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The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. Cover, Preface, TOC - MP/H Coding Rules Manual Multiple Primary and Histology Coding Rules
January 10, 2008
National Cancer Institute Surveillance Epidemiology and End Results Program Bethesda, MD TEXT VERSION PLEASE NOTE This PDF of the 2007 Multiple Primaries and Histology Coding Rules was downloaded from the SEER website
( www.seer.cancer.gov/tools/mphrules/download.html ).
The content is current as of January 10, 2008. It includes the November 2007 replacement pages (errata and
clarifications) and the benign/borderline brain tumor rules. The file has been reorganized and bookmarked for
efficient use. The site-specific terms and definitions for each set of site-specific rules have been inserted in front
of the multiple primaries rules and the histology coding rules, and the pages can be accessed using the
Bookmark feature of Adobe Acrobat 7.0. Only one format of the MP/H Rules is included in this document.
No changes have been made to the content. The page numbers shown on the pages are from the original SEER
documents. Because the content of the Terms and Definitions and the site-specific rules sections have been
merged, the page numbers are not sequential. Use the Bookmark feature to jump to the page you need. Click
on Bookmark at the upper left of the document to open the list of bookmarked pages. Click on [+] to further
expand the list or click on [] to collapse the list. Clicking on any topic will take you to the first page of that
section.
This PDF document has been ENABLED to allow you to add highlighting, comments, and/or sticky notes to
any page if you have version 7 or higher of the free Adobe Reader. To download the most recent version of
Adobe Reader (version 8), go to http://www.adobe.com/products/acrobat/readstep2.html .
To learn how to add highlighting or sticky notes to this document, download the separate document How to
Add Comments to a PDF with Adobe Reader from www.afritz.org . The instructions in that document are based on Adobe Reader 8.
The content of this document is in the public domain. This PDF was prepared for free distribution by A.Fritz
and Associates, LLC, Reno Nevada ( www.afritz.org ). Please send comments to april@afritz.org . TABLE OF CONTENTS Important NotesPlease Read Preface Multiple Primary and Histology Rules General Instructions Multiple Primary and Histology Coding Rules 1 HEAD AND NECK
Head and Neck Terms and Definitions
Head and Neck Multiple Primary Rules
Head and Neck Histology Coding Rules 2 COLON
Colon Terms and Definitions
Colon Multiple Primary Rules
Colon Histology Coding Rules 3 LUNG
Lung Terms and Definitions
Lung Multiple Primary Rules
Lung Histology Coding Rules 4 MALIGNANT MELANOMA
Melanoma Terms and Definitions
Melanoma Multiple Primary Rules
Melanoma Histology Coding Rules 5 BREAST
Breast Terms and Definitions
Breast Multiple Primary Rules
Breast Histology Coding Rules
6 KIDNEY
Kidney Terms and Definitions
Kidney Multiple Primary Rules
Kidney Histology Coding Rules 7 URINARY TRACT
Ureter/Renal Pelvis/Bladder Terms and Definitions
Ureter/Renal Pelvis/Bladder Multiple Primary Rules
Ureter/Renal Pelvis/Bladder Histology Coding Rules 8 MALIGNANT CENTRAL NERVOUS SYSTEM
Brain Terms and Definitions
Brain Multiple Primary Rules
Brain Histology Coding Rules 9 BENIGN/BORDERLINE CENTRAL NERVOUS SYSTEM
Brain Terms and Definitions
Brain Multiple Primary Rules
Brain Histology Coding Rules 10 OTHER SITES
Other Sites Terms and Definitions
Other Sites Multiple Primary Rules
Other Sites Histology Coding Rules
New Data Items Ambiguous Terminology
Date of Conclusive Terminology
Multiplicity Counter
Date of Multiple Tumors
Types of Multiple Tumors Reported as One Primary The 2007 Multiple Primary and Histology Coding Rules Carol Johnson, BS, CTR, Steve Peace, BS, CTR, Peggy Adamo, RHIT, CTR, April Fritz, RHIT, CTR, Antoinette Percy-Laurry, MSPH, Brenda K. Edwards, PhD
Preface The 2007 Multiple Primary and Histology (MP/H) Coding Rules present the first site-specific multiple primary and histology rules
developed to promote consistent and standardized coding by cancer registrars. This project was sponsored by the National Cancer Institute
(NCI) Surveillance Epidemiology and End Results (SEER) Program. In January 2003, the Multiple Primary and Histology Task Force was
formed to tackle problems identified in existing rules. The MP/H Task Force was a diverse group with membership from all but two SEER
regions, the American College of Surgeons (ACoS) Commission on Cancer (CoC), the American Joint Committee on Cancer (AJCC), the
Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR), the National Cancer Registrars
Association (NCRA), North American Association of Central Cancer Registries (NAACCR), 15 central registry representatives, and
Canadian Cancer Registries. Physician guidance by specialty pathologists and clinicians was integral to the review and revision process.
