# Presentation: 053817

## Slide 1

**Notes:**
<number>

## Multiple Primary and Histology Rules 101Format of MP/H Materials

## By the end of this presentation:

**Basic understanding of MP/H rules**
**Pick a usage style**
**Understand the MP/H rules and how they work**
**Importance of reading**
**How the equivalent terms work**

## What we will cover:

**General Information**
**Format of new rules**
**When and how to use the rules**
**What to expect from the General Rules**

## Important!

**The 2007 multiple primary rules *****replace all previous *****multiple primary rules. **

**Notes:**
First – a very important note: DO NOT USE THESE RULES TO DETERMINE CASE REPORTABILITY.

The 2007 multiple primary rules replace call previous multiple primary rules.    Even the ones like “so-n-so told me in 1988 that this is how you code these cases”

## When?

**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. **

**Notes:**
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

##   Question   ???

-   ***“******How do I code a ******	******	******	******      non-analytic case that comes to our hospital after 1/1/07 with residual/metastatic cancer diagnosed in 2005?”***

##   Answer:

**    ****Use the previous **_**rules**_**.**

**Notes:**
The rules are effective for cases diagnosed 1/1/07 and after, not accessioned.    You are not dealing with a new data item just new RULES – that is the way you assign the codes.

## Style

**The histology/multiple primary coding rules are available in three formats:                        ****	****flowchart                                              ****	****text ****	****	****	****	****	****	****	****	****matrix **
**The rules are identical, only the formats differ.**

**Notes:**
As we discussed this morning, people adapt to different styles of the same materials.  When we reviewed the Map Quest – some of you liked to use the step by step map, some like just the written materials, and others just looked at the map.  The Multiple Primary and Histology Committee have worked at developing the new rules in three different formats.  They are available in text, flowchart or the matrix format.  The rules are identical – just the presentation or format are different.

## Using the Rules

***Notes and examples***** are included with some of the rules to highlight key points or to add clarity to the rules. **
**They are not exclusive.**
**They do not replace the rules.**

**Notes:**
Notes or examples may often use a specific case to illustrate the point; it does NOT mean that the rule pertains only to cases similar to the example.

Do not attempt to code cases by using an example and deciding that your case and the case in the example are very similar, so you will code your case in the same way.  Use the rules to make coding decisions, not the examples

## How to Use the Rules

**Read the **_**General Instructions**_
**General Terms/Definitions**
**Used for all cases EXCEPT:**
**	****Hematopoietic Primaries**
** ****	****Benign or borderline CNS**
_**DO NOT**_** use for casefinding**

**Notes:**
Please turn to your handout labeled _______________; see at the top are what is considered equivalent or equal terms:  Multicentric, multifocal  or Tumor, mass, lesion, neoplasm.  This gives you an idea what terms you might encounter

## How to Use the Rules

**2.   Read the **_**site-specific equivalent or equal terms**_
**        “****Multicentric” = “Multifocal”**
**                                ****or**
**        “****Tumor” = “Mass” = “Lesion” **
**	****                ****= “Neoplasm”**

## How to Use the Rules

**3. Used for: coding ****histology**
**    ****except for hematopoietic primaries**
**	****    ****(****Do Not**** use for casefinding)**
**4. Use ****multiple primary rules**** before**
**    ****coding histology **
**5. Code ****histology**** for each primary**

**Notes:**
3. Use these rules to make a decision on coding the histology for all reportable solid malignant tumors and do not use the rules when doing casefinding.
4. You must use the multiple primary rules to determine whether the patient has a single or multiple primaries BEFORE you even try to code the histology.
5. You will then code the histology for each primary site in a separate abstract

## How to Use the Rules

**Use ****site-specific**** rules for:**
**Brain, malignant**
**Breast**
**Colon**
**Head & Neck**
**Kidney**
**Lung**
**Malignant Melanoma of Skin**
**Renal Pelvis, ureter, bladder and other urinary**

