Q&A Session
Collecting Cancer Data: Thyroid and Adrenal Gland
December 01, 2011
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Q: if the patient is receiving hormone therapy prior to the diagnosis of papillary carcinoma and the answer is "yes, it is considered first course", then for Collaborative staging would the evaluation codes be '6' indicating neoadjuvant treatment where surgery was performed?
A: A: This question has been submitted to the CAnswer forum and at the time this document was posted had not received a reply. If you would like to track this issue you can see the thread at
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Q: What would low dose I-131 be?
A: The smallest dose I've seen for treatment is 30 mci. It is recommended in the NCCN guidelines that small doses as low as 2 or 3 mci be used for scanning. This will avoid or reduce the effect of stunning. It might be a good idea to ask a physician at your facility.
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Q: There are conflicting opinions regarding the code for radiation treatment volume for I-131 treatment. Should this be coded to thyroid or whole body?
A: The CoC has definitively stated that I 131 radiation treatment volume should be coded to whole body, code 33.
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Q: Any patient who has a total thyroidectomy would have to be on hormones whether synthroid or something else, correct? However, I see cases where a total thyroidectomy has been done but no hormones are listed.
A: I would think they would have to be. However, unless you have documentation I don't think you can code it.
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Q: ICD-0 shows papillary microcarcinoma as histology common to thyroid while micropapillary carcinoma is common to sites other than thyroid. If "papillary microcarcinoma" appears in a final diagnosis, is the code 8260 still the preferred histology over 8341?
A: Yes; 8260 should be used.
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Q: If you have a papillary carcinoma and oncocytic carcinoma, do you code that to papillary/follicular carcinoma 8340? I thought I read that oncocytic is a type of follicular carcinoma so we could code to 8340.
A: This question has been submitted to SEER for Clarification. They are referring the question to an endocrine specialist for further clarification. We will post the answer once we have additional clarification.
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Q: On the pop quiz, the path says that the tumor capsule is focally invaded. Why would the code for CS Extension not be 400?
A: The invasion was of the capsule surrounding the tumor, not the capsule surround the thyroid. The tumor was centrally located and there were clear margins. It was specifically documented that there was no invasion of the thyroid capsule. Code 400 can only be used if the tumor invades into the thyroid capsule. Tumor capsule and thyroid capsule are two different things.
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Q: How do we know the FNA was cells or tissue in the exercises? We would not have coded 02 unless we knew for sure it was tissue. Thoughts?
A: We did not make that clear in the scenario,but we were assuming tissue. You are correct that if the FNA was to cells, cytology, code for diagnostic staging procedure should be 00.
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Q: If a patient has multiple I-131 treatments over a period of time, do you record this once as one treatment with one volume or record it as separate treatments?
A: This question has been submitted to the CAnswer forum and at the time this document was posted had not received a reply. If you would like to track this issue you can see the thread at ______
Q: if a FNA was done, would you code 02 (biopsy) for cytology?
A: If FNA was cytology, the code would be 00.
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Q: Is the best topography code for neuroblastoma of adrenal gland C74.0?
A: This question was referred to SEER and we received the following response:
Neuroblastoma is a disease in which malignant cells form in the nerve tissue of the adrenal gland. Code to the medulla C741. The medulla is derived from the ectoderm (one of three layers of layers of cells that originate in the embryo). The ectoderm produces nerve tissue (and other tissue). The cortex develops from the mesoderm which produces muscles, fibrous tissue, bone and cartilage, adipose, and blood vessels, so the cortex would not be the correct code for neuroblastoma.
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Q: In the presentation SSF2 for adrenal gland says tumor weight, but on quiz 2question #7, you stated that the total adrenal gland weight was coded?Shouldn’t the answer be 999?
A: The name of the data item, SSF2, for adrenal gland is tumor weight. However, the weight is a reflection of gland weight rather than tumor weight because the tumor is not dissected from the gland proper and weighed separately. So, record the weight of the resected adrenal gland in SSF2.