II.3.3 Sequence Number

Coding Instructions:

• If two or more reportable neoplasms are diagnosed at the same time, the lowest sequence number is assigned to the diagnosis with the worst prognosis.

Example:

A patient's medical record shows a history of three primary malignant (reportable) tumors in the past and two simultaneously diagnosed recent malignant tumors, one of which is the subject of this report, for a total of five malignancies. The stage of the tumor being reported is regional, whereas the stage of the second of the multiple tumors is localized, a better prognosis. Assign sequence number 04 to the tumor being reported. The number for the second multiple primary is 05.

• If more tumors are diagnosed before the report is submitted, the sequence number must be updated if it was originally coded as 00 or 60, designating a single tumor.

• If no difference in prognosis is evident, the decision is arbitrary.

• Use numeric sequence codes in the range of 00-35 to indicate reportable neoplasms of malignant or in situ behavior. Cases of juvenile astrocytomas, diagnosed prior to 1/1/2001, but entered after 1/1/2003 also use a sequence code in the 00-35 range.  This applies to cases diagnosed January 1, 2003 and forward.

• A primary, non-malignant tumor of brain or CNS sites diagnosed on or after 1/1/07 is reportable.

• Sequence numbers must be in the range of 60-87

• Sequencing of non-malignant tumors does not affect sequencing of malignant tumors and vice versa

• A malignancy (sequence 00) will remain as 00 even if followed by a non-malignant tumor (sequence 60-87)

Example: First tumor, benign meningioma, sequence 60

Second tumor, astrocytoma, sequence 00

• For Newly Reportable Hematopoietic Diseases (NRHD):

• If the original hematopoietic disease was not reportable at the time of diagnosis, do not include it in the sequencing.

Note: Alphabetic sequence codes are no longer allowed.

• In the remarks area, record the following information regarding subsequent reportable tumors/ primary sites:

• Enter the tumor # (first, second, third primary in relation to this one).

• Name of site

• Histology, and

• Diagnosis date

Example: You currently abstract a breast case however the patient had a previous squamous cell cancer of the lung diagnosed January 20, 2000.

Your text should state:  #1 – Lt Lung SCC, dx – 1/20/00

Codes for Tumors with Invasive and In Situ Behavior:

Codes for Benign and Uncertain Behavior CNS Tumors and Cases Reportable by Agreement:

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