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20031052 | Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description. |
Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)? |
Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias. |
2003 |
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20031100 | Date of diagnosis: Can a positive VMA:HVA test be used as a date of diagnosis for neuroblastoma? See Description. |
Rubin's Clinical Oncology states: Both the catecholamines and their metabolites are used as markers for neuroblastoma, with vanillylmandelic acid (VMA) and homovanillic acid (HVA) being the most commonly used. While their absolute values are not of prognostic significance, a higher VMA:HVA ratio suggests a better prognosis for patients with disseminated disease. |
Updated answer July 2024 No. Do not code the neuroblastoma diagnosis date from only the date of an elevated urine catecholamine test (VMA or HVA). Neuroblastoma diagnosis should be made on the basis of tissue biopsy or bone marrow aspiration along with elevated urinary catecholamines. Elevated urinary catecholamines alone are not diagnostic of neuroblastoma. |
2003 |
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20180109 | Date of diagnosis/Ambiguous terminology--Cervix Uteri: Is the date of diagnosis of a cervical pap smear done in December 2017, that states high-grade squamous intraepithelial lesion with features suspicious for invasion, followed by a cervical biopsy in 2018 positive for squamous cell carcinoma, in 2017? Is the ambiguous term used in the cytology in 2017 (suspicious for invasion) to determine diagnosis as the SEER manual states to use the ambiguous cytology as the date of diagnosis if confirmed later. |
Updated for cases diagnosed 2022 or later For cases diagnosed in 2022 or later, see the instructions in the SEER manual under Reportability and Date of Diagnosis for ambiguous cytology. |
2018 | |
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20150027 | Date of diagnosis--Diagnostic confirmation: How are the diagnosis date and diagnostic confirmation coded when the pathology (needle biopsy followed by resection) reports GIST, NOS and the physician subsequently states this is a malignant GIST and treats the patient for a malignancy? See Discussion. |
Pathologists rarely diagnose a GIST as a malignant tumor. Per the AJCC, GISTs encompass a continuum in terms of biologic potential, with larger more mitotically active tumors landing on the "histologically sarcomatous" or malignant end of the spectrum. Because the pathologists generally do not categorize these tumors as benign or malignant, the judgement is typically made by the clinician in light of all the clinical and pathologic findings. Unless there are obvious distant metastases, the clinician usually decides whether a GIST is malignant and treats the patient as such.
In the case above, the patient underwent a gastric biopsy on 04/10/2014 that showed GIST. The subsequent resection on 04/12/2014 showed a 4.5 cm GIST, spindle cell type with 6 mitoses/5 square mm. The resection pathology report does not indicate the GIST is malignant, but does identify a large tumor with mitotic activity. After reviewing the evidence in this case, the clinician calls this a malignant GIST on 04/29/2014 and starts the patient on Gleevec.
Although neither the biopsy nor the resection call this a malignant tumor, should the date the GIST was first diagnosed (biopsy on 04/10/2014) be used to code the diagnosis date, since this is the date the tumor (ultimately felt to be malignant) was diagnosed? If the diagnosis date is coded as the date malignant GIST was first mentioned (04/29/2014), this would exclude surgery as treatment for this tumor.
