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SEER Program Coding and Staging Manual 2021 SEER Program Coding and Staging Manual 2021 Effective with Cases Diagnosed January 1, 2021 and Forward Published September 2020 Data Quality, Analysis, and Interpretation Branch Surveillance Research Program Division of Cancer Control and Population Sciences National Institutes of Health Public Health Service U.S. Department of Health and Human Services Suggested citation: Adamo M, Groves C, Dickie L, Ruhl J. (September 2020). SEER Program Coding and Staging Manual 2021. National Cancer Institute, Bethesda, MD 20892. U.S. Department of Health and Human Services National Institutes of Health National Cancer Institute SEER Program Coding and Staging Manual 2021 SEER Program Coding and Staging Manual 2021 Acknowledgements Suzanne Adams, BS, CTR Information Management Services, Inc. Mary Brant BS, CTR SEER California Central Registry Heather Cheney, CTR SEER Utah Cancer Registry Jacqueline Clarken, BS, CTR SEER Utah Cancer Registry Elaine M Collins, MA, RHIA, CTR NAACCR Contractor Kathleen Davidson-Allen, CTR SEER Greater Bay Area Cancer Registry Daisy Michelle Gray SEER Kentucky Cancer Registry Loretta Huston, BS, CTR SEER Utah Cancer Registry Tiffany Janes, BA, CTR SEER Seattle Cancer Registry Amy R. Kahn, MS, CTR SEER New York Cancer Registry Marilynn Lang, CTR SEER Greater Bay Area Cancer Registry Bobbi Jo Matt, BS, RHIT, CTR SEER Iowa Cancer Registry Cheryl Moody, BA, CTR SEER California Central Registry Lisa G. Orr, CTR SEER Utah Cancer Registry Nektarios Pappas, MD, CTR SEER Louisiana Tumor Registry Lisa A. Pareti, BS, RHIT, CTR SEER Louisiana Tumor Registry Cathryn E. Phillips, BA, CTR SEER Connecticut Tumor Registry Elizabeth A. Ramirez Valdez, CTR SEER New Mexico Tumor Registry Nai Robinson, CTR SEER Cancer Registry of Greater California Debbi Romney, AA, CTR SEER Utah Cancer Registry Winny Roshala, BA, CTR SEER Cancer Registry of Greater California Francis E. Ross, BA, CTR SEER Kentucky Cancer Registry Nicola Schussler, BS Information Management Services, Inc. Taina Valone, RHIA, CTR SEER Cancer Registry of Greater California Copyright Information: All material in this manual is in the public domain and may be reproduced or copied without permission. We do request that you use a source citation. Acknowledgements ii SEER Program Coding and Staging Manual 2021 Table of Contents Preface to the 2021 SEER Program Coding and Staging Manual 1 Effective Date 1 Summary of Changes 1 2021 Changes 3 Submitting Questions 3 Collection and Storage of Dates 3 Transmission Instructions for Dates 4 SEER Site-Specific Factors 1 – 6 4 Introduction 5 SEER Program 5 SEER Coding and Staging Manual Contents 5 Reportability 6 Dates of Diagnosis/Residency 6 Reportable Diagnosis List 6 Diagnosis Prior to Birth 8 Disease Regression 9 Reportable Examples 9 Non-Reportable Examples 9 Instructions for Reporting Solid Tumors 9 Documentation of Reportable Diagnoses 9 Intracranial or CNS Neoplasms 10 Ambiguous Terminology 10 How to Use Ambiguous Terminology for Case Ascertainment 11 Instructions for Hematopoietic and Lymphoid Neoplasms 13 Casefinding Lists 13 Changing Information on the Abstract 15 Determining Multiple Primaries 16 Solid Tumors 16 Hematopoietic and Lymphoid Neoplasms 16 Transplants 16 Section I Basic Record Identification 17 SEER Participant 18 Patient ID Number 20 Record Type 21 Section II Information Source 22 Type of Reporting Source 23 Table of Contents iii SEER Program Coding and Staging Manual 2021 CoC Accredited Flag 26 Section III Demographic Information 27 First Name 28 Middle Name 29 Last Name 30 Birth Surname 31 Social Security Number 32 Place of Residence 33 Address at Diagnosis--Number and Street 35 Address at Diagnosis--Supplemental 36 County 37 County at Diagnosis Geocode 1970/80/90 38 County at Diagnosis Geocode 2000 39 County at Diagnosis Geocode 2010 40 County at Diagnosis Analysis 41 Address at Diagnosis--City 42 Address at Diagnosis--State 43 Address at Diagnosis--Postal Code (ZIP Code) 44 State at Diagnosis Geocode 1970/80/90 45 State at Diagnosis Geocode 2000 46 State at Diagnosis Geocode 2010 47 Census Tract 2010 48 Census Tract Certainty 2010 49 Current Address--Number and Street 51 Current Address--Supplemental 52 Current Address--City 53 Current Address--State 54 Current Address--Postal Code (ZIP Code) 55 Telephone 56 Birthplace--State 57 Birthplace--Country 58 Date of Birth 59 Date of Birth Flag 61 Place of Death--State 62 Place of Death--Country 63 Age at Diagnosis 64 Race 1, 2, 3, 4, 5 65 IHS Link 70 Table of Contents iv SEER Program Coding and Staging Manual 2021 Spanish Surname or Origin 71 NHIA Derived Hispanic Origin 73 Sex 74 Marital Status at Diagnosis 75 Primary Payer at Diagnosis 76 Section IV Description of this Neoplasm 78 Pathology Reports 78 Date of Diagnosis 79 