Regular consultation with the editors of ICD-O-3 clarified ICD-O-3 codes and ensured that the new rules accurately reflect the ICD-O-3
editors intent and purpose.
The 2007 MP/H Rules include site-specific rules for lung, breast, colon, melanoma of the skin, head and neck, kidney, renal
pelvis/ureter/bladder, and malignant brain. A separate set of rules addresses the specific and general rules for malignant solid tumors
originating in all other sites. The multiple primary rules guide and standardize the process of determining the number of primaries. The
histology rules contain detailed histology coding instructions. For example, there are instructions and guidance for identifying histologic
lineages, differentiating between general (NOS) terms and specific histologic types, and correctly assigning mixed and combination codes.
The rules are available in three formats: flowchart, matrix and text. The different formats were developed to meet the needs of registrars
who have different learning styles.
The MP/H Task Force also developed three new data items that complement these rules, Multiplicity Counter, Date of Multiple Tumors, and
Type of Multiple Tumors Reported as One Primary.
The rules are available in this stand-alone manual and also in the 2007 SEER Coding and Staging Manual.
A cadre of instructors has been trained to provide in-person education on using the new rules to registrars. Web-based cancer registrar
education is available on the SEER training website, http://seer.cancer.gov/ . Multiple primary and histology issues are covered in several modules, and a 2007 MP/H rules module will be added. Continuing education units can be requested from the National Cancer Registrars
Association. Recorded training webcasts will be available for viewing and provide another option for mass training of registrars who cannot
attend an in-person workshop. January 1, 2007 5 6 January 1, 2007 Multiple Primary and Histology Rules General Instructions January 1, 2007 7 8 January 1, 2007 Multiple Primary and Histology Coding Rules General Instructions EQUIVALENT OR EQUAL TERMS Adenocarcinoma, glandular carcinoma
Multicentric, multifocal
Tumor, mass, lesion, neoplasm
DEFINITIONS Note: Use these terms and definitions for all reportable cases except lymphoma and leukemia primaries (M9590-9989).
Bilateral: Relating to the right and left sides of the body or of a body structure; bilaterality is not an indication of single or multiple primaries.
Clinical Diagnosis: A diagnosis that is not microscopically confirmed. It may be based on information from diagnostic imaging or the clinicians
expertise.
Contiguous tumor: A single tumor that involves, invades, or bridges adjacent or connecting sites or subsites. Focal: An adjective meaning limited to one specific area. A focal cancer is limited to one specific area or organ. The area may be microscopic or
macroscopic.
Foci: Plural of focus.
Focus: A term used by pathologists to describe a group of cells that can be seen only by a microscope. The cells are noticeably different from
the surrounding tissue either by their appearance, chemical stain, or other testing.
Laterality: Indication of which side of a paired organ/site a tumor is located. (See Paired organ/site)
Most representative specimen: The pathologic specimen from the surgical procedure that removed the most tumor tissue.
Multiple primaries: More than one reportable case.
Overlapping tumor: The involved sites are adjacent (next to each other) and the tumor is contiguous.
Paired organ/site: There are two sides, one on the left side of the body and one on the right side of the body. (See Laterality)
Revised November 1, 2007 9 Multiple Primary and Histology Coding Rules General Instructions Recurrence: This term has two meanings: 1. The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy. 2. A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer. A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense a new occurrence of cancer.
Single primary: One reportable case.
Unilateral: Relating to one side of the body or one side of a body structure. DETERMINING MULTIPLE PRIMARIES FOR SOLID MALIGNANT TUMORS Note: T he rules do not apply to hematopoietic primaries (lymphoma and leukemia) of any site or to the reportable benign or borderline intracranial or CNS tumors..
A. General Information 1. Use these rules to determine the number of reportable primaries. Do not use these rules to determine case reportablility, stage, or grade. 2. The 2007 multiple primary and histology coding rules replace all previous multiple primary and histology coding rules. 3. 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. 4. Read the General Instructions and the site-specific Equivalent Terms and Definitions before using the multiple primary rules. 5. The multiple primary and histology coding rules are available in three formats: flowchart, text, and matrix. The rules are identical,
only the formats differ. Use the rules in the format that is easiest for you to follow. 6. Notes and examples are included with some of the rules to highlight key points or to add clarity to the rules. 7. Do not use a physicians statement to decide whether the patient has a recurrence of a previous cancer or a new primary. 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 cancer from the previous primary. 8. Use the Determining Multiple Primaries: Hematopoietic Primaries (Lymphoma and Leukemia) rules and table Definitions of Single
and Subsequent Primaries for Hematologic Malignancies to determine single versus multiple primaries for lymphoma and leukemia
cases. B. How to Use the Multiple Primary Rules 1. Use the Multiple Primary rules to make a decision on the number of primary malignancies to be abstracted for reportable solid malignant tumors. 2. Use the site-specific rules for the following primary sites: x Brain, malignant (intracranial and CNS) x Breast 10 January 1, 2007 Multiple Primary and Histology Coding Rules General Instructions Colon Head and neck Kidney Lung Malignant melanoma of the skin Renal pelvis, ureter, bladder, and other urinary 3. Use the Other Sites rules for solid malignant tumors that occur in primary sites not covered by the site-specific rules. 4. Each module (Unknown if Single or Multiple Tumors, Single Tumor, Multiple Tumors) is an independent, complete set of coding rules.
