Scope of Regional Lymph Node Surgery/EOD Fields: When a patient has two simultaneously diagnosed primaries, and a regional lymph node dissection intended for one of the primaries removes nodes that are also regional for the other primary, is the information from the lymph node dissection coded for both primaries?
For cases diagnosed 1998-2003:
If the lymph nodes are negative, the status of nodes that are regional for both sites would be used to code the EOD and Site-Specific Surgery fields for both sites.
If any of the lymph nodes are positive use the histology from the lymph nodes to determine how the EOD and Site-Specific Surgery will be coded. For example: If prostate cancer is an incidental finding when a cystoprostatectomy and pelvic lymph node dissection are done to treat a bladder cancer, and all of the positive lymph nodes reflect the histology of the prostate primary (adenocarcinoma), code the nodes as positive for the prostate primary and negative for the bladder primary.
Surgery of Primary Site--Prostate: What treatment code is used to represent prostate carcinoma treated with "high intensity focused ultrasound" (HIFU)?
For cases diagnosed 1998 and later:
Code the Surgery of Primary Site field to 17 [Other method of local tumor destruction]. HIFU uses focused energy to destroy tissue. It is classified as a surgical procedure.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Prostate: Radical prostatectomy reveals two distinct tumors. One is "adenocarcinoma with ductal differentiation" and the other is "adenocarcinoma with acinar differentiation." What code is used to represent the histology and how many primaries does the patient have?
For tumors diagnosed 2001-2006:
This is one primary. Code the Histology field to 8255/3 [adenocarcinoma with mixed subtypes] based on rule A of the Coding Complex Morphologic Diagnoses. This is code was added in the ICD-O-3.
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.
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.
Chemotherapy--Hematopoietic, NOS: What treatment code is used to represent the drug "Gleevec" being used to treat chronic myelogenous leukemia?
For cases diagnosed 1/1/2003 and after: Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. It should be classified as a chemotherapy agent, albeit a unique one. Gleevec seems to work the same way many other chemo drugs do. It disrupts cell division for malignant cells containing the BCR-ABL protein only, rather than for normal and abnormal cells together. When the cells can't divide and create a new generation, they simply die. This meets the definition of an antineoplastic chemotherapy agent.
Histology (Pre-2007)--Breast: What code is used to represent the histology of "invasive ductal carcinoma and in situ ductal carcinoma, cribriform type"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8500/3 [ductal carcinoma] unless the combination is ductal and lobular.
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-Size of Primary Tumor: Should the code 001 in tumor size be used for tumors described as having "focal" involvement? See discussion.
Is tumor size coded to 001 for the following examples:
Example 1: Focal adenoca in left lobe on prostatectomy.
Example 2: Multifocal ductal carcinoma of breast on mastectomy.
Example 1 and 2: There is insufficient information in the examples to determine whether EOD-Size of Primary Tumor should be coded to 001.
The instructions are that code 001 is used for a microscopic focus or foci of tumor only. That means that the tumor is small enough that it could not be seen by the naked eye, nor would it be palpable. Be careful with the term "focal" because it is most often used to describe tumor cells grouped or concentrated in one area as in example 1. There is no implication that this focus was microscopic only. Was it mentioned in the gross or macroscopic portion of the pathology report? If so, it is not coded to 001. Was it palpable? If so, it is not coded to 001.
Example 2 cites a multifocal breast cancer. Again, did the pathologist visualize the cancer (was it reported on the gross or macroscopic portion of the pathology?) If so, do not use code 001. Was the lesion palpable? If so, do not use code 001.
Grade, Differentiation--All Sites: If the grade given for the primary site is from a provisional diagnosis and the grade given for a metastatic site is from a final diagnosis, should we follow the SEER rule that says to code the grade as stated in the final diagnosis (e.g., Provisional diagnosis: High grade papillary serous carcinoma of ovary. Final dx: poorly differentiated adenocarcinoma in a caval lymph node)?
Code the Grade, Differentiation field to 4 [High grade] from the examination of the ovary (primary site). Do not code grade from a metastatic site.
Reportability/Ambiguous Terminology--Breast: Should the American College of Radiology (ACR) BI-RADS assessment categories 4 [Suspicious Abnormality--biopsy should be considered] and 5 [Highly Suggestive of malignancy-appropriate action should be taken], impressions for mammograms and sonograms, be used as the sole basis for reportability? See discussion.
ACR website:
Category 4: Lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant.
Category 5: lesions have a high probability of being cancer.
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