Date of Diagnosis/EOD-Extension--Placenta: How do you code these fields for a patient who presents with a vaginal metastatic lesion for a placenta primary? Should EOD-Extension be coded to 60 [Other genital structures NOS: vagina, ovary, broad ligament, fallopian tube] or 85 [metastasis other than lung]? See discussion.
Pt had D&C Feb 5 with features of complete mole. On March 7, pt seen for a mass just inferior to the urethral meatus. At path, vaginal introitus fragments were consistent with choriocarcinoma. At time of March 23 admit for chemo, history is given as large hydatidiform mole evacuated Feb 5. Her beta hCG titers initially fell but approximately one month later hCG titers rose. At that time, she had an obvious vaginal metastatic lesion.
For cases diagnosed 1998 or after: Code the Date of Diagnosis field to March 7, which is the date that the choriocarcinoma was first diagnosed. There was no slide review or clinical statement that the first occurrence was obviously malignant. Therefore, the vaginal mets is not progression and is codeable as extension. Code the EOD-Extension field to 60 [other genital structures, NOS] according to the current EOD scheme for placenta. Even though the mass is discontinuous, it is still included in code 60 per the guidelines of the FIGO system on which the EOD is based.
EOD-Size of Primary Tumor: 1) Can we add "Imaging studies" to those EOD schemes that currently do not include this on their priority list for coding size? 2) When an EOD scheme already lists specific types of imaging studies, are we limited to only those types of procedures or can any imaging study be used to code size? See discussion.
How do we determine where to add "imaging studies" to the priority listing? Currently the hierarchy differs for primaries that currently include imaging studies on their EOD schemes. For example, on the breast EOD imaging ranks lower than the physical exam while on the thyroid EOD imaging ranks higher than the physical exam.
For cases diagnosed 1998-2003:
1) You may add "Imaging" to the size priority list for all EOD schemes that currently do not include it. Prioritize it just above the physical exam for these sites.
2) You may use the information from any imaging technique to code tumor size, even for those sites such as breast and bladder where specific imaging tests are mentioned.
Surgery of Primary Site--Soft Tissue: What code is used to represent this field when an excisional biopsy of a soft tissue sarcoma is followed two weeks later with a wide excision (re-excision)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 26 [partial resection]. According to the CoC, "Excision" in the surgery codes refers to the lesion and "partial resection" refers to the organ. The biopsy is a local excision (code 25). The wide resection is code 26, presuming that more than just the remaining lesion was removed.
EOD Clinical Extension--Prostate: Can you assign code 15 if there is no TURP and no physical exam? See discussion.
[Code 15 = Tumor identified by needle biopsy, e.g. for elevated PSA, (T1c)]
Prostate case: Elevated PSA, Prostate u/s: no abnormal findings, Prostate biopsy: adenocarcinoma. Can this be clinically coded as 15? According to Prostate EOD Coding Guide (6/2001), code 15 requires documentation that the physical exam was negative, but in this case, we have no physical info.
For cases diagnosed 1998-2003:
Code the EOD Clinical Extension field to 30-34 when there is no documentation saying that the physical examination was negative.
Histology (Pre-2007)--Prostate: What code is used to represent the histology "prostatic duct carcinoma"? See discussion.
Should the histology be coded to duct carcinoma [8500/3] or endometrioid carcinoma [8380/3]? Prostatic duct carcinoma is defined as endometrioid carcinoma; however, sometimes the pathology report describes the histology as being only "prostatic duct carcinoma."
For tumors diagnosed prior to 2007:
If there is no mention of endometrioid carcinoma in the microscopic description, code the Histology field to 8500/3 [duct carcinoma]. If "endometrioid carcinoma" is mentioned in either the final diagnosis or in the microscopic description, code the Histology field to 8380/3 [endometrioid carcinoma].
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.
EOD-Extension--Pancreas: How do you code extension when CT scan shows a mass in the head of the pancreas "encompassing" the hepatic branch of the celiac artery? See discussion.
We do not code the term "encompasses" as involvement. However, should we code this case as extension to the peripancreatic tissue, NOS or as unknown?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [Extension to peripancreatic tissue, NOS]. There has to be extension to peripancreatic tissue if the mass encompasses the celiac artery.
Multiple Primaries (Pre-2007)--Skin: If a patient presents with two separate lesions on the left cheek (i.e., left lateral cheek and left upper cheek) that both are histologically confirmed to be superficial spreading melanoma on the same day, is this coded as one or two primaries?
For tumors diagnosed prior to 2007:
Code as one primary.
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.
Surgical Procedure of Other Site: Is the excision of a distant lymph node or a fine needle aspirate (FNA) of a distant lymph node coded as a Surgical Procedure of Other Site, even though they are performed for diagnostic purposes and not intended as treatment?
For cases diagnosed 1/1/2003 and after: Code the Surgical Procedure of Other Site field to 3 [Non-primary surgical procedure to distant lymph nodes] for an excision of a distant lymph node because it is a surgical procedure. However, if only a fine needle aspirate of a distant lymph node is done, code this field to 0 [None].
Fine needle aspirates of regional lymph nodes are the only FNA biopsies to be coded in a surgery field (Scope of Regional Lymph Node Surgery field). In addition, FNA biopsies of regional nodes are also included in the EOD-Number of Positive Regional and Examined Lymph Nodes fields.
EOD Fields--Lymphoma: Was MALT Lymphoma [9715/3 (ICD-O-2) and 9699/3 (ICD-O-3)] inadvertently excluded from SEER EOD manual, top of page 180?
For cases diagnosed 1998-2003:
Yes. Use the scheme on page 180 for MALT lymphoma. The ICD-O-2 morphology code 9715 was omitted in error. It should have been added when the EOD was printed in 1998.
Histology (Pre-2007)--Breast: What code is used to represent the histology "duct carcinoma, colloid type"? See discussion.
Do we use 8480/3 [colloid carcinoma] or 8523/3 [duct carcinoma] mixed with other types of carcinomas?
For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [colloid carcinoma] per Rule 4. The lesion is colloid type of ductal carcinoma, not ductal carcinoma mixed with colloid carcinoma.
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.
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