Appendix D

Codes for:

Surgery of Primary Site

Scope of Regional Lymph Node Surgery Surgery of Other Regional Sites, Distant Sites, or Distant Lymph Nodes

Reconstruction -- First Course

Table of Contents for Appendix D

ICD-O-3 Primary Site                                                          Page 

C00.0 - C00.9         Lip..................................................................................D - 1

C01.9                     Base of tongue ............................................................D - 1

C02.0 - C02.9         Other & Unspecified Parts of Tongue .....................D - 1

C03.0 - C03.9         Gum...............................................................................D - 1

C04.0 - C04.9         Floor of Mouth ............................................................D - 1

C05.0 - C05.9         Palate.............................................................................D - 1

C06.0 - C06.9         Other & Unspecified Parts of Mouth.......................D - 1

C07.9                     Parotid Gland ...............................................................D - 4

C08.0 - C08.9         Other & Unspecified Major Salivary Glands ..........D - 4

C09.0 - C09.9         Tonsil ............................................................................D - 7

C10.0 - C10.9         Oropharynx..................................................................D - 7

C11.0 - C11.9         Nasopharynx................................................................D - 7

C12.9                     Pyriform Sinus .............................................................D - 7

C13.0 - C13.9         Hypopharynx...............................................................D - 7

C14.0                     Pharynx, NOS...............................................................D - 7

C14.2                     Waldeyer ring ............................................................D - 71

C14.8                     Overlapping lesion of lip, oral cavity
   & pharynx................................................................D - 71

C15.0 - C15.9         Esophagus .................................................................D - 10

C16.0 - C16.9         Stomach ......................................................................D - 13

C17.0 - C17.9         Small Intestine ...........................................................D - 71

C18.0 - C18.9         Colon...........................................................................D - 16

C19.9                     Rectosigmoid junction .............................................D - 19

C20.9                     Rectum........................................................................D - 23

C21.0 - C21.8         Anus & Anal Canal ..................................................D - 27

C22.0 - C22.1         Liver & Intrahepatic Bile Ducts ..............................D - 39

C23.9                     Gallbladder .................................................................D - 71

C24.0 - C24.9         Other & Unspecified Parts of Biliary Tract ...........D - 71

C25.0 - C25.9         Pancreas .....................................................................D - 31

C26.0 - C26.9         Other & Ill-Defined Digestive Organs ...................D - 71

C30.0 - C30.1         Nasal Cavity & Middle Ear......................................D - 71

C31.0 - C31.9         Accessory Sinuses ...................................................D - 71

C32.0 - C32.9         Larynx.........................................................................D - 33

C33.9                     Trachea .......................................................................D - 71

C34.0 - C34.9         Bronchus & Lung .....................................................D - 36

C37.9                     Thymus.......................................................................D - 71

C38.0 - C38.8         Heart, Mediastinum, & Pleura .................................D - 71

C39.0 - C39.9         Other & Ill-Defined Sites Within Respir-
   atory System & Intrathoracic Organs .................D - 71

C40.0 - C40.9         Bones, Joints & Articular Cartilage of Limbs .......D - 39

C41.0 - C41.9         Bones, Joints & Articular Cartilage of
   Other & Unspecified Sites ....................................D - 39

Table of Contents for Appendix D

ICD-O-3 Primary Site                                                       Page 

C42.0, C42.1          Blood, Bone marrow .................................................D - 71

C42.2                     Spleen .........................................................................D - 41

C42.3                     Reticuloendothelial system .....................................D - 71

C42.4                     Hematopoietic system..............................................D - 71

C44.0 - C44.9         Skin..............................................................................D - 43

C47.0 - C47.9         Peripheral Nerves & Autonomic
   Nervous System.....................................................D - 39

C48.0 - C48.8         Retroperitoneum & Peritoneum..............................D - 71

C49.0 - C49.9         Connective, Subcutaneous & Other
   Soft Tissues ............................................................D - 39

C50.0 - C50.9         Breast..........................................................................D - 46

C51.0 - C51.9         Vulva ...........................................................................D - 71

C52.9                     Vagina .........................................................................D - 71

C53.0 - C53.9         Cervix Uteri.................................................................D - 49

C54.0 - C54.9         Corpus Uteri...............................................................D - 52

