As many of us abstract, we groan when we get to a hematopoietic or lymphoid primary. These types of cancers are so different that they have their own database and manual. We question whether we are using it correctly, did we come to the correct answer on a multiple or single primary? What about the histology and primary site? We decided to break down our thought processes and movement through the manual into smaller pieces to make it a little more manageable.
- Read all of the notes and path reports. What tests were run? What terms are the physicians using to describe the neoplasm? Are any of these provisional diagnoses and do we have a final diagnosis?
- Open the Heme database and look up all of the diagnoses. Tip: Write down the morphology codes for all of the diagnoses. Use only the Heme Database when coding a hematopoietic and lymphoid neoplasm. The terms in the ICD-0-3 are outdated and some are no longer valid.
- When searching, look through all of the diagnoses that come up on the database.
- The codes are listed from the most relevant to least relevant.
- Many of the codes may be a more specific type. Check the cytogenetics and IHC tests.
- Choose the best term.
- The first section lists whether or not the disease is reportable and the dates from which it is reportable.
- Click on the diagnosis year. This is important as the information may change based on diagnosis year.
- Alternate names, definitions, genetics, IHC, treatment, signs and symptoms, diagnostic exams, and abstractor notes are listed. This information may assist the CTR in ensuring the correct histology has been chosen
- Transformations from/Transformations to are listed and are very important and will assist in determination of multiple primaries.
- Once all information has been reviewed, and the correct diagnosis year is selected, click on the coding manual. The coding manual is tied to the diagnosis year.
- Take time to read the introduction and information in the coding manual. The following is contained in the beginning of the manual:
- Diagnostic confirmation for heme primaries
- Transformations are explained
- Steps for using the manual
- Treatment Information
- Reportability Information
- Appendices
- History of Heme/lymphoid neoplasm coding
- Lineages
- Lymph node Chain Reference Table
- New Histology Terms
- Obsolete hematopoietic Codes
- Multiple Primary Rules – Used much like the solid tumor manual, review the rules and stop when the rule applies.
- Primary Site and Histology Coding Rules
- Arranged in modules by the type of hematopoietic and lymphoid tumors.
- Rules are hierarchical
- These modules are used to assign the correct primary site and histology for hematopoietic and lymphoid neoplasms.
Coding Tips
Mucinous/colloid adenocarcinoma (8480): An adenocarcinoma containing extra-cellular mucin comprising more than 50% of the tumor. Note that “mucin-producing” and “mucin-secreting” are not synonymous with mucinous MPH Colon Equivalent Terms, Definitions and illustrations
If a patient doesn’t qualify for pathological staging, the tumor was not staged or stage is unknown, the staged by should be coded to 00- not staged. FORDS 2016 Pages 163 & 170.