## How to Use the Rules

**Use ****“Other Sites” ****rules**
**8.   Determine ****single**** vs. ****multiple tumors**
** ****- Don’t count metastatic tumors**
** ****- Multicentric/multifocal = Unknown if single or multiple tumors**
** ****- Don’t count the foci**
** ****- Only count tumors used to prepare abstract**

**Notes:**
You will use the rules for “Other Sites” for all solid tumors that occur in primary sites that are not included in the site-specific rules.
Then you will determine whether the patient has a single tumor or multiple tumors that will be abstracted as a single primary.
Don’t count the separate tumors that are described as metastatic (ex: Pt has breast cancer with metastatic carcinoma in liver)
When a tumor is described as multicentric or multifocal, use the unknown if single or multiple tumors module
When there is a tumor or tumors with separate foci of tumor, do not count the foci
Only count 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 vs. if you have multiple tumors considered to be one primary (ex: bladder) 

## How to Use the Rules

**Each Section = Complete Set of Rules**
**             *****Stay within module**
**10. Use the first rule that applies and**

**Notes:**
9.  Each Section (there’s a section on Single Tumors, and one on Multiple Tumors Abstracted as a Single Primary) is an independent complete set of rules.  For example – it pt. 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 

## Pathology Reports

**Code from the pathology report**
**	****1. from the *****most representative*****   ****	****specimen examined**
**	****2. from the *****final diagnosis***

## Pathology Reports

***Note 1******:*****  A *****revised/amended diagnosis *****replaces the original final diagnosis. Code the histology from the revised/amended diagnosis.**
***Note 2******:***** The new rules *****limit***** the information *****to the final diagnosis*****.  The old rules allowed coding from information in the microscopic description. **

## Pathology Reports

** ****If there is ****NO**** pathology report:**
**	**** ****1.  Cytology report**
**    ****2.  Documentation in the medical ****	****record that references pathology or ****	****cytology**

## Using the Rules

**       ****The Multiple **_**Primary**_** Rules **
**          ****3 independent modules**
**1. Unknown if Single or Multiple    ****	****	****	****Tumors**
**2. Single tumor **
**3. Multiple tumors**
**       ****Rules in appropriate module**

**Notes:**
Within the MP rules, there are three (3) independent modules.  
	First – is a module that applies to when it’s unknown if there is a single or multiple tumors
        Second module is for when there is only one (1) single tumor
        and the Third module is for when there are multiple tumors.
You must start with rules in the appropriate module and do not use rules from any other module

## Using the Rules

**    ****The **_**Histology**_** ****Coding Rules**
**      ****2 independent modules**
**   ****1. Single Tumor (one primary site)**
**   ****2. Multiple Tumors abstracted as a single     ****	****   primary site**
**    ****Rules are hierarchical within each    ****	****module**

## General Terms and Definitions

**Bilateral**
**Clinical Diagnosis**
**Contiguous tumor**
**Contralateral**
**Different histology**
**Different (multiple) primaries**
**Focal**
**Foci**
**Focus**

**Ipsilateral**
**Most representative specimen**
**Multiple primaries**
**Overlapping tumor**
**Paired organ/site**
**Single histology**
**Single (one) primary**
**Unilateral**

**Notes:**
Some of the terms you might encounter might be . . . . . . . . . . (name a few)

## General Terms and Definitions (continued)

**Recurrence **
**The reappearance of disease that was thought to be cured or inactive (in remission).  **
**2.  A new occurrence of cancer arising from cells that have nothing to do with first cancer.  A new occurrence of cancer**

**Notes:**
When dealing with a “recurrence”  this term has two (2) meanings:
It could be 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.
A new occurance of cancer arise 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) is a general sense – a new occurrence of cancer

## General Terms and Definitions (continued)

**Recurrence *****continued***
_**Do not**_** ****use a physician’s statement**
**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 the previous primary. **

**Notes:**
Do not use a physician’s 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 the previous primary.  The statement that the present tumor/mass is a recurrence of the previous primary may be anywhere on the pathology report.  