Date of Diagnosis Flag 84 Sequence Number--Central 85 Primary Site 88 Laterality 93 Diagnostic Confirmation 96 Morphology 99 Histologic Type ICD-O-3 100 Behavior Code 101 Grade Clinical 104 Grade Post Therapy Clin (yc) 105 Grade Pathological 106 Grade Post Therapy Path (yp) 107 Tumor Size--Clinical 108 Tumor Size--Pathologic 114 ICD-O-3 Conversion Flag 120 Section V Stage of Disease at Diagnosis 121 Extent of Disease Data Items 122 Extent of Disease Primary Tumor 123 Extent of Disease Regional Nodes 124 Extent of Disease Metastases 125 Summary Stage 126 Summary Stage 2018 127 Derived Summary Stage 2018 128 Section VI Stage-related Data Items 129 Stage-related Data Items 130 Lymphovascular Invasion 131 Mets at Diagnosis--Bone 134 Mets at Diagnosis--Brain 136 Mets at Diagnosis--Liver 138 Mets at Diagnosis--Lung 140 Table of Contents v SEER Program Coding and Staging Manual 2021 Mets at Diagnosis--Distant Lymph Node(s) 142 Mets at Diagnosis--Other 144 SEER Site-specific Factor 1 146 Additional Stage-related Data Items 148 Section VII First Course of Therapy 150 First Course of Therapy 151 Date Therapy Initiated 154 Date Therapy Initiated Flag 158 Treatment Status 159 Date of First Surgical Procedure 160 Date of First Surgical Procedure Flag 161 Date of Most Definitive Surgical Resection of the Primary Site 162 Date of Most Definitive Surgical Resection of the Primary Site Flag 163 Surgery of Primary Site 164 Surgical Margins of the Primary Site 166 Scope of Regional Lymph Node Surgery 167 Date of Sentinel Lymph Node Biopsy 171 Date of Sentinel Lymph Node Biopsy Flag 172 Sentinel Lymph Nodes Examined 173 Sentinel Lymph Nodes Positive 174 Date of Regional Lymph Node Dissection 176 Date of Regional Lymph Node Dissection Flag 177 Regional Nodes Positive 178 Regional Nodes Examined 181 Surgical Procedure of Other Site 184 Reason for No Surgery of Primary Site 186 Date Radiation Started 189 Date Radiation Started Flag 190 Radiation Treatment Modality--Phase I, II, III 191 Radiation External Beam Planning Technique--Phase I, II, III 192 Radiation Sequence with Surgery 195 Reason for No Radiation 197 Date Systemic Therapy Started 198 Date Systemic Therapy Started Flag 199 Date Chemotherapy Started 200 Date Chemotherapy Started Flag 201 Chemotherapy 202 Date Hormone Therapy Started 208 Table of Contents vi SEER Program Coding and Staging Manual 2021 Date Hormone Therapy Started Flag 209 Hormone Therapy 210 Date Immunotherapy Started 213 Date Immunotherapy Started Flag 214 Immunotherapy 215 Hematologic Transplant And Endocrine Procedures 218 Systemic Treatment/Surgery Sequence 221 Neoadjuvant Therapy 222 Neoadjuvant Therapy--Clinical Response 227 Neoadjuvant Therapy--Treatment Effect 231 Date Other Treatment Started 232 Date Other Treatment Started Flag 233 Other Therapy 234 Section VIII Follow Up Information 237 Death Clearance Instructions 238 Date of Last Follow-Up or of Death 239 Date of Last Follow-Up or Death Flag 242 Vital Status 243 ICD Code Revision Used for Cause of Death 244 Underlying Cause of Death 245 Survival Data Items 247 Section IX Administrative Codes 248 Site/Type Interfield Review 249 Histology/Behavior Interfield Review 250 Age/Site/Histology Interfield Review 251 Sequence Number/Diagnostic Confirmation Interfield Review 252 Site/Histology/Laterality/Sequence Interrecord Review 253 Surgery/Diagnostic Confirmation Interfield Review 254 Type of Reporting Source/Sequence Number Interfield Review 255 Sequence Number/Ill-Defined Site Interfield Review 256 Leukemia or Lymphoma/Diagnostic Confirmation Interfield Review 257 Over-ride Flag for Name/Sex 258 Over-ride Flag for Site/Behavior (IF39) 259 Over-ride Flag for Site/EOD/Diagnosis Date (IF40) 260 Over-ride Flag for Site/Laterality/EOD (IF41) 261 Over-ride Flag for Site/Laterality/Morphology (IF42) 262 Over-ride Flag for TNM Tis 263 Over-ride Flag for Site/TNM-Stage Group 264 Table of Contents vii SEER Program Coding and Staging Manual 2021 Preface to the 2021 SEER Program Coding and Staging Manual The 2021 Surveillance, Epidemiology and End Results (SEER) Program Coding and Staging Manual may be downloaded in electronic format from the SEER website: http://www.seer.cancer.gov/tools/codingmanuals. Effective Date The 2021 SEER Program Coding and Staging Manual is effective for cases diagnosed January 1, 2021 and forward. Previous editions of this manual are available on the SEER website. Summary of Changes The major changes and additions to the 2021 SEER Program Coding and Staging Manual include New section added to the Preface: 2021 Changes Reportability As of 1/1/2021, the following are reportable Early or evolving melanoma in situ, or any other early or evolving melanoma Thymomas, including thymoma, NOS Except Microscopic thymoma or thymoma benign (8580/0) Micronodular thymoma
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