C55.9                     Uterus, NOS ...............................................................D - 52

C56.9                     Ovary ..........................................................................D - 55

C57.0 - C57.9         Other & Unspecified Female
   Genital Organs ........................................................D - 71

C58.9                     Placenta ......................................................................D - 71

C60.0 - C60.9         Penis ............................................................................D - 71

C61.9                     Prostate gland............................................................D - 57

C62.0 - C62.9         Testis ..........................................................................D - 59

C63.0 - C63.9         Other & Unspecified Male Genital Organs ...........D - 71

C64.9                     Kidney ........................................................................D - 61

C65.9                     Renal pelvis ................................................................D - 61

C66.9                     Ureter ..........................................................................D - 61

C67.0 - C67.9         Bladder........................................................................D - 64

C68.0 - C68.9         Other & Unspecified Urinary Organs ....................D - 71

C69.0 - C69.9         Eye & Adnexa ............................................................D - 71

C70.0 - C70.9         Meninges ...................................................................D - 67

C71.0 - C71.9         Brain ............................................................................D - 67

C72.0 - C72.9         Spinal Cord, Cranial Nerves, & Other
   Parts of Central Nervous System.........................D - 67

C73.9                     Thyroid gland ............................................................D - 69

C74.0 - C74.9         Adrenal Gland............................................................D - 71

C75.0 - C75.9         Other Endocrine Glands &
   Related Structures ..................................................D - 71

C76.0 - C76.8         Other & Ill-Defined Sites ..........................................D - 71

C77.0 - C77.9         Lymph Nodes ............................................................D - 41

C80.9                     Unknown primary site ..............................................D - 71

D - 1

ORAL CAVITY

C00.0 - C00.9      Lip
C01.9                   Base of Tongue
C02.0 - C02.9      Other Parts of Tongue
C03.0 - C03.9      Gum
C04.0 - C04.9      Floor of Mouth
C05.0 - C05.9      Palate
C06.0 - C06.9      Other Parts of Mouth

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

Procedures in codes 20-27 include, but are not limited to:

Shave

Wedge resection

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

Procedures in code 30 include, but are not limited to:

Hemiglossectomy
Partial glossectomy

30   Wide excision, NOS

Procedures in codes 40-43 include, but are not limited to:

Radical glossectomy

40   Radical excision of tumor, NOS
41   Radical excision of tumor ONLY
42   Combination o f 41 WITH en bloc mandibulectomy (marginal, segmental, hemi-, or total)
43   Combination of 41 WITH en bloc maxillectomy (partial, subtotal, total)

90   Surgery, NOS

D - 2

ORAL CAVITY

99   Unknown if cancer-directed surgery performed; death certificate only

D - 3

ORAL CAVITY

SCOPE OF REGIONAL LYMPH NODE SURGERY

Regional cervical lymph nodes are: Caudal jugular (deep cervical) Cranial jugular (deep cervical) Dorsal cervical (superficial cervical) Medial jugular (deep cervical) Occipital
Paratracheal (anterior cervical) Prelaryngeal (anterior cervical)
Retroauricular (mastoid, posterior auricular) Submandibular (submaxillary)

Submental

Supraclavicular

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Neck dissection, NOS

3      Selective, limited; nodal sampling; “berry picking”

4      Modified / modified radical

5      Radical

9      Unknown; not stated; death certificate only

Terminology of neck dissection (Robbins et al. 1991):

A radical neck dissection includes the removal of all ipsilateral cervical lymph node groups, i.e., lymph nodes from levels I
through V (submental, submandibular, cranial jugular, medial jugular, caudal jugular, dorsal cervical nodes along the
accessory nerve, and supraclavicular), and removal of the spinal accessory nerve, internal jugular vein and
sternocleidomastoid muscle.

In a modified radical neck dissection, the same lymph nodes are removed as in a radical neck dissection; however, one or
more non-lymphatic structures are preserved.

A selective neck dissection is a neck dissection with preservation of one or more lymph node groups routinely removed in
radical neck dissection.