## Ambiguous Terms

**Apparent(ly)**
**Appears**
**Comparable with**
**Compatible with**
**Consistent with**
**Favor(s)**

**Most likely**
**Presumed**
**Probable**
**Suspect(ed)**
**Suspicious (for)**
**Typical (of)**

## No “Negative” Lists 

***If it isn’t listed, don’t code it.***
**  ****No “**_**Do not**_** use ambiguous ****	****	****terms” list**
**  ****No “Terms that **_**do not represent**_**     ****	****the majority of the tumor” list**

## Using the Rules

**Notes and examples are included with some of the rules:**
**       ****1. Highlight key points**
**	****	****   ****2. Add Clarity**
**They are NOT exclusive**
**They DO NOT replace the rules**

## Learning Styles

**Text**
**Flowchart**
**Matrix**

- Use what works for you!

**Visual**
**Auditory**
**Read/Write**
**Kinesthetic**

## Example of Text Format

**Multiple Primary Rules**
**M2****  A single tumor is always a *****single***** ****primary**
***	******Note: *****The tumor may overlap onto or extend **
**	****into adjacent/contiguous site or subsite. **
**Histology Rules**** **
**H4****  Code the *****invasive****** *****histologic type when a single tumor has invasive and in situ components.**

**Notes:**
Here is an example of MP/H rules in text format

## Example of Matrix Format

| Rule | Behavior | Notes/Examples | Code |
| --- | --- | --- | --- |
| H4 | Invasive and in situ |  | The invasive histologic type
 |

**Multiple Primary Rules**

**Histology Rules**

| Rule | Site | Notes/Examples | Primary |
| --- | --- | --- | --- |
| M2 | Single Tumor | The tumor may overlap onto or extend into adjacent/contiguous site or subsite. | Single |

**Notes:**
Here are the same rules as they appear in the matrices
(abbreviated for slide)

## Example of Flowchart FormatMultiple Primary Rules

**Notes:**
And the third format here shows the rules as a flow chart

## Example of Flowchart FormatHistology Coding Rules

## Warning!

_**Do not**_** use all three **
**format of rules at the same time**

## Using the Rules

-   **First the Multiple **_**Primary**_** Rules**
**     ****3 independent modules:**
**        ****Unknown if Single or Multiple**
**             ****Tumors**
**	****     ****Single Tumor**
**	****	**** ****Multiple Tumors**
**    ****Use rules in appropriate module**

## Using the Rules

-   **Second are the **_**Histology**_** Coding Rules**
**       ****Two independent modules:**
**            ****Single Tumor (one primary site)**
**            ****Multiple Tumors abstracted as**
**              ****a single primary site**
**       ****Rules are hierarchical within each**
**            ****module.**

## Slide 36

## Slide 37

**Notes:**
Condensed version of Chart 1. 

## Slide 38

**Notes:**
Demonstrate how to use the table by reading the instructions on the left and explaining how you would combine the histologies. Do at least two examples.

## Other Miscellaneous

**Other Sites**
**Similar to site-specific rules**
**Some site-specific rules included**
**Prostate**
**Ovary**
**Retinoblastoma**
**Kaposi sarcoma**
**Thyroid**
**Address remaining combination and mixed histology issues**

***Lung ***
***Multiple Primary Rules***
***Unknown Number of Tumors Module***

## Unknown Number Of TumorsNote: Tumors not described as metastasis

**Rule M1   **** When it is not possible to determine if there is a *****single***** tumor or *****multiple***** tumors, opt for a single tumor and abstract as a ****single**** ****primary.***
**	****	**
***Note 1: Use this rule only after all information ***
***	******	******	******      ******sources have been exhausted***

## This is the end of instructions for Unknown Number of Tumors

**Notes:**
Note that this statement appears at the end of the section concerning M1 – and what does it tell you????   That you STOP, you don’t go looking for another rule; if it meets the criteria, then you have found your answer.

