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Tumor Tip of the Week-Draining Lymph Nodes Esophagus

Scenario: 2021 Distal Esophagus Primary Treated with radiation
DOSE SITE SUMMARY: 4500 cGy was delivered. The field superiorly was 1 cm superior to the carina, inferiorly included the celiac artery, as the gastric entry was the denser portion of the medial wall, and elsewhere the paraesophageal, mediastinal and perigastric — gastrohepatic nodal areas. There was no portal hepatitis within the clinical treatment volume.
Question:  How would how would I assign the Phase 1 Radiation to Draining Lymph Nodes?
  • 02 Thoracic lymph node regions
  • 05 Abdominal lymph nodes
  • 08 Lymph node region, NOS
Answer:   08 Lymph node region, NOS
Discussion
  • Determine which lymph node regions were targeted & which category they are located.  For lack of a better resource, I used Appendix C Lymph Node/Lymph Node Chain Reference Table in the Hematopoietic and Lymphoid Neoplasm Coding Manual to help me determine the ICD-0 Lymph node regions.
    • Paraesophageal nodes-thoracic node region
    • Mediastinal nodes-thoracic node region
    • Perigastric nodes-abdominal node region
    • Gastrohepatic nodes-abdominal node region
  • Determined both Thoracic & Abdominal node regions were targeted, the STORE does not have a combination code for these lymph node regions, so consulted CAnswer Forum to determine appropriate plan of action.
  • CAnswer Forum Post We do not have all combination codes for volume and cannot cover every situation with precision coding. For this particular case we would recommend Volume Code 08, Lymph Node Regions, NOS
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