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20140062 | MP/H Rules/Multiple Primaries--Lung: Does lung MP/H Rule M6 apply to synchronous tumors only, metachronous tumors only, or both? See discussion. |
How many primaries should be reported when a patient has a history of RLL adenocarcinoma diagnosed on 10/8/2009 followed by diagnoses of LUL adenocarcinoma on 10/5/2012 and a RUL adenocarcinoma on 3/26/2014?
We applied Rule M6 to the 10/5/2012 diagnosis of LUL adenocarcinoma and reported an additional primary. However, we are unsure how to apply the MP/H rules for the 3/26/2014 RUL adenocarcinoma.
Should we apply Rule M8 because the RUL adenocarcinoma was diagnosed more than 3 years after the original RLL adenocarcinoma and then apply M6 because the RUL and LUL indicate a single tumor in each lung (resulting in a third primary); or does Rule M12 apply because there has been more than a single tumor in each lung (no new primary)? |
Assuming each of the three diagnoses is a single tumor and there are no other tumors in either lung, abstract two primaries: 1 in the RLL diagnosed on 10/8/2009 and 1 in the LUL diagnosed on 10/5/2012. Do not abstract the 3/26/2014 diagnosis as a new primary.
Rule M6 applies to the 2009 and 2012 diagnoses. Rule M12 applies to the 2012 and 2014 diagnoses. Do not compare the 2014 diagnosis to the 2009 diagnosis. Always compare the latest diagnosis to the most recent previous diagnosis in cases like this. |
2014 |
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20200064 | Primary site--Heme &Lymphoid Neoplasms: What is the primary site of two extraosseous plasmacytomas, with positive pathology of right orbit and left lung. The patient's bone marrow biopsy, flow, and peripheral blood smear were negative. Is this coded as 9732/3, multiple myeloma (Primary Site and Histology Rule PH2) with the primary site as C809 (PH27)? Or is the primary site C421 since code 9732 says primary site is always C421, though bone marrow came back as negative? |
Assign the primary site to C421 since that is the only allowable primary site for plasma cell myeloma, even though the bone marrow was negative. According to the revised criteria from the WHO Blue Book for Hematopoietic and Lymphoid Neoplasms (2017), the presence of multiple plasmacytomas is plasma cell myeloma (9732/3). |
2020 | |
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20210078 | Solid Tumor Rules (2018/2021)/Multiple Primaries--Skin Cancer: How many primaries are assigned for sebaceous carcinomas using the Solid Tumor/Multiple Primaries/Histology Rules? Does this scenario represent eight separate primaries? See Discussion. |
Details 4/15/2018: Right abdominal wall mass excision: infiltrating sebaceous carcinoma. Noted to have a history of Muir-Torre/Lynch syndrome. 1/21/2019: Two left upper back mass excisions and two lower back (laterality not specified) mass excisions: infiltrating sebaceous carcinomas 8/7/2019: Excision of multiple sebaceous carcinomas from the right posterior back, left posterior thigh, left anterior abdominal wall, left anterior thigh, right scrotum, right lower abdominal fold, all positive for sebaceous carcinoma on pathology report 9/30/2020: Right gluteal mass, left gluteal mass, back (NOS) excisions: sebaceous carcinomas. 10/14/2020: Right back excision: sebaceous carcinoma. Op note: History of Lynch syndrome with multiple sebaceous carcinomas, recurrent back mass, site of prior mass resection. 10/18/2021: Right thigh excision: sebaceous carcinoma Proposed primaries using MP/H Other Sites Rules #1: 4/15/2018: C445-1 #2: 1/21/2019: C445-2, separate from #1 per M8, same as 1/21/19 C445-9 per M18 #3: 8/7/2019: C445-1, separate from #1 per M10, separate from #2 per M8 #4: 8/7/2019: C447-2, separate from #1 & #3 per M8, separate from #2 per M12 #5: 8/7/2019: C632, separate from #1 per M10, separate from #2-#4 per M11 #6: 9/30/2020: C445-2, separate from #1 & #3 per M8, separate from #2, #4 & #5 per M10 #7: 9/30/2020: C445-1, separate from #2, #4 & #6 per M8, separate from #1, #3 & #5 per M10; I do not think the back, NOS (C445-9) is a new primary per M18. #8: 10/18/2021: C447-1, separate from #2, #4 & #6 per M8, separate from #1, #3, #5 & #7 per M10 |
Assign the number of primaries following the Other Sites Solid Tumor Rules. Based on sites, laterality and or timing there are 8 primaries. This is similar to SINQ 20061112 that advised to follow the Multiple Primaries/Histology rules for sebaceous carcinoma. According to the WHO Classification of Skin Tumors, 5th edition, there is a 30-40% risk of local tumor recurrence, and 20-25% risk of distant metastasis. In only one instance did a physician refer this as a recurrence in the available notes. |
