinoma] for the case example provided.
20010136 Reason no treatment/Surgery of Primary Site: Does the "Reason for No Cancer-Directed Therapy" field only relate to the "Surgery of Primary Site" field? If so, for what diagnosis years is that effective? Have SEER's coding guidelines changed over time? See discussion. Whenever a surgical procedure is performed that results in a non 0 or 9 code in any one of the Surgery fields, should the Reason for No Site-Specific Surgery field be coded to 0 [Cancer-directed surgery performed]? For cases diagnosed 2003 and forward: The field "Reason for No Surgery of Primary Site" applies only to surgery of primary site. This is a change from the pre-2003 instructions.
20130014 Reportability--Heme & Lymphoid Neoplasms: Is Castleman disease reportable when diagnosed 2010 and later? When checking Castleman disease in the Hematopoietic Database, the result is a reportable histology code 9738/3. However, per an online search, Castleman disease is a very rare disorder characterized by non-cancerous growths (tumors).

For cases diagnosed 2010 and forward, access the Hematopoietic Database at

Castleman disease, NOS, is not reportable for cases diagnosed 2010 and later. However, when Castleman disease is diagnosed in connection with large B-cell lymphoma [9738/3], it is reportable.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided.

20010131 Histology (Pre-2007): Can adenocarcinoma in either a villous or tubulovillous polyp or adenoma be coded as histology for sites other than colon or rectum? See discussion. When adenocarcinoma of the endometrium arises in a villoglandular polyp is the histology coded as 8263/3?

For tumors diagnosed prior to 2007:

Code the Histology field to 8263/3 [adenocarcinoma in a tubulovillous adenoma]. Histology codes 8261 [adenocarcinoma in a villous adenoma] and 8263 [adenocarcinoma in a tubulovillous adenoma] are used for non-colorectal sites when the cancer arises in a polyp.

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.

20051077 First Course Treatment--Unknown & ill-defined site: We have a case with an unknown primary site and the patient had chemoembolization into the hepatic artery. We don't know how to code this treatment. See Discussion. We were told to code as surgery (10) and chemo (01). However an unknown primary automatically gets a (98) surgery code & the chemo is coded (01) but we can't code as systemic therapy. This is an edit. Chemo coded but no date of systemic therapy.

Effective for cases coded prior to the change in policy made on January 9, 2008, code chemoembolization of a metastatic site as 1 [nonprimary surgical procedure performed] in Surgical Procedure of Other Site.

Surgery of Primary Site code 98 is assigned to all cases with an unknown primary.

In the case of a liver primary, it would be coded 10 [local tumor destruction, NOS] in Surgical Procedure of Primary Site.

20081018 CS Tumor Size: Is a 5.5 mm tumor coded as 005 or 006? See Discussion. We interpret the CS Manual general instructions to indicate to ONLY round up to 001 when the tumor size is stated to be 0.1 to 0.9mm.

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 tumor size 006. Because only whole numbers in mm can be collected, basic mathematical principles are used for rounding; 1-4 round down, 5-9 round up.