D - 4

ORAL CAVITY

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Mandibulectomy  (marginal, segmental, hemi-, or total)

4      Maxillectomy  (partial, subtotal, or total)

Code a mandibulectomy  or a maxillectomy  in this field only if the procedure is NOT a part of an en bloc resection
of the primary tumor.  (An en bloc resection is the removal of organs in one piece at one time.)  If the
mandibulectomy or maxillectomy ARE a part of an en bloc resection of the primary tumor, code under “Surgery of
Primary Site.”

5      Distant lymph node(s)

6      Distant site(s)

7      Combination of 6 WITH 2, 3, 4, or 5

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Flaps, grafts, or any type of “...plasty,”  NOS

2      WITHOUT implant / prosthesis

3      WITH implant / prosthesis

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 5

PAROTID AND OTHER UNSPECIFIED GLANDS

C07.9                 Parotid Gland
C08.0 - C08.9    Major Salivary Glands

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

30   Less than total parotidectomy, NOS; less than total removal of major salivary gland, NOS
31   Facial nerve spared
32   Facial nerve sacrificed
33   Superficial lobe ONLY
34   Facial nerve spared
35   Facial nerve sacrificed
36   Deep lobe (WITH or WITHOUT superficial lobe)
37   Facial nerve spared
38   Facial nerve sacrificed

40   Total parotidectomy, NOS; total removal of major salivary gland, NOS
41   Facial nerve spared
42   Facial nerve sacrificed

50   Radical parotidectomy, NOS; radical removal of major salivary gland, NOS
51   WITHOUT removal of temporal bone
52   WITH removal of temporal bone

80   Parotidectomy, NOS

90   Surgery, NOS

D - 6

PAROTID AND OTHER UNSPECIFIED GLANDS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

Regional cervical lymph nodes are:

Buccal (facial)
Caudal jugular (deep cervical) Cranial jugular (deep cervical) Dorsal cervical (superficial cervical) Medial jugular (deep cervical) Occipital
Paratracheal (anterior cervical) Parotid
Prelaryngeal (anterior cervical) Retroauricular (mastoid, posterior auricular) Retropharyngeal
Submandibular (submaxillary) Submental

Supraclavicular

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Neck dissection, NOS

3      Selective, limited; nodal sampling; “berry picking”

4      Modified / modified radical

5      Radical

9      Unknown; not stated; death certificate only

Terminology of neck dissection (Robbins et al. 1991):

A radical neck dissection includes the removal of all ipsilateral cervical lymph node groups, i.e., lymph nodes from levels I
through V (submental, submandibular, cranial jugular, medial jugular, caudal jugular, dorsal cervical nodes along the
accessory nerve, and supraclavicular), and removal of the spinal accessory nerve, internal jugular vein and
sternocleidomastoid muscle.

In a modified radical neck dissection, the same lymph nodes are removed as in a radical neck dissection; however, one or
more non-lymphatic structures are preserved.

A selective neck dissection is a neck dissection with preservation of one or more lymph node groups routinely removed in
radical neck dissection.

D - 7

PAROTID AND OTHER UNSPECIFIED GLANDS

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Flaps, grafts, or any type of “...plasty,”  NOS

2      WITHOUT implant / prosthesis

3      WITH implant / prosthesis

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 8

PHARYNX C09.0 - C09.9      Tonsil C10.0 - C10.9      Oropharynx
C11.0 - C11.9      Nasopharynx C12.9                   Pyriform Sinus C13.0 - C13.9      Hypopharynx C14.0                   Pharynx

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
15   Stripping
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

30   Pharyngectomy, NOS
31   Limited/partial pharyngectomy; tonsillectomy, NOS
32   Total pharyngectomy

40   Pharyngectomy WITH mandibulectomy (marginal, segmental, hemi-, and/or laryngectomy), NOS
41   WITH laryngectomy (laryngopharyngectomy)
42   WITH mandibulectomy
43   WITH both 41 and 42

50   Radical pharyngectomy (includes total mandibular resection), NOS
51   WITHOUT laryngectomy
52   WITH laryngectomy

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 9

PHARYNX

SCOPE OF REGIONAL LYMPH NODE SURGERY

Regional cervical lymph nodes are:

Buccal (facial)
Caudal jugular (deep cervical) Cranial jugular (deep cervical) Dorsal cervical (superficial cervical) Medial jugular (deep cervical) Occipital
Paratracheal (anterior cervical) Parotid
Prelaryngeal (anterior cervical) Retroauricular (mastoid, posterior auricular) Retropharyngeal
Submandibular (submaxillary) Submental