## Single Tumor Module

## Single TumorNote: Tumor not described as metastasis

***	******	*****Rule M2**** A single tumor is always a ****	****single primary. ***
***	******	******Note: The tumor may overlap onto or extend ***
***	******	******into adjacent/contiguous site or subsite.***
-  ***Prepare one abstract.**
-    **This is the end of instructions for Single        ****	****Tumor.**

**Notes:**
A single non-metastatic tumor is always a single primary; Now here is a NOTE:
The tumor may overlap onto or extend into adjacent/contiguous site or subsite.  
And see the notation:  This is the end of instructions for single tumor.  If this fits the case, then you stop here

## This is the end of instructions for Single Tumors

**Notes:**
Note that this statement appears at the end of the section concerning M1 – and what does it tell you????   That you STOP, you don’t go looking for another rule; if it meets the criteria, then you have found your answer.

## Multiple Tumors Module

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M3**** Tumors in sites with ICD-O-3 topography codes that are different at second (C**_**x**_**xx) and/or third character (Cx****x****x) are ****multiple**** primaries. ****
***Note: This is a change in rules; tumors in the trachea (C33) and in the lung (C34) were a single primary in the previous rules.***

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M4  ****At least one tumor that is *****non-small cell****** *****carcinoma (8046) *****and *****another tumor that is *****small cell****** *****carcinoma (8041-8045) are multiple primaries.****

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M5  ****A tumor that is *****adenocarcinoma***** with *****mixed***** *****subtypes *****(8255) and another that is *****bronchioloalveolar***** (8250-8254) are multiple primaries. ****

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M6****  A *****single***** tumor in *****each***** lung is multiple primaries. ****
***	******Note:  When there is a single tumor in each ******	******lung, abstract as multiple primaries unless stated or proven to be metastatic. ***

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M7**  ***Multiple***** tumors in *****both***** lungs with ICD-O-3 histology codes that are different at the first (**_**x**_**xxx), second (x**_**x**_**xx) or third (xx**_**x**_**x) number are multiple primaries. ** **

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M8  ****Tumors diagnosed **_***more than three (3) years***_*** *****apart are multiple primaries.****

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M9  ****An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary.****
***Note 1: The purpose of this rule is to ensure that the case is counted as an incident (invasive) when incidence data are analyzed.***
***Note 2: Abstract as multiple primaries even if the medical record/physician states that it is recurrence or  progression of disease******.***

**Notes:**
In the rare instance where the patient has not been treated and is still having diagnostic tests greater than 60 days after the in situ malignancy is diagnosed, do not count the invasive as a multiple primary.   In other words, when the invasive component is found during the work-up phase, it is not coded as a multiple primary. 

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M10 ****Tumors with *****non-small cell *****carcinoma, *****NOS *****(8046) *****and***** a more *****specific***** non-small cell carcinoma *****type***** (Chart 1) are a single primary.***

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M11  ****Tumors with ICD-O-3 histology codes that are different at the first (****x****xxx), second (x****x****xx) or third (xx****x****x) number are multiple primaries****
***Note: Adenocarcinoma in one tumor and squamous cell carcinoma in another tumor are multiple primaries.***

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

**Rule M12 ****Tumors that **_***do not meet any***_*** *****of the above **_***criteria***_** are a single primary.***
** *****Note 1: When an invasive tumor follows an in situ tumor within 60 days, abstract as a single primary.***
***Note 2: All cases covered by this rule are the same histology.***

## Multiple TumorsMultiple tumors may be a single or multiple primariesNote: Tumors not described as metastases

***Footnotes:***
***	******* Prepare one abstract. Use the histology coding rules to assign the appropriate histology code.***
***	********Prepare two or more abstracts. Use the histology coding rules to assign the appropriate histology code to each abstract. ***

## This is the end of instructions for Multiple Tumors

## Lung  HistologyRules

**Excludes lymphoma and leukemia M9590-9989 and Kaposi Sarcoma M9140**

## Lung  Histology RulesSingle Tumor Module

**Notes:**
Ok – we’ve just covered how to determine the number of primaries; now let’s talk about the rules for coding the histology of these primaries.