To determine which set of primary site rules to use:
a.. When there is no tumor in the primary site, only metastatic lesions are present: I. Use the primary site documented by a physician and use the multiple primary and histology coding rules for that primary site.
II. If no primary site is documented, code the primary site as unknown and use the general multiple primary and histology coding rules. Use the Unknown if Single or Multiple Tumors module to determine multiple primaries and the Single Tumor module
for coding histology. b. To choose the appropriate module (Unknown if Single or Multiple Tumors, Single Tumor, Multiple Tumors), I. Use the multiple primary and histology coding rules for the primary site II. Determine the number of tumors
i. Do not count metastatic lesions ii. When the tumor is only described as multicentric or multifocal and the number of tumors is not mentioned, use the Unknown
if Single or Multiple Tumors module iii. When there is a tumor or tumors with separate microscopic foci, ignore the separate microscopic foci and use the Single
Tumor or Multiple Tumor modules as appropriate iv. When the patient has a single tumor, use the Single Tumor module. v. If there are multiple tumors, use the Multiple Tumor module. III. See the Equivalent Terms and Definitions for Head and Neck for guidance in coding the primary site IV. Use the primary site documented by the physician on the medical record 5. If a single primary, prepare one abstract. 6. If there are multiple primaries, prepare two or more abstracts. 7. Rules are in hierarchical order within each module (Unknown if Single or Multiple Tumors, Single Tumor, and Multiple Tumors). Use the
first rule that applies and STOP January 1, 2007 11 Histologic Type ICD-O-3 Item Length: 4 NAACCR Item #: 522 NAACCR Name: Histologic Type ICD-O-3
The data item Histologic Type ICD-O-3 describes the microscopic composition of cells and/or tissue for a specific primary. The tumor type or
histology is a basis for staging and determination of treatment options. It affects the prognosis and course of the disease.
The International Classification of Diseases for Oncology, Third Edition (ICD-O-3) is the standard reference for histology codes for tumors
diagnosed in 2001 and later. Do not record the M that precedes the histology code. See sections Coding Guidelines for Topography and
Morphology. and Summary of Principal Rules for Using the ICD-O, Third Edition for guidance in using the ICD-O-3.
Information about the 2007 Histology Coding Rules Note: Do not use these rules to determine case reportability. 1. The 2007 multiple primary rules replace all previous multiple primary rules. 2. 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. 3. The histology coding rules are available in three formats: flowchart, text, and matrix. The rules are identical, only the formats differ.
Use the set of rules in the format that is easiest for you to follow. 4. Notes and examples are included with some of the rules to highlight key points or to add clarity to the rules. 5. Rules are in hierarchical order within each section (Single Tumor and Multiple Tumors Abstracted as a Single Primary). How to Use the Rules 1. Read the General Instructions. 2. Read the site-specific Equivalent Terms and Definitions. 3. Use these rules to make a decision on coding the histology for all reportable solid malignant tumors. 4. Use the multiple primary rules to determine whether the patient has a single or multiple primaries before coding the histology. 5. Code the histology for each primary in a separate abstract. 6. Use the site-specific rules for the following primary sites: Brain, malignant (intracranial and CNS) Breast Colon Head and neck Kidney Lung Malignant melanoma of the skin 12 January 1, 2007 x Renal pelvis, ureter, bladder, and other urinary
7. Use the Other Sites rules for all solid malignant tumors that occur in primary sites not included in the site-specific rules.
