Examples of Assigning EOD

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Example 1: Breast

History and Physical

Patient presented to her primary care physician with tender right breast. The physician noted the breast was inflamed, with an orange peel appearance. She had a left breast cancer in 1999; stage III, treated with modified radical mastectomy, chemotherapy and Tamoxifen.

Discharge Summary

Patient seen in outpatient department on 2/8/20xx for a biopsy of the right breast. Pathology was infiltrating duct carcinoma. No axillary nodes were palpable. CXR, bone scan, and LFT’s all negative. She was referred to medical and radiation oncology departments.

  • Primary site: C509 (Breast, NOS, no specific subsite mentioned)
  • Histology: 8500/3 (Infiltrating ductal carcinoma)
  • EOD Schema: Breast
  • EOD Primary Tumor: 100 (Based on imaging, this looks like a localized tumor. “Localized, NOS” is included in code 100)
  • EOD Regional Nodes: 000 (Based on physical exam and imaging, there is no clinical evidence of lymph node involvement)
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 2: Colon and Rectum

Rectal primary with invasive adenocarcinoma through the muscularis propria, involving the internal sphincter muscle. CT scan of abdomen and pelvis shows no evidence of lymph nodes or metastatic involvement.

  • Primary site: C209 (Rectum)
  • Histology: 8140 (Adenocarcinoma)
  • EOD Schema: Colon and Rectum
  • EOD Primary Tumor: 600 (Involves the internal sphincter muscle, which is part of the anus/anal canal)
  • EOD Regional Nodes: 000 (CT scan shows no evidence of lymph node involvement)
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 3: Prostate

Admitting note

Mr. Nighttime is a white male who presented to his primary care physician for a routine physical. He was treated for colon cancer six years ago. A sigmoid colon resection was performed, with several nodes involved. He has no evidence of disease at this time. His PSA on 2/1/20xx was 1500 and a mass was felt in the left lobe of the prostate. He was referred to my office for an ultrasound-guided biopsy on 2/15/20xx, which was positive for adenocarcinoma. Work-up on 2/18/20xx consisted of a CXR and bone scan; both negative. On exam, a firm mass can be felt in the left lobe of the prostate with no palpable lymphadenopathy. He was taken to the OR on 3/1/20xx for a radical prostatectomy.

Pathology Report

Summary: Multifocal adenocarcinoma, Gleason Score 5 in the left lobe. The carcinoma extends into the left seminal vesicle, no disease on the right. The largest mass is 1.5cm with smaller areas of cancer, < 3mm, seen throughout the left lobe.

Margins

Microscopic description: Two areas on the lateral margin of the capsule are involved with adenocarcinoma.

LN

Right external iliac nodes (5), 5 negative
Left external iliac nodes (7), 1 positive for adenocarcinoma Left common iliac nodes (1), 1 positive for adenocarcinoma

  • Primary site: C619 (Primary site prostate)
  • Histology: 8140 (Adenocarcinoma)
  • EOD Schema: Prostate
  • EOD Primary Tumor:  200 (Based on involvement of left lobe. Since there is no mention of whether this is less than half, or greater than half, go with the less than half code)
  • Prostate Path Extension: 400 (Involvement of the seminal vesicle)
  • EOD Regional Nodes: 300 (2 positive lymph nodes)
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 4: Lung

Patient presented to the ER with cough, hoarseness and SOB. A chest x-ray showed multiple lesions within the left upper lobe of the lung consistent with primary carcinoma. A biopsy was positive for squamous cell carcinoma of the left lung. CT scan of the chest confirmed the lung lesions with left mediastinal adenopathy and involvement of the recurrent laryngeal nerve.

  • Primary site: C341 (Lung, left upper lobe)
  • Histology: 8070/3 (Squamous Cell Carcinoma)
  • EOD Schema: Lung
  • EOD Primary Tumor: 650 (Clinical involvement of the recurrent laryngeal nerve)
  • EOD Regional Nodes: 400 (Clinical involvement of the mediastinal nodes [mediastinal adenopathy])
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 5: Head and Neck

Oral examination showed a large lesion in the right buccal mucosa that apparently extended through the full thickness of the cheek. The skin of the cheek was reddened and inflamed. No palpable nodes were detected in the neck. The lesion was widely excised, and the area was reconstructed. Pathologic findings showed squamous cell carcinoma arising in the buccal mucosa and extending through muscle and invading dermis. The margins were clear.

  • Primary site: C060 (Buccal mucosa)
  • Histology: 8070/3 (Squamous Cell Carcinoma)
  • EOD Schema: Buccal Mucosa
  • EOD Primary Tumor: 600 (Invasion of muscle)
  • EOD Regional Nodes: 000 (Per physical exam, no palpable nodes)
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 6: Ovary

A 57-year-old lady was admitted with a recent diagnosis of cancer. Abdomen was distended, and she complained of considerable pain. A paracentesis was performed with cytologic results of papillary serous cystadenocarcinoma. The surgeon noted during the debulking of the tumor, that there was seeding on the surface of both ovaries and that during the procedure, the left ovary burst causing tumor spill.

  • Primary site: C569 (Ovary)
  • Histology: 8460/3 (Papillary serous cystadenocarcinoma)
  • EOD Schema: Ovary
  • EOD Primary Tumor: 600 (Paracentesis positive for cystadenocarcinoma, microscopic confirmation of seeding outside of pelvis)
  • EOD Regional Nodes: 999 (No mention of lymph node involvement. With seeding of the abdomen, cannot assume that the lymph nodes are negative)
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 7: Brain

Patient has become steadily less responsive over the last 3 days. STAT head CT led to MRI which is concerning for frontal mass that is increasing in size with vasoedema. CT shows a large heterogeneously enhancing mass involving the entirety of the corpus callosum extending from the genu to the splenium; involving the entirety of the corpus callosum. This is favored to reflect high-grade glial neoplasm.

Stereotactic biopsy: Glioblastoma, IDH-Wild Type, WHO Grade IV.

  • Primary site: C711 (Frontal Lobe)
  • Histology: 9400/3 (Glioblastoma, NOS)
  • EOD Schema: Brain
  • EOD Primary Tumor: 500 (Involvement of the corpus callosum)
  • EOD Regional Nodes: 888 (Not applicable: Default value (no lymph nodes in the brain))
  • EOD Mets: 00 (No clinical evidence of mets, assume negative)

Example 8: Hematopoietic

Bone marrow biopsy positive for CLL/SLL. Imaging shows evidence of lymph node involvement above and below the diaphragm.

  • Primary site: C421 (Per the Hematopoietic Manual/Database, Rule PH5, if there is a diagnosis of CLL/SLL and the bone marrow is involved, the primary site is C421.
  • Histology: 9823/3 (CLL/SLL)
  • EOD Schema: Lymphoma (CLL/SLL)
  • EOD Primary Tumor: 800 (For all lymphomas, code 800 is for bone marrow (and peripheral blood) involvement
  • EOD Regional Nodes: 888 (Not applicable for this schema)
  • EOD Mets: 88 (Not applicable for this schema)

Updated: December 11, 2023