## Single Tumor

-  **Rule H1  **Code histology documented by physician when there is no pathology/cytology specimen or pathology/cytology report is not available.**	**

## Single Tumor

**Rule H1 ****continued**
***Note 1:  Priority of documents***
***Documentation referring to pathologic/cytologic findings***
***Physician’s reference to type of cancer in medical record***
***CT, PET, or MRI scans***
***Chest x-rays***

## Single Tumor

**Rule H1 ****continued**
***   ******Note 2:  Code the specific histology when documented***
***   ******Note 3: Code histology to 8000 or 8010 as stated by the physician when nothing more specific is documented***

## Single Tumor

-  **Rule H2  **Code histology from a metastatic site when there is no pathology/cytology specimen from primary site.
-   ***  ****Note:  Code behavior /3*

## Single Tumor

**Rule H3  **Code histology when only one histologic type is identified.
***Note:  Do not code terms that do not appear in the histology description.  ***
***Ex 1:  Do not code squamous cell carcinoma non-keratinizing unless the words “non-keratinizing” actually appear in the diagnosis. ***
***Ex 2:  Do not code bronchioalveolar non-mucinous unless the words “non-mucinous” actually appear in the diagnosis.***

## Single Tumor

**  ****Rule H4   **Code invasive histologic type when a single tumor has invasive and in situ components

## Single Tumor

-  **Rule H5  **Code most specific term using Chart 1 when multiple histologies within same branch.
**Examples of histologies within the same branch are: **
**Cancer/malignant neoplasm, NOS (8000) and a more specific histology or**
**Carcinoma, NOS (8010) and a more specific carcinoma or**
**Adenocarcinoma, NOS (8140) and a more specific adenocarcinoma or**
**Sarcoma, NOS (8800) and a more specific sarcoma**

## Single Tumor

**Rule H5 ****continued**
***Note: ***The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ____differentiation
***Ex 1:***  Adenocarcinoma, predominantly mucinous.  Code 8480 (mucinous adenocarcinoma).
***Ex 2:***  Non-small cell carcinoma, papillary squamous cell.  Code 8052 (papillary squamous cell carcinoma).

## Chart 1

**Chart 1**

## Single Tumor

-   **Rule H6  **Code appropriate combination/mixed code (Table 1) when there are multiple specific histologies or when there is a non-specific with multiple specific histologies

## Single Tumor

**Rule H6 ****continued**
***Note:*****	****The specific histologies may be identified as type, subtype, predominantly, with features of, major, or with ____differentiation.**
***Ex 1 (multiple specific histologies):  *****Solid and papillary adenocarcinoma. Code 8255 (adenocarcinoma with mixed subtypes). **
***Ex 2 (multiple specific histologies): ***** Combined small cell and squamous cell carcinoma.  Code 8045 (combined small cell carcinoma).**
***Ex 3 (non-specific  with multiple specific histologies):***** Adenocarcinoma with papillary and clear cell features. Code 8255 (adenocarcinoma with mixed subtypes).**

## Slide 72

**Notes:**
Demonstrate how to use the table by reading the instructions on the left and explaining how you would combine the histologies. Do at least two examples.

## Single Tumor

-   **Rule H7  **Code the histology with the numerically higher ICDO-3 code.

## This is the end of instructions for Single Tumor

**Notes:**
Note that this statement appears at the end of the section concerning M1 – and what does it tell you????   That you STOP, you don’t go looking for another rule; if it meets the criteria, then you have found your answer.