8. Determine whether the patient has a single tumor or multiple tumors that will be abstracted as a single primary a. Do not count metastatic tumors
b. When the tumor is described as multifocal or multicentric, use the Multiple Tumors module
c. When there is a tumor or tumors with separate foci of tumor do not count the foci
d. Only count the tumors that will be used to prepare that abstract. For example, when there are two tumors that will be abstracted as multiple primaries, you would use the Single Tumor modules to determine the histology code for each of the abstracts.. 9. Each section (Single Tumor and Multiple Tumors Abstracted as a Single Primary) is an independent, complete set of coding rules. For example, if the patient has multiple tumors, that will be abstracted as a single primary start with the first rule under the heading Multiple
Tumors Abstracted as a Single Primary. Do not use any of the rules under the header Single Tumor. 10. Use the first rule that applies and STOP
Priority order for using Documents to Code Histology Medical records frequently include multiple pathology reports and references to histologic diagnosis. Use the following instructions to
identify which reports best represent the histology to be coded. 1. Pathology report:
a. From the most representative tumor specimen examined
b. From the final diagnosis Note 1: Use information from addenda and comments associated with the final diagnosis to code the histology. Note 2: A revised/amended diagnosis replaces the original final diagnosis. Code the histology from the revised/amended diagnosis. Note 3: The new rules limit the information to the final diagnosis. The old rules allowed coding from information in the microscopic description. You will only use information from the microscopic portion of the pathology report when instructed to do so in one of the site-specific
rules. 2. Cytology report. 3. When you do not have either a pathology report or cytology report:
a. Documentation in the medical record that references pathology or cytology findings
b. From mention of type of cancer (histology) in the medical record January 1, 2007 13 Multiple Primary and Histology Coding Rules General Instructions Ambiguous Terms Used to Code Histology When any of the ambiguous terms are used to describe a more specific histology, code the more specific histology.
Ambiguous terms that are characteristic (used to code histology) Apparent(ly)
Appears
Comparable with
Compatible with
Consistent with
Favor(s)
Most likely
Presumed
Probable
Suspect(ed)
Suspicious (for)
Typical (of) Example: Non-small cell carcinoma, most likely adenocarcinoma. Code adenocarcinoma.
General Instructions Histology Coding Rules
When using rule (see note) that states Code the histology documented by the physician when the pathology/cytology report is not available code
the histology from the document with the highest priority. Make a second pass through the histology rules to determine which histology code
should be recorded. Start with the appropriate module, Single Tumor or Multiple Tumors, and continue through the rules until you reach the rule
that fits the case you are coding. Note: For most sites this will be rule H1 and the first rule in the Multiple Tumors module When using rule (see note) that states When the only histology is from a metastatic site make a second pass through the histology rules to
determine which histology code should be recorded. Start with the appropriate module, Single Tumor or Multiple Tumors, and continue through
the rules until you reach the rule that fits the case you are coding. Note: For most sites this will be rule H2 and the second rule in the Multiple Tumors module When the patient has a previous or subsequent unknown primary site (80.9) or an ill-defined primary site, check carefully to see if this abstract or
document should be consolidated into the previous abstract rather than making it a new primary. 14 Revised November 1, 2007 Multiple Primary and Histology Coding Rules January 1, 2007 275 Site-Specific Terms and Definitions 276 January 1, 2007 Head and Neck Terms and Definitions Head and Neck Equivalent Terms, Definitions, Charts, Tables and Illustrations C000-C148, C300-C329 (Excludes lymphoma and leukemia M-9590 9989 and Kaposi sarcoma M9140) Guidelines for Head and Neck The head and neck rules cover the following sites: Lip C000-C009, Oral Cavity C019-C069, Salivary Gland C079-C089, Tonsil C090-C099,
Oropharynx C100-C109, Nasopharynx C110-C119, Pyriform Sinus C129, Hypopharynx C130-C139, Other and Ill-defined Sites in Lip, Oral
cavity and Pharynx C140-C148, Nasal Cavity C300, Middle Ear C301, Accessory Sinuses C310-C319, and Larynx C320-C329. Head and neck tumors frequently extend into adjacent anatomic sites, or overlap multiple contiguous sites. The workup for these tumors often
includes physical examinations, imaging, scans, endoscopies, biopsies and surgical observations. Each of these diagnostic tools provides a unique
view of the tumor. More than one anatomic location may be involved with tumor and reports may contain conflicting information regarding the
primary site. Coding the Primary Site
Code the site where the tumor originated; do not simply code the biopsy site. When there are multiple biopsies and the primary site is not documented, or when there is discrepant information, code the primary site using the
following priority order. Priority Order 1. Tumor board a. Specialty
b. General 2. Staging physicians site assignment a. AJCC staging form
b. TNM statement in medical record If neither 1 nor 2 are available, the priority order for using information depends upon whether the patient had a surgical resection of the
primary tumor. 3. Total (complete) resection of primary tumor Note: The primary tumor is completely removed. The surgical margins may be microscopically positive. a. Surgeons statement from operative report
b. Final diagnosis from pathology report January 1, 2007 17 Head and Neck Terms and Definitions Head and Neck Equivalent Terms, Definitions, Charts, Tables and Illustrations C000-C148, C300-C329 (Excludes lymphoma and leukemia M-9590 9989 and Kaposi sarcoma M9140) 4. No resection (biopsy only): Documentation from: a. Endoscopy (physical exam with scope)
b. Radiation oncologist
c. Diagnosing physician
d. Primary care physician
e. Other physician
f. Radiologist impression from diagnostic imaging g. Physician statement based on physical exam (clinical impression) When the point of origin cannot be determined, use a topography code for overlapping sites:
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. Cover, Preface, TOC - MP/H Coding Rules Manual Multiple Primary and Histology Coding Rules
January 10, 2008
National Cancer Institute Surveillance Epidemiology and End Results Program Bethesda, MD TEXT VERSION PLEASE NOTE This PDF of the 2007 Multiple Primaries and Histology Coding Rules was downloaded from the SEER website
( www.seer.cancer.gov/tools/mphrules/download.html ).