2021 |
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20210074 | Update to Current Manual/Neoadjuvant Therapy--Pancreas: How are the neoadjuvant items coded for a patient who has unresectable pancreatic cancer and starts chemotherapy but will be evaluated after X cycles to see if patient may become a surgical candidate? |
Assign the neoadjuvant therapy data items as if the patient had neoadjuvant therapy. Neoadjuvant Therapy data item would be coded either code 1 or 2 depending on whether the chemotherapy was completed or not. In this case, they are a surgical candidate by having the chemotherapy with the plan from the beginning to evaluate the chemotherapy after X cycles to see if surgery can be performed. After the patient is evaluated, update the abstract as needed. |
2021 | |
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20240059 | Update to the Current Manual/SEER*RSA--SEER Site-specific Factor 1: The 2024 SEER Manual and SEER*RSA say that Codes 10-51 are hierarchical; use the highest code that applies (10 is highest, 51 is lowest). Should the guidance say that 51 is highest, 10 is lowest since code 10 is a HPV negative p16 test? |
Assign the highest code with 51 as the highest and 10 the lowest when there is more than one test performed with differing results. The SEER Manual will be updated in the 2025 release. SEER*RSA will be updated in a future release, version 3.3 in 2026, as version 3.2 has been updated for 2025. |
2024 | |
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20190068 | First course treatment/Scope of Reg LN Surgery--Breast: How is Scope of Regional Lymph Node Surgery coded when the operative report does not agree with the actual number and type of nodes removed? Are we attempting to capture the intended surgery or the type and number of nodes removed? See Discussion. |
Example 1: Operative report states the surgery is a right breast simple mastectomy. There is no lymph node removal documented or attempted; however, a single incidental intramammary node is found in the final pathology results. How should these nodes be captured in the Scope of Regional Lymph Node Surgery field? CAnswer Forum states to code Scope of Regional Lymph Node Surgery as 0 (No regional lymph nodes removed), see Scope LN surgery, incidental LN found on path, Breast. However, SEER Program Coding and Staging Manual 2018 instruction states: Code the removal of intra-organ lymph nodes in Scope of Regional Lymph Node Surgery. Example: Local excision of breast cancer. Specimen includes an intra-mammary lymph node. Assign code 4 (1 to 3 regional lymph nodes removed). The STORE 2018 Manual does not provide instruction for incidental nodes specifically, but does appear to be focused on capturing procedural intent. Example 2: Patient has bilateral breast primaries. Operative report states the surgery is bilateral simple/skin-sparing mastectomies with bilateral sentinel node biopsies and immediate reconstruction. However, pathology shows that the left breast specimens are labeled: (a) Left breast mastectomy, (b) Left sentinel lymph node biopsy, (c) Additional left lymph nodes biopsy, and (d) Left axillary contents biopsy. The total nodes removed for this case are: 2/2 positive SLN, 0/1 positive intramammary nodes, 1/1 positive additional lymph node, and 3/3 positive axillary contents nodes. How should these nodes be captured in the Scope of Regional Lymph Node Surgery field? |
Assign the best code in Scope of Regional Lymph Node Surgery to capture the type and number of nodes removed. Example 1: Code 4; 1 to 3 regional lymph nodes removed. There is no statement of the procedure being a SLNBx or dissection in the operative report; the pathology report identified one incidental regional lymph node. Coding instruction #4 example says to assign code 4 if there is a local excision of breast cancer and specimen includes an intra-mammary lymph node. Example 2: Code 6, Sentinel node biopsy and code 3, 4, or 5 at same time or timing not noted. The operative report describes sentinel node biopsies only and does not mention axillary lymph node dissection; however, the pathology report details other lymph nodes in addition to the SLNBx. In addition to the LSLNbx and left LN bx, the pathology report describes "Left axillary contents biopsy" and a total of seven lymph nodes removed. |
2019 |
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20150042 | Surgery of Primary Site--Breast: Is the surgery code 42 or 52? Does it matter that the procedure states no axillary LN, but the pathology found 2 additional LN? See discussion.
