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Tumor Tip of the Week – Endometrioid Adenocarcinoma pT3b pN0 treated with TAH/BSO + XRT

Scenario:  Endometrioid Adenocarcinoma pT3b pN0 treated with TAH/BSO + XRT

1/7/21 to 2/11/21, Whole pelvis RT w/ 6X/IMRT, 180 cGy x 25 fx to 45 Gy.

2/13/21 to 2/18/21, Vaginal cuff HDR brachytherapy via Ir-192 seeds, 600 cGy x 2 fx for a total of 1200 cGy.

 

Question 1:  How would you code Phase I Volume?

  • 71 Uterus or Cervix
  • 86 Pelvis Nos

Answer: 71 Uterus or Cervix

 

Rationale:  CTR Guide to Coding Radiation Therapy Treatment in the STORE Version 3.0 February 2021

Example #16 Gyn-Brachytherapy + External Beam Radiotherapy (EBRT) . If a primary site in the pelvic region is surgically resected, code the primary irradiated volume to the primary site

 

Question 2:  How would you code Phase I Radiation to Draining Lymph Nodes?

  • 00 No radiation treatment to draining lymph nodes
  • 06 Pelvic lymph nodes

Answer: 06 Pelvic Lymph nodes

 

Rationale:  STORE Phase I-II-III Radiation to Draining Lymph Nodes page 267 Example: Prostate cancer patient declines surgery for management of his prostate cancer, and opts for EBRT. The treatment summary states that pelvis/prostate were targeted on phase 1 with 180 cGy X 25 fx= 45 Gy. Record Phase I Radiation to Draining Lymph Nodes as 06 because when the pelvis is specifically mentioned in the treatment summary, we can assume that regional lymph nodes were targeted.

 

CTR Guide to Coding Radiation Therapy Treatment in the STORE Version 3.0 February 2021

When a region like the pelvis is treated, code the primary site. Pelvic lymph nodes are identified as a target in Rad to Nodes Example #6, #8, #16, #24, #26

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