Would this be a histologic diagnosis because the tumor was histologically confirmed to be GIST? Or must this be a clinical diagnosis because the diagnosis of malignancy was only made clinically (by the clinician's review of the clinical and pathologic findings)? |
Code the diagnosis date for this case as 04/10/2014. Code the diagnostic confirmation as histologically confirmed. The clinician is using all of the information available to determine the diagnosis, including the biopsy and resection. |
2015 |
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20180037 | Date of Diagnosis--Colon: If a patient has a positive Cologuard test, is the date of diagnosis the date of the cologuard test or the date of the biopsy? |
Do not use the date of a positive Cologuard test as the date of diagnosis. |
2018 | |
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20200032 | Date of Diagnosis--Brain and CNS: How is the Date of Diagnosis coded when an MRI clinically diagnoses a borderline brain tumor on 4/4/2020, but the subsequent biopsy pathologically diagnoses a malignant brain tumor on 5/20/2020? See Discussion. |
Clinically, the patient was felt to have a pineocytoma (borderline tumor) on imaging, but the subsequent biopsy proved a pineal germinoma (malignant tumor). The Date of Diagnosis instructions state to code the month, day and year the tumor was first diagnosed, clinically or microscopically, by a recognized medical practitioner, but it does not indicate whether differences in behavior alter the diagnosis date. For brain and central nervous system tumors, should the diagnosis date be the first date a tumor is SEER reportable? Or should the diagnosis date for those tumors ultimately proven to be malignant, be the date the malignancy was diagnosed? |
This tumor was first diagnosed on 4/4/2020 according to the information provided. The pineocytoma was reportable based on a behavior of /1; it was later confirmed as a pineal germinoma; update both the histology and behavior on the abstract as better information was obtained, retaining the original date of diagnosis. |
2020 |
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20071044 | Date of Conclusive Terminology: Is there an applicable timeframe when coding this field? |
There is no strict timeframe for Date of Conclusive Terminology. The diagnosis using conclusive terminology could be made any time following the diagnostic work-up. The date of conclusive terminology is related to code 2 [ambiguous term followed by conclusive term] in the data item "Ambiguous terminology." Assign code 2 when a conclusive diagnosis is made 60 days or more after a diagnosis using ambiguous terminology. Record the date of the conclusive diagnosis in "Date of Conclusive Terminology." |
2007 | |
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20021162 | Chemotherapy: Should radiosensitizing chemotherapy agents (i.e., drugs typically coded as treatment for cancer) be coded as treatment when they are given in combination with radiation therapy with the intention of enhancing that treatment? See discussion. |
Per our consultant, these drugs are given at a lower dose than that typically given to treat cancer patients. |
Do not code radiosensitizers and radioprotectants as cancer-directed therapy. Drugs typically classified as chemotherapy agents would be "ancillary drugs" for the purpose of coding cancer-directed therapy because the drugs are given at a much lower dosage than that typically given to treat cancer patients. Per Book 8, ancillary drugs are not to be coded as cancer-directed therapy. Radiosensitizers and radioprotectants do not work directly on the cancer and are not coded under any of the systemic therapy fields. |
2002 |
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20110088 | Chemotherapy/Neoadjuvant treatment: Should neoadjuvant chemotherapy be coded for an incidental second primary discovered at the time of surgery? If so, how is the diagnosis date coded? See Discussion. |
The patient had neoadjuvant chemotherapy for rectal carcinoma. An AP resection revealed an incidental second primary intramucosal carcinoma in adenomatous polyp in the descending colon. Is the chemotherapy coded as therapy for the intramucosal carcinoma of the descending colon? |
Record the neoadjuvant therapy only for the first primary and do not record the neoadjuvant therapy for the incidental new primary found on surgery. |
2011 |
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20100039 | Casefinding--Heme & Lymphoid Neoplasms: Is the 2010 casefinding code of 289.6 (Familial Polycythemia) addressed anywhere in the Hematopoietic Database? See Discussion. |
When you enter "familial polycythemia" into the Heme DM, polycythemia vera (PV) appears; however, the term "familial polycythemia" is not listed as one of the synonyms for PV. |
Familial polycythemia by itself is not reportable. This is a benign condition which occurs within families. Familial polycythemia can progress to polycythemia vera (9950/3), which would then be reportable. The code, 289.6, which is the ICD-9-CM code for Familial polycythemia is not included on the reportable list for casefinding. There is only one ICD-9-CM code for Polycythemia vera, 238.4. "Familial polycythemia" is listed in Appendix F: Non-Reportable List for Hematopoietic Diseases. |
2010 |
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