The content is current as of January 10, 2008. It includes the November 2007 replacement pages (errata and
clarifications) and the benign/borderline brain tumor rules. The file has been reorganized and bookmarked for
efficient use. The site-specific terms and definitions for each set of site-specific rules have been inserted in front
of the multiple primaries rules and the histology coding rules, and the pages can be accessed using the
Bookmark feature of Adobe Acrobat 7.0. Only one format of the MP/H Rules is included in this document.
No changes have been made to the content. The page numbers shown on the pages are from the original SEER
documents. Because the content of the Terms and Definitions and the site-specific rules sections have been
merged, the page numbers are not sequential. Use the Bookmark feature to jump to the page you need. Click
on Bookmark at the upper left of the document to open the list of bookmarked pages. Click on [+] to further
expand the list or click on [] to collapse the list. Clicking on any topic will take you to the first page of that
section.
This PDF document has been ENABLED to allow you to add highlighting, comments, and/or sticky notes to
any page if you have version 7 or higher of the free Adobe Reader. To download the most recent version of
Adobe Reader (version 8), go to http://www.adobe.com/products/acrobat/readstep2.html .
To learn how to add highlighting or sticky notes to this document, download the separate document How to
Add Comments to a PDF with Adobe Reader from www.afritz.org . The instructions in that document are based on Adobe Reader 8.
The content of this document is in the public domain. This PDF was prepared for free distribution by A.Fritz
and Associates, LLC, Reno Nevada ( www.afritz.org ). Please send comments to april@afritz.org . TABLE OF CONTENTS Important NotesPlease Read Preface Multiple Primary and Histology Rules General Instructions Multiple Primary and Histology Coding Rules 1 HEAD AND NECK
Head and Neck Terms and Definitions
Head and Neck Multiple Primary Rules
Head and Neck Histology Coding Rules 2 COLON
Colon Terms and Definitions
Colon Multiple Primary Rules
Colon Histology Coding Rules 3 LUNG
Lung Terms and Definitions
Lung Multiple Primary Rules
Lung Histology Coding Rules 4 MALIGNANT MELANOMA
Melanoma Terms and Definitions
Melanoma Multiple Primary Rules
Melanoma Histology Coding Rules 5 BREAST
Breast Terms and Definitions
Breast Multiple Primary Rules
Breast Histology Coding Rules
6 KIDNEY
Kidney Terms and Definitions
Kidney Multiple Primary Rules
Kidney Histology Coding Rules 7 URINARY TRACT
Ureter/Renal Pelvis/Bladder Terms and Definitions
Ureter/Renal Pelvis/Bladder Multiple Primary Rules
Ureter/Renal Pelvis/Bladder Histology Coding Rules 8 MALIGNANT CENTRAL NERVOUS SYSTEM
Brain Terms and Definitions
Brain Multiple Primary Rules
Brain Histology Coding Rules 9 BENIGN/BORDERLINE CENTRAL NERVOUS SYSTEM
Brain Terms and Definitions
Brain Multiple Primary Rules
Brain Histology Coding Rules 10 OTHER SITES
Other Sites Terms and Definitions
Other Sites Multiple Primary Rules
Other Sites Histology Coding Rules
New Data Items Ambiguous Terminology
Date of Conclusive Terminology
Multiplicity Counter
Date of Multiple Tumors
Types of Multiple Tumors Reported as One Primary The 2007 Multiple Primary and Histology Coding Rules Carol Johnson, BS, CTR, Steve Peace, BS, CTR, Peggy Adamo, RHIT, CTR, April Fritz, RHIT, CTR, Antoinette Percy-Laurry, MSPH, Brenda K. Edwards, PhD
Preface The 2007 Multiple Primary and Histology (MP/H) Coding Rules present the first site-specific multiple primary and histology rules
developed to promote consistent and standardized coding by cancer registrars. This project was sponsored by the National Cancer Institute
(NCI) Surveillance Epidemiology and End Results (SEER) Program. In January 2003, the Multiple Primary and Histology Task Force was
formed to tackle problems identified in existing rules. The MP/H Task Force was a diverse group with membership from all but two SEER
regions, the American College of Surgeons (ACoS) Commission on Cancer (CoC), the American Joint Committee on Cancer (AJCC), the
Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR), the National Cancer Registrars
Association (NCRA), North American Association of Central Cancer Registries (NAACCR), 15 central registry representatives, and
Canadian Cancer Registries. Physician guidance by specialty pathologists and clinicians was integral to the review and revision process.
