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Tumor Tip of the Week-What to do with those Needle Biopsies

Scenario: [Biopsy Cytology (other than lymph node)]

1/6/2018 Fine Needle Aspirate cytology of the thyroid nodule showed papillary carcinoma

Question: How do you code the 1/6/2018 FNA of the Thyroid Nodule?

  • Code 02 in in the Diagnostic & Staging Procedure
  • Do not code the procedure but list it in the text.

Answer: Do not code the procedure, but list it in the text

Rationale: STORE Surgical Diagnostic and Staging Procedure Code brushings, washings, cell aspiration, and hematologic findings (peripheral blood smears) as positive cytologic diagnostic confirmation in the data item Diagnostic Confirmation [490]. These are not considered surgical procedures and should not be coded in this item.

Scenario: [Biopsy Histology (other than lymph node)]

1/6/2018 Core needle biopsy histology of the thyroid nodule showed papillary carcinoma

Question: How do you code the 1/6/2018 FNA core biopsy of the Thyroid Nodule?

  • Code 02 in in the Diagnostic & Staging Procedure
  • Do not code the procedure but list it in the text.

Answer: Code 02 in in the Diagnostic & Staging Procedure

Rationale: STORE Surgical Diagnostic and Staging Procedure Code 02= A biopsy (incisional, needle, or aspiration) was done to the primary site [The reason the answer is different from the prior scenario is because this is positive histology, not cytology.]

Scenario: [Cytology or histology of regional lymph node for a non-lymph node primary]

1/6/2018 Fine Needle Aspirate cytology of hilar lymph node + metastatic non-small carcinoma consistent with lung primary

Question: How do you code the 1/6/2018 Fine Needle Aspirate of the hilar lymph node?

  • Code 02 in in the Diagnostic & Staging Procedure
  • Do not code the procedure but list it in the text.
  • Code 1 in Scope of Regional Lymph Node Surgery (Bx or Aspiration of Regional LN)

Answer: Code 1 in Scope of Regional Lymph Node Surgery (Bx or Aspiration of Regional LN)

Rationale: STORE Scope of Regional Lymph Node Surgery Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes in an effort to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.

Scenario: [Negative cytology or histology of regional lymph node for a non-lymph node primary]

1-4-2018 patient diagnosed with RUL adenocarcinoma

1/6/2018 Fine Needle Aspirate cytology of hilar lymph node was negative for adenocarcinoma

Question: How do you code the 1/6/2018 Fine Needle Aspirate of the hilar lymph node?

  • Code 02 in in the Diagnostic & Staging Procedure
  • Do not code the procedure but list it in the text.
  • Code 1 in Scope of Regional Lymph Node Surgery (Bx or Aspiration of Regional LN)

Answer: Code 1 in Scope of Regional Lymph Node Surgery (Bx or Aspiration of Regional LN)

Rationale: STORE Scope of Regional Lymph Node Surgery Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes in an effort to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.

CAnswer Forum Post Code 1 in Scope of Regional Lymph Nodes regardless of whether the result is positive or negative.

http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/fords/initial-diagnosis/scope-of-regional-lymph-nodes/65014-do-we-code-negative-results-in-scope-of-regional-lymph-nodes

Scenario: [Cytology or histology of regional lymph node for a lymph node primary]

1/6/2018 Fine Needle Aspirate cytology of hilar lymph node + lymphoma [Scans show multiple areas of lymph node involvement]

Question: How do you code the 1/6/2018 Fine Needle Aspirate of the hilar lymph node?

  • Code 02 in in the Diagnostic & Staging Procedure
  • Do not code the procedure but list it in the text.
  • Code 1 in Scope of Regional Lymph Node Surgery

Answer: Code 02 in in the Diagnostic & Staging Procedure

Rationale: STORE Surgical Diagnostic and Staging Procedure If a lymph node is biopsied or removed to diagnose or stage lymphoma, and that node is NOT the only node involved with lymphoma, use code 02. If there is only a single lymph node involved with lymphoma, use the data item Surgical Procedure of Primary Site [1290] to code

these procedures.

Scenario: [Ambiguous terms & cytology]

1/6/2018 Fine Needle Aspirate cytology of the thyroid nodule suspicious for papillary carcinoma

Question: Can you use the date of the 01-06-2018 FNA Aspirate that is suspicious for papillary carcinoma as the date of diagnosis?

  • Yes
  • No

Answer: No

Rationale: STORE Ambiguous Terms that Constitute a Diagnosis EXCEPTION: If cytology is identified only with an ambiguous term, do not interpret it as a diagnosis of cancer. Abstract the case only if a positive biopsy or a physician’s clinical impression of cancer supports the cytology findings.

Summary

  • Biopsy of Site Other than Lymph Nodes
    • If the biopsy (other than lymph node) is obtained using FNA technique and issued as a cytology report, it is NOT coded in the item Surgical Diagnostic and Staging Procedure.
    • If the biopsy (other than lymph node) is obtained using FNA technique and issued in a pathology report, it IS coded in the item Surgical Diagnostic and Staging Procedure.
    • Only record positive procedures. For benign and borderline reportable tumors, report the biopsies positive for those conditions
  • Biopsy of Regional Lymph Nodes
    • Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes in an effort to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.
    • Record the biopsy of regional lymph nodes whether it is positive or negative.
    • If a lymph node is biopsied or removed to diagnose or stage lymphoma, and that node is NOT the only node involved with lymphoma, use code 02. If there is only a single lymph node involved with lymphoma, use the data item Surgical Procedure of Primary Site [1290] to code these procedures
  • If cytology is identified only with an ambiguous term, do not interpret it as a diagnosis of cancer. Abstract the case only if a positive biopsy or a physician’s clinical impression of cancer supports the cytology findings.
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