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Tumor Tip of the Week -Diagnostic Confirmation, New Instructions Heme Manual

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Scenario: 2022 Bone Marrow Biopsy:  Myelodysplastic Syndrome FISH negative for del(5q), monosomy (5) del (7q), monosomy (7), trisomy 8 del (20q)

Question:  How would you code diagnostic confirmation?

  • 1 Positive histology (Includes: peripheral blood smear only)
  • 2 Positive cytology
  • 3 Positive histology PLUS:
    • Positive immunophenotyping AND/OR
    • Positive genetic studies
    • Includes: peripheral blood smear followed by flow cytometry

Answer & Rationale:  1 Positive histology

Hematopoietic and Lymphoid Neoplasm Coding Manual Coding Diagnostic Confirmation

Assign code 1 for Bone marrow specimens (aspiration and biopsy)

Note 2: The following histologies are diagnosed based on immunophenotyping or genetics and therefore should only be diagnostic confirmation 3: 9806/3, 9807/3, 9808/3, 9809/3, 9812/3, 9813/3, 9814/3, 9815/3, 9816/3, 9817/3, 9818/3, 9819/3, 9865/3, 9866/3, 9869/3, 9871/3, 9877/3, 9878/3, 9879/3, 9896/3, 9897/3, 9911/3, 9912/3, 9965/3, 9966/3, 9967/3, 9968/3, 9986/3.

Note 3: The following histologies should never be assigned diagnostic confirmation 3 since they are non specific codes and neither genetic testing or immunophenotyping are listed as Definitive Diagnostic Methods for these histologies. If there is immunophenotyping or genetics available, then a more specific histology code may be able to be assigned: 9590/3, 9655/3, 9800/3, 9820/3, 9860/3, 9863/3, 9980/3, 9982/3, 9989/3, 9991/3.

Be Sure to Note the Revision History for the Hematopoietic Project https://seer.cancer.gov/tools/heme/update.html

2022 Changes
Released August 11, 2021

  • Diagnostic confirmation section of the manual updated to indicate which histologies have a default code of 3 (histology plus immunophenotyping/genetics), those that should never have a code 3.
  • The Hematopoietic database has a new field called “Diagnostic Confirmation.” Information for each /3 histology has information about diagnostic confirmation added.
  • For 9896/3: Alternate name “AML with recurrent genetic abnormalities, NOS” was removed from this code and was moved to 9861/3. a. Due to questions received about a case presented at NCRA and then consultation with a Hematopoietic expert, it was determined that this alternate name was incorrectly placed in code 9896/3 and the appropriate place for this alternate name was in 9861/3.
  • Additional information added in 9861/3 about the “AML with recurrent genetics abnormalities” group.
  • For 9811/3, the more specific B-cell lymphoma/leukemias were added as a reference.

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