EOD-Extension--Ovary: What code is used to represent this field for an ovarian primary presenting with "spread to the omentum"?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 75 [Peritoneal implants, NOS] because the size of the implants on the omentum is not known.
Note 6 was added to the EOD scheme which states that both direct extension and discontinuous metastasis to the omentum are coded in the range 70-75 depending on how the peritoneal implants are described.
Histology (Pre-2007): What code is used to represent the histology for a "malignant invasive gastrointestinal stromal tumor (GIST)"?
For tumors diagnosed 2001-2006: Malignant GIST is coded 8936/3.
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.
EOD-Extension--Lung: Is bilateral pleural effusion coded as 72 [malignant pleural effusion] or 85 [metastasis]? See discussion.
Example:
10/30/98 CXR: Widespread malignancy, hilar, superior mediastinal masses, bilateral pleural effusions, fullness in soft tissue right neck.
11/01/98 CT chest/ABD: Extensive infiltrate mediastinum by radiolucent tumor mass that engulfs esophagus/trachea. Pleural effusion extends so low it apes ascites. Normal ABS/pelvis.
11/01/98 Pathology: FNA right supraclavicular lymph node: metastic oat cell ca. Sputum cytology reported to be negative.
For cases diagnosed 1998-2003, code the EOD-Extension field to 72 [malignant pleural effusion; pleural effusion, NOS].
EOD-Size of Primary Tumor--Melanoma: How do you code tumor size for a melanoma diagnosed by a positive lymph node biopsy when the primary site is coded C44.9 because no primary site was identified? See discussion.
Should the size be 000 because no primary was found or 999 for unknown?
For cases diagnosed 1998-2003:
Code the EOD-Size of Primary Tumor field to 000 [No mass; no tumor found] when primary site is coded to C449.
Extension/Ambiguous terminology: How should the terms "entrapped by tumor" and "encased by tumor" be interpreted when coding these fields?
Each case must be reviewed in its entirety to determine the appropriate coding of these fields. However, in general the terms "entrapped" and "encased" should NOT be interpreted as involvement unless there is other clinical or pathologic evidence to support involvement.
Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
Terminology: Do focus, focal, foci and chips mean the same thing?
Focus, focal, and foci are variations of the same word. Focus (noun) describes an area or point of disease, either grossly or microscopically. Focal (adjective) relates to the area/focus of disease; an example is a prostate with focal adenocarcinoma. This means that the majority of the prostate is benign and the adenocarcinoma is confined to one small area/point. Foci (plural) describe more than one area/focus of disease. A prostate with foci of adenocarcinoma means the disease is multifocal (several areas/points of disease).
Chips are microscopic amounts of either tissue or tumor. A pathologist might examine several chips of prostate tissue, one of which contains a focus of adenocarcinoma.
EOD-Extension/SEER Summary Stage 2000--Kidney/Eye: What codes are used to represent these fields for simultaneous bilateral Wilms tumor or simultaneous bilateral retinoblastoma?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.
Surgery of Primary Site: Should laparoscopy be coded as exploratory surgery? See discussion.
Many surgeons are doing exploratory surgery with laparoscopy involving a very small incision, but they can examine organs and take biopsies. Should laparoscopy be coded as exploratory surgery?
For cases diagnosed 1/1/1998 and later: Exploratory surgical procedures, such as laparoscopic surgeries, are not coded in the Surgery of Primary Site field.
Histology (Pre-2007)--Colon: What code is used to represent the histology "adenocarcinoma arising in a papillary adenomatous polyp"? See discussion.
Is "adenocarcinoma arising in a papillary adenomatous polyp" equivalent to adenocarcinoma in a villous adenoma [8261/3] or adenocarcinoma in an adenomatous polyp [8210/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8261/3 [adenocarcinoma in a villous adenoma]. In describing colon polyps, papillary and villous are equivalent terms.
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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