MP/H Rules Presenation

1 Multiple Primary and Histology Rules 101 Format of MP/H Materials By the end of this presentation: Basic understanding of MP/H rules Pick a usage style Understand the MP/H rules and how they work Importance of reading How the equivalent terms work 3 What we will cover:

General Information Format of new rules When and how to use the rules What to expect from the General Rules 4 Important! The 2007 multiple primary rules replace all previous multiple primary rules. 5 When? The rules are effective for cases diagnosed January 1, 2007 and

after. Do not use these rules to abstract cases diagnosed prior to January 1, 2007. 6 Question ??? How do I code a non-analytic case that comes to our hospital after 1/1/07 with residual/metastatic cancer diagnosed in 2005? 7 Answer:

Use the previous rules. 8 Style The histology/multiple primary coding rules are available in three formats: flowchart text matrix The rules are identical, only the formats differ. 9 Using the Rules Notes and examples are included with some of the rules to highlight key

points or to add clarity to the rules. They are not exclusive. They do not replace the rules. 10 How to Use the Rules 1. Read the General Instructions General Terms/Definitions Used for all cases EXCEPT: Hematopoietic Primaries Benign or borderline CNS DO NOT use for casefinding 11 How to Use the Rules 2. Read the site-specific equivalent or

equal terms Multicentric = Multifocal or Tumor = Mass = Lesion = Neoplasm 12 How to Use the Rules 3. Used for: coding histology except for hematopoietic primaries (Do Not use for casefinding) 4. Use multiple primary rules before coding histology 5. Code histology for each primary 13

How to Use the Rules 6. Use site-specific rules for: Brain, malignant Breast Colon Head & Neck Kidney Lung

Malignant Melanoma of Skin Renal Pelvis, ureter, bladder and other urinary 14 How to Use the Rules 7. Use Other Sites rules 8. Determine single vs. multiple tumors - Dont count metastatic tumors - Multicentric/multifocal = Unknown if single or multiple tumors - Dont count the foci - Only count tumors used to prepare abstract 15 How to Use the Rules

9. Each Section = Complete Set of Rules *Stay within module 10. Use the first rule that applies and 16 Pathology Reports Code from the pathology report 1. from the most representative specimen examined 2. from the final diagnosis 17 Pathology Reports Note 1: A revised/amended diagnosis replaces the original final diagnosis.

Code the histology from the revised/amended diagnosis. Note 2: The new rules limit the information to the final diagnosis. The old rules allowed coding from information in the microscopic description. 18 Pathology Reports If there is NO pathology report: 1. Cytology report 2. Documentation in the medical record that references pathology or cytology 19

Using the Rules The Multiple Primary Rules 3 independent modules 1. Unknown if Single or Multiple Tumors 2. Single tumor 3. Multiple tumors Rules in appropriate module 20 Using the Rules The Histology Coding Rules 2 independent modules 1. Single Tumor (one primary site) 2. Multiple Tumors abstracted as a single primary site

Rules are hierarchical within each module 21 General Terms and Definitions Bilateral Clinical Diagnosis Contiguous tumor Contralateral

Different histology Different (multiple) primaries Focal Foci Focus Ipsilateral Most representative specimen Multiple primaries Overlapping tumor Paired organ/site Single histology Single (one)

primary Unilateral 22 General Terms and Definitions (continued) Recurrence 1. The reappearance of disease that was thought to be cured or inactive (in remission). 2. A new occurrence of cancer arising from cells that have nothing to do with first cancer. A new occurrence of cancer 23

General Terms and Definitions (continued) Recurrence continued Do not use a physicians statement Use the multiple primary rules as written unless a pathologist compares the present tumor to the original tumor and states that this tumor is a recurrence of the previous primary. 24 Ambiguous Terms Apparent(ly) Appears Comparable with

Compatible with Consistent with Favor(s) Most likely Presumed Probable Suspect(ed) Suspicious (for) Typical (of)

25 No Negative Lists If it isnt listed, dont code it. No Do not use ambiguous terms list No Terms that do not represent the majority of the tumor list 26 Using the Rules Notes and examples are included with some of the rules:

1. Highlight key points 2. Add Clarity They are NOT exclusive They DO NOT replace the rules 27 Learning Styles Visual Auditory Text Flowchart Read/Write Kinesthetic Matrix

28 Example of Text Format Multiple Primary Rules M2 A single tumor is always a single primary Note: The tumor may overlap onto or extend into adjacent/contiguous site or subsite. Histology Rules H4 Code the invasive histologic type when a single tumor has invasive and in situ components. 29 Example of Matrix Format Multiple Primary Rules Rule

Site Notes/Examples Primary M2 Single Tumor The tumor may overlap onto or extend into adjacent/contiguous site or subsite. Single Histology Rules Rule

Behavior H4 Invasive and in situ Notes/Examples Code The invasive histologic type 30 Example of Flowchart Format

Multiple Primary Rules L U N G D E C IS IO N S IN G L E T U M O R M 2 Is t h e r e a s in g le tu m o r ? Y ES S IN G L E P r im a r y * NO T ES T u m o r n o t d e s c r ib e d a s m e t a s t a s is .

T h e t u m o r m a y o v e r la p o n t o o r e x t e n d in t o a d ja c e n t /c o n t ig u o u s s it e o r s u b s it e . NO E n d o f in s tr u c tio n s f o r S i n g le T u m o r . G o t o M u lt ip le T u m o rs . 31 Example of Flowchart Format Histology Coding Rules LUNG

S IN G L E T U M O R A c tio n R u le H 4 D o e s th e tu m o r h a v e in v a s iv e a n d in s it u c o m p o n e n ts ? Y ES N o te s a n d E x a m p le s C o d e th e in v a s iv e h is to lo g ic

ty p e . NO 32 Warning! Do not use all three format of rules at the same time 33 Using the Rules First the Multiple Primary Rules 3 independent modules: Unknown if Single or Multiple

Tumors Single Tumor Multiple Tumors Use rules in appropriate module 34 Using the Rules Second are the Histology Coding Rules Two independent modules: Single Tumor (one primary site) Multiple Tumors abstracted as a single primary site Rules are hierarchical within each module. 35 Chart 1 Lung Histology Groups and Specific Types

Note: This chart is based on the WHO Classification of Tumors for tumors of the lung. The chart is not a complete listing of histologies that may occur in the lung. C h a rt I n s t ru c tio n s : U s e th is c h a r t w ith m u ltip le p r im a r y r u le M 1 0 to id e n tify ty p e s o f n o n -s m a ll c e ll c a r c in o m a . U s e th is c h a r t w ith th e h is to lo g y r u le s to c o d e th e m o s t s p e c ific h is to lo g ic te r m . T h e tr e e is a r r a n g e d in d e s c e n d in g o r d e r . E a c h b r a n c h is a h is to lo g y g r o u p , s ta r tin g w ith th e N O S o r g r o u p te r m s a n d d e s c e n d in g in to th e s p e c ific ty p e s fo r th a t g r o u p . A s y o u fo llo w th e b r a n c h d o w n , th e te r m s b e c o m e m o r e s p e c ific . M a lig n a n t n e o p la s m , N O S a n d M a lig n a n t t u m o r c e lls (8 0 0 0 a n d 8 0 0 1 ) C a r c in o m a , N O S ,

C a r c in o m a , u n d if f e r e n t ia t e d , N O S a n d C a r c in o m a , a n a p la s t ic , N O S (8 0 1 0 , 8 0 2 0 a n d 8 0 2 1 ) N o n - S m a ll C e ll C A (8 0 4 6 ) N e u r o e n d o c r in e C A , N O S (8 2 4 6 ) C a r c in o id , N O S (8 2 4 0 ) C o m b in e d S m a ll C e ll C A (8 0 4 5 ) A t y p ic a l c a r c in o id ( 8 2 4 9 )

S a r c o m a t o id C A (8 0 3 3 ) S m a ll C e ll C A , N O S (8 0 4 1 ) F u s ifo r m C a r c in o s a r c o m a (8 9 8 0 ) G ia n t c e ll C A (8 0 3 1 ) P le o m o r p h ic C A (8 0 2 2 )