Supraclavicular

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Neck dissection, NOS

3      Selective, limited; nodal sampling; “berry picking”

4      Modified / modified radical

5      Radical

9      Unknown; not stated; death certificate only

Terminology of neck dissection (Robbins et al. 1991):

A radical neck dissection includes the removal of all ipsilateral cervical lymph node groups, i.e., lymph nodes from levels I
through V (submental, submandibular, cranial jugular, medial jugular, caudal jugular, dorsal cervical nodes along the
accessory nerve, and supraclavicular), and removal of the spinal accessory nerve, internal jugular vein and
sternocleidomastoid muscle.

In a modified radical neck dissection, the same lymph nodes are removed as in a radical neck dissection; however, one or
more non-lymphatic structures are preserved.

A selective neck dissection is a neck dissection with preservation of one or more lymph node groups routinely removed in
radical neck dissection.

D - 10

PHARYNX

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Laryngectomy ONLY

3      Mandibulectomy ONLY (marginal, segmental, or hemi-)

4      Combination of 2 and 3

5      Removal of other regional sites

6      Combination of 5 WITH any of 2-4

7      Removal of other distant sites(s) or distant lymph node(s)

8      Combination of 7 WITH any of 2-6

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Code only the following procedures:
Myocutaneous flaps (pectoralis major, trapezius) Reconstruction of mandible

Regional flaps

0      No reconstruction / restoration

1      Reconstruction / restoration, NOS

2      WITHOUT implant / prosthesis

3      WITH implant / prosthesis

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 11

ESOPHAGUS

C15.0 - C15.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

30   Partial esophagectomy

40   Total esophagectomy

50   Partial esophagectomy WITH laryngectomy and/or gastrectomy, NOS
51   WITH laryngectomy
52   WITH gastrectomy, NOS
53   Partial gastrectomy
54   Total gastrectomy
55   Combination of 51 WITH any of 52-54

60   Total esophagectomy, NOS WITH laryngectomy and/or gastrectomy, NOS
61   WITH laryngectomy
62   WITH gastrectomy, NOS
63   Partial gastrectomy
64   Total gastrectomy
65   Combination of 61 WITH any of 62-64

70   Esophagectomy, NOS WITH pharyngectomy and laryngectomy

80   Esophagectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 12

ESOPHAGUS

SCOPE OF REGIONAL LYMPH NODE SURGERY

Regional lymph nodes are different for each anatomical subsite.  The following list identifies nodes classified as regional for each subsite:

Cervical esophagus
Cervical, NOS Internal jugular Periesophageal Scalene Supraclavicular Upper cervical

Intrathoracic esophagus (upper, middle, lower):

Carinal
Hilar (pulmonary roots) Internal jugular Mediastinal, NOS Paracardial Periesophageal Perigastric

Peritracheal

Superior mediastinal

Tracheobronchial

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

Note:  Celiac nodes are DISTANT for the intrathoracic esophagus.  Code removal of celiac nodes in the data item
“Surgery of Other Regional Sites, Distant Sites or Distant Lymph Nodes.”

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

D - 13

ESOPHAGUS

RECONSTRUCTION - FIRST COURSE

Code only the following procedures: Endoluminal stents Endoprosthesis

Esophageal stents
Esophagogastric fundoplasty Esophagogastrostomy (cardioplasty) Esophagojejunostomy Esophagomyotomy

Esophagoplasty (plastic repair or reconstruction)

Esophagoplasty WITH / WITHOUT repair of a tracheoesophageal fistula

Esophagostomy

Gastropharyngostomy

Interposition of remaining esophagus with stomach using large or small bowel

Self expanding metal vynal

Stent placement in conjunction with cancer-directed surgery

0      No reconstruction / restoration

1      Reconstruction / restoration, NOS

2      WITHOUT implant / prosthesis

3      WITH implant / prosthesis

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 14

STOMACH

C16.0 - C16.0

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

Code 30, partial gastrectomy , includes a sleeve resection of the stomach.
Billroth I:  anastomosis to duodenum (duodenostomy) Billroth II:  anastomosis to jejunum (jejunostomy)

