Ill-Define Site Override (IF22)

This edit forces review of multiple primary cancers when one of the primaries is coded to a site-morphology combination that could indicate a metastatic site rather than a primary site.

GENERAL

It is important to verify that the suspect case is indeed a separate primary from any others that may have been reported for the patient. Correction of errors may require inspection of the abstracted text, either online or as recorded on a paper abstract. Review of the original medical record may be necessary. If the suspect case is accurate as coded, and the number of primaries is correct, set the Over-ride Ill-define site flag to 1 so that the case will not be considered in error when the edit is run again. It is not necessary to set the over-ride flag on the patient’s other primary cancers.

If it turns out that the suspect cancer is considered a manifestation of one of the patient’s other cancers, delete the former case, resequence remaining cases, and correct the coding on the latter case as necessary.

SPECIFIC GUIDELINES

1.   Ill-defined sites (C76.0 - C76.8) or unknown primary (C80.9) and histology code less than 9590: Look for evidence that the unknown or ill-defined primary is a secondary site (extension or metastasis) from one of the patient’s other cancers. For example, a clinical discharge diagnosis of ”r;abdominal carcinomatosis” may be attributable to the patient’s primary ovarian cystadenocarcinoma known to the registry, and should not be entered as a second primary.

2.   Lymph nodes (C77.0 - C77.9) and histology code not in the range 9590-9714: Primary malignancies of lymph nodes are almost exclusively the lymphomas coded in the range 9590-9714. A carcinoma, sarcoma, leukemia, or other diagnosis outside that range in a lymph node is most likely a metastatic (secondary) lesion. Check whether the lymph node lesion could be a manifestation of one of the patient’s other cancers. If the lesion in the lymph node is considered a separate primary, try to ascertain a more appropriate primary site than lymph nodes.

3.   Hematopoietic and reticuloendothelial systems (C42.0 - C42.4) and histology not in the range 9590-9941: Primary cancers of the blood, bone marrow, spleen, etc. are almost exclusively lymphomas, leukemias, and related conditions coded in the range 9590-9941. A carcinoma, sarcoma, or other diagnosis outside that range in one of these sites is most likely a metastatic (secondary) lesion. Check whether the lesions could be a manifestation of one of the patient’s other cancers. If the lesion is considered a separate primary, try to ascertain a more appropriate primary site other than those in the C42 group.

4.   Other lymphoreticular neoplasms and mast cell tumors of any site (histologies 9720-9723 and 9740-9741): Verify that these diagnoses are coded correctly and are indeed separate primaries from the other reported ones.

Instructions for Coding

•            Leave blank if the EDITS program does not generate an error message for this edit.

•            Leave blank and correct any errors for the case if an item is discovered to be incorrect.

•            Code 1 if review of all items in the error or warning message confirms that all are correct.