P u lm o n a r y B la s t o m a ( 8 9 7 2 ) S p in d le c e ll C A (8 0 3 2 ) L a r g e C e ll C A , N O S (8 0 1 2 ) c e ll C A ( 8 0 4 3 ) A d e n o C A , N O S (8 1 4 0 ) A d e n o id c y s t ic C A ( 8 2 0 0 ) a n d M u c o e p id e r m o id C A

(8 4 3 0 ) A c in a r c e ll C A ( 8 5 5 0 ) A d e n o c a r c in o m a , m ix e d s u b ty p e s (8 2 5 5 ) A lv e o la r a d e n o c a r c in o m a ( 8 2 5 1 ) B r o n c h io lo a lv e o la r C A , N O S ( 8 2 5 0 ) B r o n c h io lo a lv e o la r C A , n o n m u c in o u s ( 8 2 5 2 ) B r o n c h io lo a lv e o la r C A , m u c in o u s (8 2 5 3 ) B r o n c h io lo a lv e o la r C A , m ix e d m u c in o u s & n o n m u c in o u s (8 2 5 4 ) C le a r c e ll a d e n o C A ( 8 3 1 0 ) M u c in o u s c y s ta d e n o C A (8 4 7 0 ) M u c in o u s / c o llo id a d e n o C A ( 8 4 8 0 )

M u c in - p r o d u c in g a d e n o c a r c in o m a (8 4 8 1 ) P a p illa r y a d e n o C A ( 8 2 6 0 ) S ig n e t r In g a d e n o C A ( 8 4 9 0 ) S o lid A d e n o C A ( 8 2 3 0 ) W e ll d If f e r e n t ia t e d f e t a l A d e n o C A (8 3 3 3 ) A d e n o s q u a m o u s (8 5 6 0 ) L a r g e c e ll n e u r o e n d o c r in e C A ( 8 0 1 3 ) L a r g e c e ll C A w it h r h a b d o id p h e n o ty p e (8 0 1 4 ) L y m p h o e p it h e lio m a lik e C A ( 8 0 8 2 ) B a s a lo id C A ( 8 1 2 3 ) C le a r c e ll C A ( 8 3 1 0 )

S q u a m o u s C e ll C A , N O S (8 0 7 0 ) B a s a lo id s q u a m o u s c e ll C A ( 8 0 8 P a p illa r y s q u a m o u s c e ll C A ( 8 0 5 S q u a m o u s c e ll C A , c le a r c e ll t y p (8 0 8 4 ) S q u a m o u s c e ll C A , k e r a t in iz in g , (8 0 7 1 ) S q u a m o u s c e ll C A , la r g e c e ll, n o n k e r a t in iz in g , N O S ( 8 0 7 2 ) S q u a m o u s c e ll C A , s m a ll c e ll, n o n k e r a t in iz in g , ( 8 0 7 3 ) 3 ) 2 )

e N O S 36 Chart 2 Most Common Lung Histology Groups Chart Instructions: Use this chart to identify the most common group terms and histology types. Note: This chart is based on the WHO Classification of Tumors for tumors of the lung. The chart is not a complete listing of histologies that may occur in the lung. M a lig n a n t n e o p la s m , N O S a n d M a lig n a n t t u m o r c e lls (8 0 0 0 a n d 8 0 0 1 ) C a r c in o m a , N O S , C a r c in o m a , u n d iffe r e n tia te d , N O S a n d C a r c in o m a , a n a p la s t ic , N O S

(8 0 1 0 , 8 0 2 0 a n d 8 0 2 1 ) N e u r o e n d o c r in e C A , N O S (8 2 4 6 ) N o n -S m a ll C e ll C A (8 0 4 6 ) S a r c o m a to id C A (8 0 3 3 ) C a r c in o id , N O S (8 2 4 0 ) S m a ll C e ll C A , N O S (8 0 4 1 ) P le o m o r p h ic C A (8 0 2 2 )

L a r g e C e ll C A , N O S (8 0 1 2 ) A d e n o C A , N O S (8 1 4 0 ) S q u a m o u s C e ll C A , N O S (8 0 7 0 ) 37 Table 1 Combination/Mixed Codes for Lung Histologies Note: This table is not a complete listing of histologies that may occur in the lung. Column 1:

Required Terms Giant cell carcinoma AND spindle cell carcinoma Small cell carcinoma AND one of the histologies in Column 2 Note: Diagnosis must be small cell carcinoma (NOS), not a subtype of small cell Squamous cell carcinoma* AND large cell nonkeratinizing Squamous cell carcinoma AND small cell nonkeratinizing Squamous cell carcinoma* AND one of the histologies in Column 2 A combination of at least two of the histologies in Column 2**

Column 2: Additional Required Terms Column 3: ICD-O-3 Term Giant cell and spindle cell carcinoma Adenocarcinoma Large cell carcinoma Squamous cell carcinoma Spindle cell carcinoma Sarcomatoid Acinar Bronchioloalveolar carcinoma Bronchioloalveolar carcinoma non mucinous

(Clara cell/type II pneumocyte) Bronchioloalveolar carcinoma mucinous (goblet cell) Bronchioloalveolar carcinoma mixed mucinous and non-mucinous Clear cell adenocarcinoma Papillary adenocarcinoma Solid adenocarcinoma Well-differentiated fetal adenocarcinoma Column 4: ICD-O-3 Code 8030 Combined small cell carcinoma Mixed small cell carcinoma

8045 Squamous cell carcinoma, large cell, nonkeratinizing Squamous cell caricinoma, small cell, nonkeratinizing Squamous cell carcinoma, spindle cell Squamous cell carcinoma, sarcomatoid Adenocarcinoma with mixed subtypes** 8072 8073 8074 8255**

38 Other Miscellaneous Other Sites Similar to site-specific rules Some site-specific rules included Prostate Ovary Retinoblastoma Kaposi sarcoma Thyroid

Address remaining combination and mixed histology issues 39 Lung Multiple Primary Rules Unknown Number of Tumors Module Unknown Number Of Tumors Note: Tumors not described as metastasis Rule M1 When it is not possible to determine if there is a single tumor or multiple tumors, opt for a single tumor

and abstract as a single primary.* Note 1: Use this rule only after all information sources have been exhausted 41 This is the end of instructions for Unknown Number of Tumors 42 Single Tumor Module Single Tumor Note: Tumor not described as metastasis Rule M2 A single tumor is always a

single primary. * Note: The tumor may overlap onto or extend into adjacent/contiguous site or subsite. *Prepare one abstract. This is the end of instructions for Single Tumor. 44 This is the end of instructions for Single Tumors 45 Multiple Tumors Module Multiple Tumors

Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M3 Tumors in sites with ICD-O3 topography codes that are different at second (Cxxx) and/or third character (Cxxx) are multiple primaries. ** Note: This is a change in rules; tumors in the trachea (C33) and in the lung (C34) were a single primary in the previous rules. 47 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M4 At least one tumor that is

non-small cell carcinoma (8046) and another tumor that is small cell carcinoma (8041-8045) are multiple primaries.** 48 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M5 A tumor that is adenocarcinoma with mixed subtypes (8255) and another that is bronchioloalveolar (8250-8254) are multiple primaries. **

49 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M6 A single tumor in each lung is multiple primaries. ** Note: When there is a single tumor in each lung, abstract as multiple primaries unless stated or proven to be metastatic. 50 Multiple Tumors Multiple tumors may be a single or multiple primaries

Note: Tumors not described as metastases Rule M7 Multiple tumors in both lungs with ICD-O-3 histology codes that are different at the first (xxxx), second (xxxx) or third (xxxx) number are multiple primaries. ** 51 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M8 Tumors diagnosed more than three (3) years apart are multiple primaries.**

52 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M9 An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary.** Note 1: The purpose of this rule is to ensure that the case is counted as an incident (invasive) when incidence data are analyzed. Note 2: Abstract as multiple primaries even if the medical record/physician states that it is recurrence or progression of disease. 53

Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M10 Tumors with non-small cell carcinoma, NOS (8046) and a more specific non-small cell carcinoma type (Chart 1) are a single primary.* 54 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases

Rule M11 Tumors with ICD-O-3 histology codes that are different at the first (xxxx), second (xxxx) or third (xxxx) number are multiple primaries** Note: Adenocarcinoma in one tumor and squamous cell carcinoma in another tumor are multiple primaries. 55 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Rule M12 Tumors that do not meet any of the above criteria are a single primary.*

Note 1: When an invasive tumor follows an in situ tumor within 60 days, abstract as a single primary. Note 2: All cases covered by this rule are the same histology. 56 Multiple Tumors Multiple tumors may be a single or multiple primaries Note: Tumors not described as metastases Footnotes: * Prepare one abstract. Use the histology coding rules to assign the appropriate histology code. **Prepare two or more abstracts. Use the histology coding rules to assign the

appropriate histology code to each abstract. 57 This is the end of instructions for Multiple Tumors 58 Lung Histology Rules Excludes lymphoma and leukemia M9590-9989 and Kaposi Sarcoma M9140 59

Lung Histology Rules Single Tumor Module Single Tumor Rule H1 Code histology documented by physician when there is no pathology/cytology specimen or pathology/cytology report is not available. 61 Single Tumor Rule H1 continued Note 1: Priority of documents

Documentation referring to pathologic/cytologic findings Physicians reference to type of cancer in medical record CT, PET, or MRI scans Chest x-rays 62 Single Tumor Rule H1 continued Note 2: Code the specific histology when documented Note 3: Code histology to 8000 or 8010 as stated by the physician

when nothing more specific is documented 63 Single Tumor Rule H2 Code histology from a metastatic site when there is no pathology/cytology specimen from primary site. Note: Code behavior /3 64 Single Tumor Rule H3 Code histology when only one histologic type is identified. Note: Do not code terms that do not appear

in the histology description. Ex 1: Do not code squamous cell carcinoma non-keratinizing unless the words nonkeratinizing actually appear in the diagnosis. Ex 2: Do not code bronchioalveolar nonmucinous unless the words nonmucinous actually appear in the diagnosis. 65 Single Tumor Rule H4 Code invasive histologic type when a single tumor has invasive and in situ components 66 Single Tumor Rule H5 Code most specific term using Chart 1 when multiple histologies within

same branch. Examples of histologies within the same branch are: Cancer/malignant neoplasm, NOS (8000) and a more specific histology or Carcinoma, NOS (8010) and a more specific carcinoma or Adenocarcinoma, NOS (8140) and a more specific adenocarcinoma or Sarcoma, NOS (8800) and a more specific sarcoma 67 Single Tumor Rule H5 continued Note: The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ____differentiation Ex 1: Adenocarcinoma, predominantly mucinous.

Code 8480 (mucinous adenocarcinoma). Ex 2: Non-small cell carcinoma, papillary squamous cell. Code 8052 (papillary squamous cell carcinoma). 68 Chart 1 Chart 1 Lung Histology Groups and Specific Types Note: This chart is based on the WHO Classification of Tumors for tumors of the lung. The chart is not a complete listing of histologies that may occur in the lung. C h a rt I n s tru c t io n s : U s e th is c h a r t w ith m u ltip le p r im a r y r u le M 1 0 to id e n tify ty p e s o f n o n -s m a ll c e ll c a r c in o m a . U s e t h is c h a r t w ith th e h is t o lo g y r u le s to c o d e th e m o s t s p e c ific h is to lo g ic t e r m . T h e tr e e is a r r a n g e d in d e s c e n d in g o r d e r . E a c h b r a n c h is a h is to lo g y g r o u p , s ta r tin g w ith th e N O S o r g ro u p te r m s a n d d e s c e n d in g in to th e s p e c ific ty p e s fo r th a t g r o u p .