30   Gastrectomy, NOS (partial, subtotal, hemi-)
31   Antrectomy, lower (distal)
Resection of less than 40% of stomach

32   Lower (distal) gastrectomy (partial, subtotal, hemi-)
33   Upper (proximal) gastrectomy (partial, subtotal, hemi-)

40   Near-total or total gastrectomy
A total gastrectomy may follow a previous partial resection of the stomach.

50   Gastrectomy, NOS, WITH removal of a portion of esophagus
51   Partial or subtotal gastrectomy
52   Near total or total gastrectomy

60   Gastrectomy WITH en bloc resection of other organs, NOS
61   Partial or subtotal gastrectomy WITH en bloc resection
62   Near total or total gastrectomy WITH en bloc resection
63   Radical gastrectomy WITH en bloc resection
An en bloc resection is the removal of organs in one piece at one time, and may include an omentectomy.

80   Gastrectomy, NOS

90   Surgery, NOS

D - 15

STOMACH

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are different for these areas:

Greater Curvature of Stomach
Gastroduodenal Gastroepiploic, left Gastroepiploic, right or NOS Greater omental

Greater curvature

Pancreaticoduodenal
   (anteriorly along the first part of duodenum) Pyloric, including subpyloric and infrapyloric

Pancreatic and Splenic Area
Pancreaticolienal Peripancreatic Splenic hilum

Lesser Curvature of Stomach

Cardioesophageal

Celiac
Common hepatic Hepatoduodenal Left gastric Lesser omental Lesser curvature

Paracardial; cardial

Perigastric, NOS

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

D - 16

STOMACH

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of gallbladder, bile ducts, appendix, or vagus nerve.  [Incidental removal is when an
organ is removed for a reason unrelated to the malignancy (e.g., gallbladder removed for obvious cholelithiasis).]

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Removal of other regional sites, ONLY

3      Removal of distant node(s)

4      Removal of distant site

5      Combination of 2 WITH 3 and/or 4

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Gastrostomy

2      WITHOUT reservoir / pouch

3      WITH reservoir / pouch (abdominal)

9      Unknown; not stated; death certificate only

D - 17

COLON

C18.0 - C18.9

SURGERY OF PRIMARY SITE

Note:  Code the removal / surgical ablation of single or multiple liver metastases  under the data item "Surgery of Other
Regional Sites, Distant Sites or Distant Lymph Nodes."

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

Procedures coded 30-31 include, but are not limited to:
Appendectomy (for an appendix primary only) Enterocolectomy

Ileocolectomy

Partial colectomy, NOS
Partial resection of transverse colon and flexures Segmental resection, e.g., cecectomy Sigmoidectomy

30   Partial colectomy, but less than hemicolectomy
31   Partial colectomy WITH permanent colostomy  (Hartmann’s operation)
Also code colostomy in the data item “Reconstruction - First Course”.

40   Hemicolectomy  or greater (but less than total);  right colectomy; left colectomy
A hemicolectomy is the removal of total right or left colon and a portion of transverse colon.

50   Total colectomy (removal of colon from cecum to the rectosigmoid or a portion of the rectum)

60   Total proctocolectomy (commonly used for familial polyposis or polyposis coli)

D - 18

COLON

SURGERY OF PRIMARY SITE (cont.)

70   Colectomy or coloproctectomy WITH an en bloc resection of other organs; pelvic exenteration

Code 70 includes any colectomy (partial, hemicolectomy, or total) WITH an en bloc resection of any other organs. The
other organs may be partially or totally removed.   Procedures that may be a part of an en bloc resection include, but
are not limited to:  oophorectomy, partial proctectomy, rectal mucosectomy.

En bloc resection is the removal of organs in one piece at one time.

The creation of ileal reservoir which is a part of a pelvic exenteration must also be coded in the data item
“Reconstruction - First Course”.