Regular consultation with the editors of ICD-O-3 clarified ICD-O-3 codes and ensured that the new rules accurately reflect the ICD-O-3
editors intent and purpose.
The 2007 MP/H Rules include site-specific rules for lung, breast, colon, melanoma of the skin, head and neck, kidney, renal
pelvis/ureter/bladder, and malignant brain. A separate set of rules addresses the specific and general rules for malignant solid tumors
originating in all other sites. The multiple primary rules guide and standardize the process of determining the number of primaries. The
histology rules contain detailed histology coding instructions. For example, there are instructions and guidance for identifying histologic
lineages, differentiating between general (NOS) terms and specific histologic types, and correctly assigning mixed and combination codes.
The rules are available in three formats: flowchart, matrix and text. The different formats were developed to meet the needs of registrars
who have different learning styles.
The MP/H Task Force also developed three new data items that complement these rules, Multiplicity Counter, Date of Multiple Tumors, and
Type of Multiple Tumors Reported as One Primary.
The rules are available in this stand-alone manual and also in the 2007 SEER Coding and Staging Manual.
A cadre of instructors has been trained to provide in-person education on using the new rules to registrars. Web-based cancer registrar
education is available on the SEER training website, http://seer.cancer.gov/ . Multiple primary and histology issues are covered in several modules, and a 2007 MP/H rules module will be added. Continuing education units can be requested from the National Cancer Registrars
Association. Recorded training webcasts will be available for viewing and provide another option for mass training of registrars who cannot
attend an in-person workshop. January 1, 2007 5 6 January 1, 2007 Multiple Primary and Histology Rules General Instructions January 1, 2007 7 8 January 1, 2007 Multiple Primary and Histology Coding Rules General Instructions EQUIVALENT OR EQUAL TERMS Adenocarcinoma, glandular carcinoma
Multicentric, multifocal
Tumor, mass, lesion, neoplasm
DEFINITIONS Note: Use these terms and definitions for all reportable cases except lymphoma and leukemia primaries (M9590-9989).
Bilateral: Relating to the right and left sides of the body or of a body structure; bilaterality is not an indication of single or multiple primaries.
Clinical Diagnosis: A diagnosis that is not microscopically confirmed. It may be based on information from diagnostic imaging or the clinicians
expertise.
Contiguous tumor: A single tumor that involves, invades, or bridges adjacent or connecting sites or subsites. Focal: An adjective meaning limited to one specific area. A focal cancer is limited to one specific area or organ. The area may be microscopic or
macroscopic.
Foci: Plural of focus.
Focus: A term used by pathologists to describe a group of cells that can be seen only by a microscope. The cells are noticeably different from
the surrounding tissue either by their appearance, chemical stain, or other testing.
Laterality: Indication of which side of a paired organ/site a tumor is located. (See Paired organ/site)
Most representative specimen: The pathologic specimen from the surgical procedure that removed the most tumor tissue.
Multiple primaries: More than one reportable case.
Overlapping tumor: The involved sites are adjacent (next to each other) and the tumor is contiguous.
Paired organ/site: There are two sides, one on the left side of the body and one on the right side of the body. (See Laterality)
Revised November 1, 2007 9 Multiple Primary and Histology Coding Rules General Instructions Recurrence: This term has two meanings: 1. The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy. 2. A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer. A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense a new occurrence of cancer.
Single primary: One reportable case.
Unilateral: Relating to one side of the body or one side of a body structure. DETERMINING MULTIPLE PRIMARIES FOR SOLID MALIGNANT TUMORS Note: T he rules do not apply to hematopoietic primaries (lymphoma and leukemia) of any site or to the reportable benign or borderline intracranial or CNS tumors..
A. General Information 1. Use these rules to determine the number of reportable primaries. Do not use these rules to determine case reportablility, stage, or grade. 2. The 2007 multiple primary and histology coding rules replace all previous multiple primary and histology coding rules. 3. 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. 4. Read the General Instructions and the site-specific Equivalent Terms and Definitions before using the multiple primary rules. 5. The multiple primary and histology coding rules are available in three formats: flowchart, text, and matrix. The rules are identical,
only the formats differ. Use the rules in the format that is easiest for you to follow. 6. Notes and examples are included with some of the rules to highlight key points or to add clarity to the rules. 7. Do not use a physicians statement to decide whether the patient has a recurrence of a previous cancer or a new primary. 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 cancer from the previous primary. 8. Use the Determining Multiple Primaries: Hematopoietic Primaries (Lymphoma and Leukemia) rules and table Definitions of Single
and Subsequent Primaries for Hematologic Malignancies to determine single versus multiple primaries for lymphoma and leukemia
cases. B. How to Use the Multiple Primary Rules 1. Use the Multiple Primary rules to make a decision on the number of primary malignancies to be abstracted for reportable solid malignant tumors. 2. Use the site-specific rules for the following primary sites: x Brain, malignant (intracranial and CNS) x Breast 10 January 1, 2007 Multiple Primary and Histology Coding Rules General Instructions Colon Head and neck Kidney Lung Malignant melanoma of the skin Renal pelvis, ureter, bladder, and other urinary 3. Use the Other Sites rules for solid malignant tumors that occur in primary sites not covered by the site-specific rules. 4. Each module (Unknown if Single or Multiple Tumors, Single Tumor, Multiple Tumors) is an independent, complete set of coding rules.