A s y o u fo llo w th e b r a n c h d o w n , th e te r m s b e c o m e m o re s p e c ific . M a lig n a n t n e o p la s m , N O S a n d M a lig n a n t t u m o r c e lls (8 0 0 0 a n d 8 0 0 1 ) C a r c in o m a , N O S , C a r c in o m a , u n d if f e r e n t ia t e d , N O S a n d C a r c in o m a , a n a p la s t ic , N O S (8 0 1 0 , 8 0 2 0 a n d 8 0 2 1 ) N o n - S m a ll C e ll C A (8 0 4 6 ) N e u r o e n d o c r in e C A , N O S (8 2 4 6 )

C a r c in o id , N O S (8 2 4 0 ) C o m b in e d S m a ll C e ll C A ( 8 0 4 5 ) A t y p ic a l c a r c in o id ( 8 2 4 9 ) S a r c o m a t o id C A (8 0 3 3 ) S m a ll C e ll C A , N O S (8 0 4 1 ) F u s if o r m

C a r c in o s a r c o m a (8 9 8 0 ) G ia n t c e ll C A (8 0 3 1 ) P le o m o r p h ic C A (8 0 2 2 ) P u lm o n a r y B la s t o m a (8 9 7 2 ) S p in d le c e ll C A (8 0 3 2 ) L a r g e C e ll C A , N O S (8 0 1 2 )

c e ll C A (8 0 4 3 ) A d e n o C A , N O S (8 1 4 0 ) A d e n o id c y s tic C A (8 2 0 0 ) a n d M u c o e p id e r m o id C A (8 4 3 0 ) A c in a r c e ll C A ( 8 5 5 0 ) A d e n o c a r c in o m a , m ix e d s u b t y p e s (8 2 5 5 ) A lv e o la r a d e n o c a r c in o m a ( 8 2 5 1 ) B r o n c h io lo a lv e o la r C A , N O S ( 8 2 5 0 ) B r o n c h io lo a lv e o la r C A , n o n m u c in o u s (8 2 5 2 )

B r o n c h io lo a lv e o la r C A , m u c in o u s (8 2 5 3 ) B r o n c h io lo a lv e o la r C A , m ix e d m u c in o u s & n o n m u c in o u s (8 2 5 4 ) C le a r c e ll a d e n o C A ( 8 3 1 0 ) M u c in o u s c y s t a d e n o C A ( 8 4 7 0 ) M u c in o u s / c o llo id a d e n o C A ( 8 4 8 0 ) M u c in - p r o d u c in g a d e n o c a r c in o m a (8 4 8 1 ) P a p illa r y a d e n o C A ( 8 2 6 0 ) S ig n e t r In g a d e n o C A ( 8 4 9 0 ) S o lid A d e n o C A ( 8 2 3 0 ) W e ll d Iff e r e n t ia t e d fe t a l A d e n o C A (8 3 3 3 ) A d e n o s q u a m o u s

(8 5 6 0 ) L a r g e c e ll n e u r o e n d o c r in e C A ( 8 0 1 3 ) L a r g e c e ll C A w it h r h a b d o id p h e n o ty p e (8 0 1 4 ) L y m p h o e p it h e lio m a lik e C A ( 8 0 8 2 ) B a s a lo id C A ( 8 1 2 3 ) C le a r c e ll C A ( 8 3 1 0 ) S q u a m o u s C e ll C A , N O S (8 0 7 0 ) B a s a lo id s q u a m o u s c e ll C A ( 8 0 8 P a p illa r y s q u a m o u s c e ll C A ( 8 0 5 S q u a m o u s c e ll C A , c le a r c e ll t y p (8 0 8 4 ) S q u a m o u s c e ll C A , k e r a t in iz in g ,

(8 0 7 1 ) S q u a m o u s c e ll C A , la r g e c e ll, n o n k e r a t in iz in g , N O S ( 8 0 7 2 ) S q u a m o u s c e ll C A , s m a ll c e ll, n o n k e r a t in iz in g , ( 8 0 7 3 ) 3 ) 2 ) e N O S 69 Single Tumor Rule H6 Code appropriate combination/mixed code (Table 1) when there are multiple specific

histologies or when there is a non-specific with multiple specific histologies 70 Single Tumor Rule H6 continued Note: The specific histologies may be identified as type, subtype, predominantly, with features of, major, or with ____differentiation. Ex 1 (multiple specific histologies): Solid and papillary adenocarcinoma. Code 8255 (adenocarcinoma with mixed subtypes). Ex 2 (multiple specific histologies): Combined small cell and squamous cell carcinoma. Code 8045 (combined small cell carcinoma). Ex 3 (non-specific with multiple specific histologies):