80   Colectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The pathology report often describes regional lymph nodes by their anatomic location:  colic nodes; mesenteric nodes; peri-\epi-\para-\ colic.  Regional lymph nodes differ for each anatomical subsite.  The following list identifies the regional lymph nodes for each subsite of the colon:

Cecum and Appendix
Anterior cecal Ileocolic Posterior cecal Right colic

Ascending colon
Ileocolic Middle colic Right colic

Hepatic flexure
Middle colic
Right colic

Transverse colon
Middle colic

Splenic flexure
Inferior mesenteric
Middle colic
Left colic

Descending colon
Inferior mesenteric
Left colic
Sigmoid

Sigmoid colon
Inferior mesenteric Sigmoid mesenteric Sigmoidal
Superior rectal (hemorrhoidal)

Superior mesenteric, external iliac and common iliac nodes are DISTANT lymph nodes.  Code the removal of any of these nodes in the data item “Surgery of Other Regional Sites, Distant Sites or Distant Lymph Nodes.”

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

D - 19

COLON

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of appendix, gallbladder, bile ducts, or spleen.  [Incidental removal is when an organ is
removed for a reason unrelated to the malignancy (e.g., gallbladder removed for obvious cholelithiasis).]

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Removal of other regional site(s), ONLY

3      Removal / surgical ablation of single liver metastasis

4      Removal / surgical ablation of multiple liver metastases

5      Combination of code 2 WITH 3 or 4

6      Removal of other distant site(s) or distant lymph node(s), ONLY

7      Combination of code 6 WITH 3 or 5

8      Combination of code 6 WITH 4

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Do not code anastomosis  as reconstruction.

0      No reconstruction / restoration

1      Colostomy (permanent)

2      Ileostomy, NOS

3      WITHOUT a reservoir or pouch

4      WITH an abdominal reservoir or pouch

5      WITH an anal reservoir or pouch; artificial sphincter

9      Unknown; not stated; death certificate only

D - 20

RECTOSIGMOID

C19.9

SURGERY OF PRIMARY SITE

Note:  Code removal / surgical ablation of single or multiple liver metastases  under the data item "Surgery of Other
Regional Sites, Distant Sites or Distant Lymph Nodes."

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser ablation
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

Procedures coded 30 include, but are not limited to:

Anterior resection

Hartmann’s operation
Low anterior resection (LAR) Partial colectomy, NOS Rectosigmoidectomy, NOS Sigmoidectomy

30   Wedge or segmental resection; partial proctosigmoidectomy, NOS

Procedures coded 40 include, but are not limited to:

Altemeier’s operation

Duhamel’s operation
Soave’s submucosal resection Swenson’s operation Turnbull’s operation

40   Pull through WITH sphincter preservation (coloanal anastomosis)

D - 21

RECTOSIGMOID

SURGERY OF PRIMARY SITE (cont.)

Procedures coded 50 include, but are not limited to:
Abdominoperineal resection (A & P resection) Anterior/posterior resection (A/P resection) / Miles’ operation Rankin’s operation

50   Total proctectomy

51   Total colectomy (removal of the colon from cecum to the rectosigmoid or a portion of the rectum)

60   Combination of 50 and 51

70   Colectomy or proctocolectomy WITH an en bloc resection of other organs; pelvic exenteration

En bloc resection is the removal of organs in one piece at one time.  Procedures that may be a part of an en bloc
resection include, but are not limited to:  an oophorectomy and a rectal mucosectomy.

Code 70 includes any colectomy (partial, hemicolectomy, or total) WITH an en bloc resection of any other organs.
The other organs may be partially or totally removed.

An ileal reservoir which is part of a pelvic exenteration should be coded in the data item “Reconstruction - First
Course".

80   Colectomy, NOS; Proctectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 22

RECTOSIGMOID

SCOPE OF REGIONAL LYMPH NODE SURGERY

The pathology report often identifies regional lymph nodes by their anatomic location:  colic; mesenteric; peri-/para-/ colic;
perirectal; rectal.

The specific regional lymph nodes are:

Inferior mesenteric

Left colic
Middle rectal (hemorrhoidal) Perirectal

Sigmoid mesenteric

Sigmoidal

Superior rectal (superior hemorrhoidal)

Superior mesenteric, external iliac and common iliac nodes are DISTANT nodes.  Code removal of these nodes under the data item “Surgery of Other Regional Sites, Distant Sites or Distant Lymph Nodes.”

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

D - 23

RECTOSIGMOID

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of appendix, gallbladder, or bile ducts.  [Incidental removal is when an organ is removed
for a reason unrelated to the malignancy (e.g., gallbladder removed for obvious cholelithiasis)].