## Lung  Histology RulesMultiple Tumor Module

## Multiple Tumors Abstracted as a Single Primary

-   **Rule H8  **Code histology documented by physician when there is no pathology/cytology specimen/report available

## Multiple Tumors Abstracted as a Single Primary

**Rule H8 ****continued**
***Note 1:  Priority of documents***
***Documentation that refers to pathologic/cytologic findings***
***Physician’s reference to type of cancer in medical record***
***CT, PET, or MRI scans***
***Chest x-rays***

## Multiple Tumors Abstracted as a Single Primary

**Rule H8 ****continued**
***   ******Note 2:  Code the specific histology when documented***
***   ******Note 3: Code histology to 8000 or 8010 as stated by the physician when nothing more specific is documented***

## Multiple Tumors Abstracted as a Single Primary

-   **Rule H9 **Code the histology from a metastatic site when there is no pathology/cytology specimen from primary site
-      ***Note: Code behavior /3***

## Multiple Tumors Abstracted as a Single Primary

**Rule H10****  ****Code the histology when only one histologic type is identified.**
***Note:  Do not code terms that do not appear in the histology description.  ***
***Ex 1:  Do not code squamous cell carcinoma non-keratinizing unless the words “non-keratinizing” actually appear in the diagnosis. ***
***Ex 2:  Do not code bronchioalveolar non-mucinous unless the words “non-mucinous” actually appear in the diagnosis.***

## Multiple Tumors Abstracted as a Single Primary

-   **Rule H11  **Code the histology of the **most invasive** tumor.
***   ******Note 1****: This rule should only be used when the first three numbers of histology are identical (This is a single primary).*
***   ******Note 2:**** See Lung Equivalent Terms, Definitions, Charts, Tables, Illustrations for definition of most invasive.*

## This is the end of instructions for Multiple Tumors

**Notes:**
Note that this statement appears at the end of the section concerning M1 – and what does it tell you????   That you STOP, you don’t go looking for another rule; if it meets the criteria, then you have found your answer.

## Slide 83

## Chart 2: Most Common Lung Histology Groups 

*Chart Instructions****:*** Use this chart to identify the most common group terms and histology types.
*	**Note:  *This chart is based on the WHO Classification of Tumors for tumors of the lung.  The chart is *not* a complete
- 	listing of histologies that may occur in
- 	the lung.

## Table 1: Combination/Mixed Codes for Lung Histologies 

*Table Instructions:* Use this table to select combination/mixed histology codes.  Compare the terms in the diagnosis to the terms in columns 1 and 2. If the terms match, abstract the case using the ICD-O-3 histology code in column 4. Use the combination/mixed codes listed in this table only when the histologies in the tumor match the histologies listed below.

## Use the combination/mixed codes for a single tumor when all histologies are present in a single tumor. 
Note:  This table is not a complete listing of histologies that may occur in the lung

*Note*:  This table is not a complete listing of histologies that may occur in the lung

**Table 1 *****continued***

## Slide 87

## Case 1
Lung bx: Poorly differentiated non-small cell lung carcinoma (mixed large cell undifferentiated and adenocarcinoma).

(Single primary)
Histology code:
Histology rule:   

- Lung bx: Poorly differentiated non-small cell lung carcinoma (mixed large cell undifferentiated and adenocarcinoma).
- (Single primary)
- Histology code:
- Histology rule:

- Multiple Primaries and Histology Coding Rules–Lung Cases

**8140**

**H7**

## Multiple Primaries and Histology Coding Rules–Lung Cases

- Case 2
- Lung with moderately differentiated adenocarcinoma, mucin secreting cells, mixed acinar, papillary, and bronchioalveolar features.
- (Single primary)
- Histology code:
- Histology rule:

**8255**

**H6**

**Notes:**
“mucin-secreting” cells and “mucin-producing” cells are not synonymous with mucinous. 

## Multiple Primaries and Histology Coding Rules–Lung Cases

- Case 3
- Poorly differentiated carcinoma, non-small cell type.
- (Single primary)
- Histology code:
- Histology rule:

**8046**

**H5**

## Multiple Primaries and Histology Coding Rules–Lung Cases

- Case 4
- Lung, right upper lobectomy: 2 nodules of carcinoma with mucin production (c/w pulmonary primary), one nodule has bronchoalveolar features, the other shows focal squamous differentiation.
- (2 primaries)	     #1		#2
- Histology code:
- Histology rule:

**8250**

**H5**

**8070**

**H5**

## MP/H Task Force