Adenocarcinoma with papillary and clear cell features. Code 8255 (adenocarcinoma with mixed subtypes). 71 Table 1 Combination/Mixed Codes for Lung Histologies Note: This table is not a complete listing of histologies that may occur in the lung. Column 1: Required Terms Giant cell carcinoma AND spindle cell carcinoma Small cell carcinoma AND one of the histologies in Column 2 Note: Diagnosis must be small cell carcinoma (NOS), not a

subtype of small cell Squamous cell carcinoma* AND large cell nonkeratinizing Squamous cell carcinoma AND small cell nonkeratinizing Squamous cell carcinoma* AND one of the histologies in Column 2 A combination of at least two of the histologies in Column 2** Column 2: Additional Required Terms Column 3: ICD-O-3 Term Giant cell and spindle cell carcinoma

Adenocarcinoma Large cell carcinoma Squamous cell carcinoma Spindle cell carcinoma Sarcomatoid Acinar Bronchioloalveolar carcinoma Bronchioloalveolar carcinoma non mucinous (Clara cell/type II pneumocyte) Bronchioloalveolar carcinoma mucinous (goblet cell) Bronchioloalveolar carcinoma mixed mucinous and non-mucinous Clear cell adenocarcinoma Papillary adenocarcinoma Solid adenocarcinoma

Well-differentiated fetal adenocarcinoma Column 4: ICD-O-3 Code 8030 Combined small cell carcinoma Mixed small cell carcinoma 8045 Squamous cell carcinoma, large cell, nonkeratinizing Squamous cell caricinoma, small cell, nonkeratinizing Squamous cell carcinoma, spindle cell

Squamous cell carcinoma, sarcomatoid Adenocarcinoma with mixed subtypes** 8072 8073 8074 8255** 72 Single Tumor Rule H7 Code the histology with the numerically higher ICDO-3 code. 73

This is the end of instructions for Single Tumor 74 Lung Histology Rules Multiple Tumor Module Multiple Tumors Abstracted as a Single Primary Rule H8 Code histology documented by physician when there is no pathology/cytology specimen/report available

76 Multiple Tumors Abstracted as a Single Primary Rule H8 continued Note 1: Priority of documents Documentation that refers to pathologic/cytologic findings Physicians reference to type of cancer in medical record CT, PET, or MRI scans Chest x-rays 77 Multiple Tumors Abstracted as a Single Primary

Rule H8 continued Note 2: Code the specific histology when documented Note 3: Code histology to 8000 or 8010 as stated by the physician when nothing more specific is documented 78 Multiple Tumors Abstracted as a Single Primary Rule H9 Code the histology from a metastatic site when there is no pathology/cytology specimen from primary site Note: Code behavior /3

79 Multiple Tumors Abstracted as a Single Primary Rule H10 Code the histology when only one histologic type is identified. Note: Do not code terms that do not appear in the histology description. Ex 1: Do not code squamous cell carcinoma nonkeratinizing unless the words non-keratinizing actually appear in the diagnosis. Ex 2: Do not code bronchioalveolar non-mucinous unless the words non-mucinous actually appear in the diagnosis. 80

Multiple Tumors Abstracted as a Single Primary Rule H11 Code the histology of the most invasive tumor. Note 1: This rule should only be used when the first three numbers of histology are identical (This is a single primary). Note 2: See Lung Equivalent Terms, Definitions, Charts, Tables, Illustrations for definition of most invasive. 81 This is the end of instructions for Multiple Tumors 82

Chart 2 Most Common Lung Histology Groups Chart Instructions: Use this chart to identify the most common group terms and histology types. Note: This chart is based on the WHO Classification of Tumors for tumors of the lung. The chart is not a complete listing of histologies that may occur in the lung. M a lig n a n t n e o p la s m , N O S a n d M a lig n a n t tu m o r c e lls (8 0 0 0 a n d 8 0 0 1 ) C a r c in o m a , N O S , C a r c in o m a , u n d iffe r e n tia te d , N O S a n d C a r c in o m a , a n a p la s t ic , N O S (8 0 1 0 , 8 0 2 0 a n d 8 0 2 1 ) N e u r o e n d o c r in e C A , N O S (8 2 4 6 )

