#1: Date of diagnosis
Source 1: 2018 SEER Manual
pgs: 10, 83
Date of diagnosis: The 2018 SEER Manual confirms the date of a suspicious cytology may be used to code the date of diagnosis when there is a subsequent definitive biopsy. Does this new instruction apply if the definitive biopsy or resection is performed 6 months following the suspicious cytology? See Discussion.
The example provided in the 2018 SEER Manual states, Cytology suspicious for malignancy 01/12/2018. Diagnosis of carcinoma per biopsy on 02/06/2018. Record 01/12/2018 as the date of diagnosis. In this example, it is clear that a malignancy was suspected, so a diagnostic procedure was repeated within a few weeks.
Does this new rule apply to the following case? Patient underwent a thyroid fine needle aspirate (FNA) on 11/09/2017 that was suspicious for carcinoma. No further biopsy was done and the patient did not undergo a resection until 05/21/2018 that definitively proved papillary thyroid carcinoma. The clinical indication noted on the resection path was goiter with no mention of malignancy. Should the diagnosis date be 11/09/2017 or 05/21/2018?
Should a time parameter be established for this rule that indicates if the definitive biopsy (or resection) occurs X number of days or months subsequent to the suspicious cytology, to code the date of diagnosis to the date of definitive biopsy rather than the date of the suspicious cytology? If such a guideline is not added, won’t there be cases that appear to have a treatment delay when, in fact, there was not really a diagnosis of a reportable disease process until much later?
Do not use the date of the suspicious cytology as the date of diagnosis for the example you provide.
If the physicians do not act on the suspicious cytology resutls, do not use the date of the suspicious cytology as the date of diagnosis when there is a later definitive diagnosis. If the physicians recommend further workup, but the patient does not comply, use the date of the suspicious cytology when there is a later definitive diagnosis. We will add examples to the 2018 SEER manual to illustrate these points.