Reportability--Heme & Lymphoid Neoplasms: Is the term "thrombocytopenia" equivalent to the term "refractory thrombocytopenia" and should be a subsequent primary if it follows a treated diagnosis of pancreatic cancer?
Thrombocytopenia NOS is not a reportable diagnosis per Appendix F. Thrombocytopenia and Refractory Thrombocytopenia are not the same disease.
Thrombocytopenia is caused by a decreased number of platelets in the blood. Non-malignant causes include disseminated intravascular coagulation (DIC), drug-induced non-immune thrombocytopenia, drug-induced immune thrombocytopenia, hypersplenism, immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura, and infections of the bone marrow.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Histology--Heme & Lymphoid Neoplasms: How is this field coded when the final diagnosis for excisional biopsy of two cervical lymph nodes shows classical Hodgkin lymphoma, histologic subtype cannot be determined, but the COMMENT section of the report indicates there are features of both lymphocyte rich and nodular sclerosis subtypes?
Per Rule PH28, code histology to 9650/3 [Classical Hodgkin lymphoma]. This rule states to code the non-specific (NOS) histology when the diagnosis is one non-specific (NOS) histology and two or more specific histologies.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. http://seer.cancer.gov/seertools/hemelymph.
Primary site--Heme & Lymphoid Neoplasms: What is the primary site code for a primary effusion lymphoma if the patient has multiple regions that are positive (e.g., pleural and pericardial effusion and the pleural fluid) for lymphoma?
Per the Abstractor Notes in the Heme DB, primary effusion lymphoma (PEL) is unusual in that the majority of cases arise in body cavities, such as the pleural, pericardial, and peritoneal cavities. Because there are no ICD-O-3 codes for the pleural space, pericardium, or peritoneal cavity, code the primary site to pleura C384 when the neoplasm arises in the pleural cavity, to pericardium C380 when it occurs in the pericardium, and to peritoneal cavity C482 when it occurs in the peritoneum.
Typically only one body cavity is involved. However, if multiple regions are positive for PEL as in this case, code the primary site to C809 per Rule PH27. Rule PH27 indicates one is to code the to primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician in the medical record that he/she that the lymphoma in an
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Reportability--Melanoma: Please explain how a CTR is to interpret the guideline in the MP/H rules (Cutaneous Melanoma): Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. Is this to mean that evolving melanoma in situ is not reportable? Or should we follow the guidelines in SEER Question 20130022 that states the reportability terms for melanoma and melanoma in situ.
Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.
Laterality: Why is a code 5 for laterality midline only allowed for certain sites of brain and skin? I have a nasal cavity tumor and the path report specifically says "Tumor laterality: midline". What is the correct laterality code here?
Assign laterality code 9 for midline nasal cavity tumor. We will investigate this issue further.
Histology--Heme & Lymphoid Neoplasms: Should the 1995 diagnosis be changed to plasmacytoma? A 1995 case on the central registry database indicates that MRI and bone surveys revealed a pubic ramus lesion that was biopsied. There are no other bone lesions. A bone marrow biopsy was negative. The pathologist's diagnosis at that time was "Plasma Cell Myeloma". In 2013 there was a positive bone marrow biopsy and a diagnosis of Plasma Cell Myeloma. In 2013, a history of "sequential plasmacytomas since 1995" was mentioned. Since the 1995 diagnosis was only a solitary bone lesion with no marrow involvement, it certainly seems to fit a diagnosis of plasmacytoma better than myeloma.
Do not change the 1995 diagnosis in this case. It is best to code the histology according to information from the time of the diagnosis. Using information obtained many years later is less reliable.
Ambiguous terminology/Reportability--Heme & Lymphoid Neoplasms: Is a physician diagnosis of "appears to be a myeloproliferative disorder" reportable if the patient has no treatment and the physician elects to follow the patient with CBC's?.
Yes. This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].
The word is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4).
Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.
EOD-Size of Primary Tumor--Breast: How would this field be coded, using the revised and expanded breast code, for a lesion described as "1.3 cm infiltrating ductal carcinoma, associated DCIS?"
For cases diagnosed 1998-2003: Code size of primary tumor as 013. The phrasing suggests that the infiltrating ductal carcinoma measures 1.3 cm. DCIS is also present, but no size mentioned.
Reportability/Behavior:
Our registry collects some borderline (behavior /1) cases that are not
reportable to SEER or any other standard setters. Can we assign a behavior code
of /2 to these cases?
Do not assign a behavior code of /2 to these cases unless you
have a way to flag them so that they are not reported to the standard setters
as in situ cases. Work with your state central registry to ensure that these cases are not unintentionally included in state case submission.
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