To determine which set of primary site rules to use:
a.. When there is no tumor in the primary site, only metastatic lesions are present: I. Use the primary site documented by a physician and use the multiple primary and histology coding rules for that primary site.
II. If no primary site is documented, code the primary site as unknown and use the general multiple primary and histology coding rules. Use the Unknown if Single or Multiple Tumors module to determine multiple primaries and the Single Tumor module
for coding histology. b. To choose the appropriate module (Unknown if Single or Multiple Tumors, Single Tumor, Multiple Tumors), I. Use the multiple primary and histology coding rules for the primary site II. Determine the number of tumors
i. Do not count metastatic lesions ii. When the tumor is only described as multicentric or multifocal and the number of tumors is not mentioned, use the Unknown
if Single or Multiple Tumors module iii. When there is a tumor or tumors with separate microscopic foci, ignore the separate microscopic foci and use the Single
Tumor or Multiple Tumor modules as appropriate iv. When the patient has a single tumor, use the Single Tumor module. v. If there are multiple tumors, use the Multiple Tumor module. III. See the Equivalent Terms and Definitions for Head and Neck for guidance in coding the primary site IV. Use the primary site documented by the physician on the medical record 5. If a single primary, prepare one abstract. 6. If there are multiple primaries, prepare two or more abstracts. 7. Rules are in hierarchical order within each module (Unknown if Single or Multiple Tumors, Single Tumor, and Multiple Tumors). Use the
first rule that applies and STOP January 1, 2007 11 Histologic Type ICD-O-3 Item Length: 4 NAACCR Item #: 522 NAACCR Name: Histologic Type ICD-O-3
The data item Histologic Type ICD-O-3 describes the microscopic composition of cells and/or tissue for a specific primary. The tumor type or
histology is a basis for staging and determination of treatment options. It affects the prognosis and course of the disease.
The International Classification of Diseases for Oncology, Third Edition (ICD-O-3) is the standard reference for histology codes for tumors
diagnosed in 2001 and later. Do not record the M that precedes the histology code. See sections Coding Guidelines for Topography and
Morphology. and Summary of Principal Rules for Using the ICD-O, Third Edition for guidance in using the ICD-O-3.
Information about the 2007 Histology Coding Rules Note: Do not use these rules to determine case reportability. 1. The 2007 multiple primary rules replace all previous multiple primary rules. 2. 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. 3. The histology coding rules are available in three formats: flowchart, text, and matrix. The rules are identical, only the formats differ.
Use the set of rules in the format that is easiest for you to follow. 4. Notes and examples are included with some of the rules to highlight key points or to add clarity to the rules. 5. Rules are in hierarchical order within each section (Single Tumor and Multiple Tumors Abstracted as a Single Primary). How to Use the Rules 1. Read the General Instructions. 2. Read the site-specific Equivalent Terms and Definitions. 3. Use these rules to make a decision on coding the histology for all reportable solid malignant tumors. 4. Use the multiple primary rules to determine whether the patient has a single or multiple primaries before coding the histology. 5. Code the histology for each primary in a separate abstract. 6. Use the site-specific rules for the following primary sites: Brain, malignant (intracranial and CNS) Breast Colon Head and neck Kidney Lung Malignant melanoma of the skin 12 January 1, 2007 x Renal pelvis, ureter, bladder, and other urinary
7. Use the Other Sites rules for all solid malignant tumors that occur in primary sites not included in the site-specific rules.
