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SEER Inquiry System - Report
Produced: 04/03/2025 10:10 PM
Question 20110150
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
The physician states the "patient's clinical picture certainly is most consistent with MDS." Several FISH probes were performed on peripheral blood, specifically looking for the 5q minus syndrome as well as other molecular rearrangements to suggest or confirm MDS. These studies came back as normal. The initial bone marrow also came back negative. The physician then states, "The suspicion was that this represented a myelodysplastic syndrome despite the normal cytogenetics. Additional studies performed on the date of the clinic visit included the FISH for the 5q minus syndrome as well as CD59 to exclude PNH. Both of these were negative. Therefore, at this juncture, the patient has a macrocytic anemia not yet requiring transfusion support with a normal white count and an elevated platelet count and a hypercellular bone marrow. This is certainly consistent with a myelodysplastic syndrome."
Per coding guidelines, ambiguous terminology is not used to code histology, only for reportability. What is the histology code for this case?
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology as Myelodysplastic syndrome, unclassifiable [9989/3].
Ambiguous terminology is used to accession cases (determine reportability). While ambiguous terminology is generally not used to code a specific histology, it can be used to code histology if it is the .
The statement that you do not use ambiguous terms to code histology is intended for those NOS histologies with an ambiguous term being used to describe the subtype. For example, if the physician states this is a myelodysplastic syndrome, NOS, refractory thrombocytopenia. The correct histology would be MDS, NOS [9989/3] and not refractory thrombocytopenia [9992/3].
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. https://educate.fhcrc.org/LandingPage.aspx.
History:
This SINQ question has been updated to the Hematopoietic & Lymphoid Neoplasm Manual & Database published January 2014.
The original answer below was written based on the rules in 2010
For cases diagnosed 2010-2011, access the Hematopoietic Database at
http://seer.cancer.gov/tools/heme/.
Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. For 2010-2011 diagnoses, click on the "use the 2010 database" label in the upper right corner of the screen. The 2010 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.
Code the histology as Myelodysplastic syndrome, unclassifiable [9989/3]. The steps used to arrive at this decision are:
Enter in the Heme DB to find the histology. Click on the SEARCH button. Ensure that the term "myelodysplastic syndrome, unclassifiable" [9989/3] is highlighted on the screen.
Scroll down to the ABSTRACTOR NOTE section which indicates that this is a clinical diagnosis. When the testing has excluded other diseases the physician uses the information from the equivocal test results plus the patient's clinical history to make a diagnosis of MDS. Also note that in the DEFINITIVE DIAGNOSTIC METHODS section it indicates that a clinical diagnosis is the definitive diagnostic method for MDS. This is often a diagnosis of exclusion meaning that the tests are not positive for any other neoplasms. The physician uses his/her expertise to evaluate the clinical presentation as well as the equivocal and negative test results and determines a diagnosis of MDS, NOS.
The statement that you do not use ambiguous terms to code histology is intended for those NOS histologies with an ambiguous term being used to describe the subtype. For example, the physician states this is a myelodysplastic syndrome, NOS, probably refractory thrombocytopenia. The correct histology would be MDS, NOS [9989/3] and not refractory thrombocytopenia [9992/3].