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Removal of other regional site(s), ONLY

3      Removal / surgical ablation of single liver metastasis

4      Removal / surgical ablation of multiple liver metastases

5      Combination of code 2 WITH 3 or 4

6      Removal of other distant site(s) or distant lymph node(s), ONLY

7      Combination of code 6 WITH 3, 4 or 5

8      Combination of code 6 WITH 3 or 5

9      Unknown; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Colostomy (permanent)

2      Ileostomy, NOS

3      WITHOUT a reservoir or pouch

4      WITH an abdominal reservoir or pouch

5      WITH an anal reservoir or pouch; artificial sphincter

9      Unknown; not stated; death certificate only

D - 24

RECTUM

C20.9

SURGERY OF PRIMARY SITE

Note:  Code removal / surgical ablation of single or multiple liver metastases  under the data item "Surgery of Other
Regional Sites, Distant Sites or Distant Lymph Nodes."

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use o f hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
28   Curette and fulguration
Specimen sent to pathology from this surgical event.

Procedures coded 30 include, but are not limited to:

Anterior resection

Hartmann’s operation
Low anterior resection (LAR) Trans-sacral rectosigmoidectomy

30   Wedge or segmental resection; partial proctectomy, NOS

Procedures coded 40 include, but are not limited to:

Altemeier’s operation

Duhamel’s operation
Soave’s submucosal resection Swenson’s operation Turnbull’s operation

40   Pull through WITH sphincter preservation (coloanal anastomosis)

D - 25

RECTUM

SURGERY OF PRIMARY SITE (cont.)

Procedures coded 50 include, but are not limited to:
Abdominoperineal resection (A & P resection) Anterior/Posterior (A/P) resection / Miles’ operation Rankin’s operation

50   Total proctectomy

60   Total proctocolectomy, NOS

70   Proctectomy or proctocolectomy WITH an en bloc resection of other organs; pelvic exenteration

En bloc resection is the removal of organs in one piece at one time.

The creation of an ileal reservoir which is a part of a pelvic exenteration should be coded in the data item “Reconstruction
- First Course”.

80   Proctectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 26

RECTUM

SCOPE OF REGIONAL LYMPH NODE SURGERY

The pathology report often identifies regional lymph nodes by their anatomic location:  mesenteric nodes; perirectal nodes; rectal nodes.

The specific regional lymph nodes are: Inferior rectal (hemorrhoidal) Inferior mesenteric

Internal iliac

Lateral sacral
Middle rectal (hemorrhoidal) Perirectal

Presacral
Sacral promontory (Gerota’s) Sigmoid mesenteric

Superior rectal (hemorrhoidal)

Superior mesenteric, external iliac and common iliac nodes are classified as DISTANT lymph nodes.  Code removal of these nodes under the data item “Surgery of Other Regional Sites, Distant Sites or Distant Lymph Nodes.”

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

D - 27

RECTUM

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of appendix, gallbladder, bile ducts, or spleen.  [Incidental removal is when an organ is
removed for a reason unrelated to the malignancy (e.g., gallbladder removed for obvious cholelithiasis).]

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Removal of other regional site(s), ONLY

3      Removal / surgical ablation of single liver metastasis

4      Removal / surgical ablation of multiple liver metastases

5      Combination of code 2 WITH 3 or 4

6      Removal of other distant site(s) or distant lymph node(s), ONLY

7      Combination of code 6 WITH 3, 4 or 5

8      Combinatio n of code 6 WITH 3 or 5

9      Unknown; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Colostomy (permanent)

2      Ileostomy, NOS

3      WITHOUT a reservoir or pouch

4      WITH an abdominal reservoir or pouch

5      WITH an anal reservoir or pouch; artificial sphincter

9      Unknown; not stated; death certificate only

D - 28

ANUS

C21.0 - C21.8

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

Procedures for codes 10-14 include, but are not limited to:
Cryosurgery Electrocautery Excisional biopsy Laser

Thermal ablation

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

Note:  Margins of resection may have microscopic involvement.