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Procedure stated = Bilateral skin-sparing mastectomies, left axillary sentinel lymph node biopsy. On the pathology report it indicates two additional lymph nodes were removed that were not SLN. The axillary aspect measures 2 x 2 x 1 cm. Two lymph nodes are identified ranging from 0.5 up to 1 cm. The lymph nodes are bisected and entirely submitted. Final Diagnosis Left breast, mastectomy including nipple: no residual carcinoma; FINAL DIAGNOSIS for LN = Lymph nodes, left axillary sentinel #1; excision: Two lymph nodes examined - negative for tumor (0/2); Two lymph nodes - negative for tumor (0/2) |
Assign surgery of primary site code 42. It is possible to obtain lymph nodes in a mastectomy specimen without an axillary dissection. Remember to capture the excised lymph nodes in the scope of lymph node surgery field. |
2015 |
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20210011 | Primary site: Is C720 the correct primary site for a diagnosis of a paraspinal neuroblastoma on autopsy in a nine month old with Noonan syndrome? See Discussion. |
Autopsy/Pathology Report (2020) excerpts External Examination Nervous System: There is an 8.5 cm mass located in the right thoracic paraspinal area. Final Anatomic Diagnosis Clinical History: Paraspinal mass suspicious for neuroblastic tumor (detected by imaging studies) Nervous System: Right thoracic paraspinal neuroblastoma, poorly differentiated |
Assign primary site code C473 for this case based on the information provided (peripheral nerves and autonomic nervous system of thorax). From our expert pathologist consultant: The origin of neuroblastomas is generally in the adrenal medulla or one of the sympathetic ganglia on either side of the vertebral column (although they have been reported in many other locations given the migration of the neural crest cells embryologically). |
2021 |
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20150025 | Primary Site--Lung: What are the guidelines for coding primary site when a lung tumor is described as a hilar mass? See discussion. |
At a recent meeting, one registry stated that they apply the following guidelines. 1) If the tumor is described as a hilar mass and there is no mention of LN involvement, Primary Site is coded to hilum (C340) 2) If there is LN involvement along with the mention of a hilar mass, then Primary Site is coded to C349 |
Assign primary site code C340 when a lung tumor is described as a hilar mass. |
2015 |
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20230078 | Primary Site/Heme & Lymphoid Neoplasms--CLL/SLL: Should the primary site be coded C421 (bone marrow) for a diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) when the managing physician provides a Rai stage? See Discussion. |
The patient has adenopathy and a lymph node biopsy proved CLL/SLL. The patient underwent a peripheral blood smear, but the final diagnosis only indicated there is an abnormal CLL panel, positive for monoallelic or biallelic deletion of 13q. The pathologist noted a CLL related clone was detected, but there was no definitive diagnosis of CLL on the peripheral blood. No bone marrow biopsy was performed. However, the managing physician noted this was Rai Stage I CLL/SLL with adenopathy in the neck. The SSDI Manual notes, “Rai stage is only applicable for CLL, in which the bone marrow and/or peripheral blood are involved (primary site C421 for bone marrow, see Hematopoietic Manual, Module 3: PH 5, 6).” Should primary site default to C421 if the physician provides a Rai Stage in the absence of definitive peripheral blood or bone marrow involvement documented in the medical record? |
Assign primary site C421. The Site-Specific Data item (SSDI) Manual, Rai Classification section, states: Per confirmation from medical oncologists, Rai stage is only recorded for patients who have bone marrow and/or peripheral blood involvement. Per the Hematopoietic Rules, primary site would be C421 (See Hematopoietic Manual, Module 3: Rules PH 5, 6). A new code has been added to the 5 SSDIs (code 5) to use when primary site is not C421. |
2023 |
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