N o n - S m a ll C e ll C A (8 0 4 6 ) S a r c o m a to id C A (8 0 3 3 ) C a r c in o id , N O S (8 2 4 0 ) S m a ll C e ll C A , N O S (8 0 4 1 ) P le o m o r p h ic C A (8 0 2 2 ) L a r g e C e ll C A , N O S (8 0 1 2 )

A d e n o C A , N O S (8 1 4 0 ) S q u a m o u s C e ll C A , N O S (8 0 7 0 ) 83 Chart 2: Most Common Lung Histology Groups Chart Instructions: Use this chart to identify the most common group terms and histology types. Note: This chart is based on the WHO Classification of Tumors for tumors of the lung. The chart is not a complete

listing of histologies that may occur in the lung. 84 Table 1: Combination/Mixed Codes for Lung Histologies Table Instructions: Use this table to select combination/mixed histology codes. Compare the terms in the diagnosis to the terms in columns 1 and 2. If the terms match, abstract the case using the ICD-O-3 histology code in column 4. Use the combination/mixed codes listed in this table only when the histologies in the tumor match the histologies listed below. 85

Table 1 continued Use the combination/mixed codes for a single tumor when all histologies are present in a single tumor. Note: This table is not a complete listing of histologies that may occur in the lung 86 Table 1 Combination/Mixed Codes for Lung Histologies Note: This table is not a complete listing of histologies that may occur in the lung. Column 1: Required Terms Giant cell carcinoma AND spindle cell carcinoma

Small cell carcinoma AND one of the histologies in Column 2 Note: Diagnosis must be small cell carcinoma (NOS), not a subtype of small cell Squamous cell carcinoma* AND large cell nonkeratinizing Squamous cell carcinoma AND small cell nonkeratinizing Squamous cell carcinoma* AND one of the histologies in Column 2 A combination of at least two of the histologies in Column 2** Column 2: Additional Required Terms

Column 3: ICD-O-3 Term Giant cell and spindle cell carcinoma Adenocarcinoma Large cell carcinoma Squamous cell carcinoma Spindle cell carcinoma Sarcomatoid Acinar Bronchioloalveolar carcinoma Bronchioloalveolar carcinoma non mucinous (Clara cell/type II pneumocyte) Bronchioloalveolar carcinoma mucinous (goblet cell)

Bronchioloalveolar carcinoma mixed mucinous and non-mucinous Clear cell adenocarcinoma Papillary adenocarcinoma Solid adenocarcinoma Well-differentiated fetal adenocarcinoma Column 4: ICD-O-3 Code 8030 Combined small cell carcinoma Mixed small cell carcinoma 8045

Squamous cell carcinoma, large cell, nonkeratinizing Squamous cell caricinoma, small cell, nonkeratinizing Squamous cell carcinoma, spindle cell Squamous cell carcinoma, sarcomatoid Adenocarcinoma with mixed subtypes** 8072 8073 8074 8255** 87 Multiple Primaries and Histology

Coding RulesLung Cases Case 1 Lung bx: Poorly differentiated non-small cell lung carcinoma (mixed large cell undifferentiated and adenocarcinoma). (Single primary) Histology code: 8140 Histology rule: H7 88 Multiple Primaries and Histology Coding RulesLung Cases Case 2 Lung with moderately differentiated adenocarcinoma, mucin secreting cells, mixed acinar, papillary, and

bronchioalveolar features. (Single primary) Histology code: 8255 Histology rule: H6 89 Multiple Primaries and Histology Coding RulesLung Cases Case 3 Poorly differentiated carcinoma, non-small cell type. (Single primary) Histology code: 8046 Histology rule: H5

90 Multiple Primaries and Histology Coding RulesLung Cases Case 4 Lung, right upper lobectomy: 2 nodules of carcinoma with mucin production (c/w pulmonary primary), one nodule has bronchoalveolar features, the other shows focal squamous differentiation. (2 primaries) #1 #2 Histology code: 8250 Histology rule: H5

8070 H5 91 MP/H Task Force 92

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