8. Determine whether the patient has a single tumor or multiple tumors that will be abstracted as a single primary a. Do not count metastatic tumors
b. When the tumor is described as multifocal or multicentric, use the Multiple Tumors module
c. When there is a tumor or tumors with separate foci of tumor do not count the foci
d. Only count the tumors that will be used to prepare that abstract. For example, when there are two tumors that will be abstracted as multiple primaries, you would use the Single Tumor modules to determine the histology code for each of the abstracts.. 9. Each section (Single Tumor and Multiple Tumors Abstracted as a Single Primary) is an independent, complete set of coding rules. For example, if the patient has multiple tumors, that will be abstracted as a single primary start with the first rule under the heading Multiple
Tumors Abstracted as a Single Primary. Do not use any of the rules under the header Single Tumor. 10. Use the first rule that applies and STOP
Priority order for using Documents to Code Histology Medical records frequently include multiple pathology reports and references to histologic diagnosis. Use the following instructions to
identify which reports best represent the histology to be coded. 1. Pathology report:
a. From the most representative tumor specimen examined
b. From the final diagnosis Note 1: Use information from addenda and comments associated with the final diagnosis to code the histology. Note 2: A revised/amended diagnosis replaces the original final diagnosis. Code the histology from the revised/amended diagnosis. Note 3: The new rules limit the information to the final diagnosis. The old rules allowed coding from information in the microscopic description. You will only use information from the microscopic portion of the pathology report when instructed to do so in one of the site-specific
rules. 2. Cytology report. 3. When you do not have either a pathology report or cytology report:
a. Documentation in the medical record that references pathology or cytology findings
b. From mention of type of cancer (histology) in the medical record January 1, 2007 13 Multiple Primary and Histology Coding Rules General Instructions Ambiguous Terms Used to Code Histology When any of the ambiguous terms are used to describe a more specific histology, code the more specific histology.
Ambiguous terms that are characteristic (used to code histology) Apparent(ly)
Appears
Comparable with
Compatible with
Consistent with
Favor(s)
Most likely
Presumed
Probable
Suspect(ed)
Suspicious (for)
Typical (of) Example: Non-small cell carcinoma, most likely adenocarcinoma. Code adenocarcinoma.
General Instructions Histology Coding Rules
When using rule (see note) that states Code the histology documented by the physician when the pathology/cytology report is not available code
the histology from the document with the highest priority. Make a second pass through the histology rules to determine which histology code
should be recorded. Start with the appropriate module, Single Tumor or Multiple Tumors, and continue through the rules until you reach the rule
that fits the case you are coding. Note: For most sites this will be rule H1 and the first rule in the Multiple Tumors module When using rule (see note) that states When the only histology is from a metastatic site make a second pass through the histology rules to
determine which histology code should be recorded. Start with the appropriate module, Single Tumor or Multiple Tumors, and continue through
the rules until you reach the rule that fits the case you are coding. Note: For most sites this will be rule H2 and the second rule in the Multiple Tumors module When the patient has a previous or subsequent unknown primary site (80.9) or an ill-defined primary site, check carefully to see if this abstract or
document should be consolidated into the previous abstract rather than making it a new primary. 14 Revised November 1, 2007 Multiple Primary and Histology Coding Rules January 1, 2007 275 Site-Specific Terms and Definitions 276 January 1, 2007 Head and Neck Terms and Definitions Head and Neck Equivalent Terms, Definitions, Charts, Tables and Illustrations C000-C148, C300-C329 (Excludes lymphoma and leukemia M-9590 9989 and Kaposi sarcoma M9140) Guidelines for Head and Neck The head and neck rules cover the following sites: Lip C000-C009, Oral Cavity C019-C069, Salivary Gland C079-C089, Tonsil C090-C099,
Oropharynx C100-C109, Nasopharynx C110-C119, Pyriform Sinus C129, Hypopharynx C130-C139, Other and Ill-defined Sites in Lip, Oral
cavity and Pharynx C140-C148, Nasal Cavity C300, Middle Ear C301, Accessory Sinuses C310-C319, and Larynx C320-C329. Head and neck tumors frequently extend into adjacent anatomic sites, or overlap multiple contiguous sites. The workup for these tumors often
includes physical examinations, imaging, scans, endoscopies, biopsies and surgical observations. Each of these diagnostic tools provides a unique
view of the tumor. More than one anatomic location may be involved with tumor and reports may contain conflicting information regarding the
primary site. Coding the Primary Site
Code the site where the tumor originated; do not simply code the biopsy site. When there are multiple biopsies and the primary site is not documented, or when there is discrepant information, code the primary site using the
following priority order. Priority Order 1. Tumor board a. Specialty
b. General 2. Staging physicians site assignment a. AJCC staging form
b. TNM statement in medical record If neither 1 nor 2 are available, the priority order for using information depends upon whether the patient had a surgical resection of the
primary tumor. 3. Total (complete) resection of primary tumor Note: The primary tumor is completely removed. The surgical margins may be microscopically positive. a. Surgeons statement from operative report
b. Final diagnosis from pathology report January 1, 2007 17 Head and Neck Terms and Definitions Head and Neck Equivalent Terms, Definitions, Charts, Tables and Illustrations C000-C148, C300-C329 (Excludes lymphoma and leukemia M-9590 9989 and Kaposi sarcoma M9140) 4. No resection (biopsy only): Documentation from: a. Endoscopy (physical exam with scope)
b. Radiation oncologist
c. Diagnosing physician
d. Primary care physician
e. Other physician
f. Radiologist impression from diagnostic imaging g. Physician statement based on physical exam (clinical impression) When the point of origin cannot be determined, use a topography code for overlapping sites:
