Q: A CT and PET scan performed in August of 2014 are positive for anterior mediastinal and lower paratracheal lymphadenopathy suspicious for lymphoma. A biopsy supports the lymphoma diagnosis. All other workup is negative. What is the primary site?
A: Refer to Module 7, PH Rule 20 of the Hematopoietic and Lymphoid Neoplasm Coding Manual – Code the primary site to the specific lymph node region when multiple lymph node chains within the same region as defined by ICD-0-3 are involved.
Use Appendix C: Lymph Node/Chain Reference of to look up anterior mediastinal and lower paratracheal lymph nodes. Both are within the Intrathoracic region so the primary site would be coded to C771 for Intrathoracic lymph node region NOT C778.
Q: What is the primary site in the following Lymphoma scenario?
Imaging on 9/13/2014 described involvement of the mediastinal lymph nodes (C771) and inguinal lymph nodes (C774). All other workup was negative. A biopsy of an inguinal node was positive for B-cell lymphoma.
A: Refer to Module 7, PH Rule 21 of the Hematopoietic and Lymphoid Neoplasm Coding Manual – Code the primary site to multiple lymph nodes NOS C778 when multiple lymph node “regions” as defined by ICD-0-3 are involved and it is not possible to determine the lymph node region where the tumor originated.
Use Appendix C: Lymph Node/Chain Reference to look up mediastinal and inguinal nodes. Mediastinal are of the Intrathoracic region and the inguinal are of the Inguinal region or leg. Code the primary site to C778 lymph nodes of multiple regions since the two are of different lymph node regions.