60   Abdominal perineal resection, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 29

ANUS

SCOPE OF REGIONAL LYMPH NODE SURGERY

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Perirectal, anorectal lymph nodes

3      Internal iliac lymph nodes (hypogastric), unilateral

4      Inguinal lymph nodes, unilateral

5      Combination of 2 and 4

6      Bilateral internal iliac and/or bilateral inguinal lymph nodes

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sit es

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Colostomy (permanent)

2      Ileostomy, NOS

3      WITHOUT a reservoir or pouch

4      WITH an abdominal reservoir or pouch

5      WITH an anal reservoir or pouch; artificial sphincter

9      Unknown; not stated; death certificate only

D - 30

LIVER and INTRAHEPATIC BILE DUCTS

C22.0, C22.1

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
15   Alcohol (percutaneous ethanol injection) (PEI)
16   Heat
17   Other (ultrasound, acetic acid)

20   Wedge resection, NOS; segmental resection

30   Lobectomy, NOS
31   Simple
32   Extended (resection of a single lobe plus a segment of another lobe)

40   Excision of a bile duct (for an intrahepatic bile duct primary only)

70   Total hepatectomy WITH transplant
A liver transplant must also be coded under the data item “Reconstruction - First Course”.

80   Hepatectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 31

LIVER and INTRAHEPATIC BILE DUCTS

SCOPE OF REGIONAL LYMPH NODE SURGERY

Regional lymph nodes are the hilar nodes...:

...along the portal vein

...along the inferior vena cava

...along the proper hepatic artery

...at the hepatic pedicle

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s) (includes inferior phrenic lymph nodes)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Rioux-en-Y; hepatojejunostomy including stent

2      Liver transplant

9      Unknown; not stated; death certificate only

D - 32

PANCREAS

C25.0 - C25.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local excision of tumor, NOS

20   Partial pancreatectomy, NOS

40   Total pancreatectomy

50   Local or partial pancreatectomy and duodenectomy
51   Without subtotal gastrectomy
52   With subtotal gastre ctomy (Whipple)

60   Total pancreatectomy and subtotal gastrectomy or duodenectomy

70   Extended pancreatoduodenectomy

80   Pancreatectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 33

PANCREAS

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are:
Celiac (head only) Hepatic artery Infrapyloric (head only) Lateral aortic

Pancreaticolienal (body and tail only)
Peripancreatic (superior, inferior, anterior, posterior splenic) Retroperitoneal
Splenic (body and tail only) Subpyloric (head only) Superior mesenteric

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Extended lymphadenectomy

An extended pancreaticoduodenectomy incorporates selected aspects of the Whipple procedure and regional
pancreatectomy.  A wide Kocher maneuver removes all lymphatic tissue over the medial aspect of the right
kidney, inferior vena cava, and left renal vein.

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODE(S)

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Removal of other regional sites, ONLY

3      Removal of distant node(s)

4      Removal of distant site

5      Combination of 2 WITH 3 and/or 4

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Use the following code only:

9      Not applicable  (There are no known reconstructive procedures for this site.)

D - 34

LARYNX

C32.0 - C32.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
15   Stripping
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
28   Stripping
Specimen sent to pathology from this surgical event.

30   Partial excision of the primary site, NOS; subtotal/partial laryngectomy, NOS; hemilaryngectomy, NOS
31   Vertical laryngectomy
32   Anterior commissure laryngectomy
33   Supraglottic laryngectomy

40   Total or radical laryngectomy, NOS
41   Total laryngectomy ONLY
42   Radical laryngectomy ONLY

50   Pharyngolaryngectomy

80   Laryngectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery perfo rmed; death certificate only

D - 35

LARYNX

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional cervical lymph nodes are:

Buccal (facial)
Caudal jugular (deep cervical) Cranial jugular (deep cervical) Dorsal cervical (superficial cervical) Medial jugular (deep cervical) Occipital
Paratracheal (anterior cervical) Parotid
Prelaryngeal (anterior cervical) Retroauricular (mastoid, posterior auricular) Retropharyngeal
Submandibular (submaxillary) Submental

Supraclavicular

0      No regional lymph nodes removed

1      Regional lymp h node(s) removed, NOS

2      Neck dissection, NOS

3      Selective, limited; nodal sampling; “berry picking”

4      Modified / modified radical

5      Radical

9      Unknown; not stated; death certificate only

Terminology of neck dissection (Robbins et al. 1991):

A radical neck dissection includes the removal of all ipsilateral cervical lymph node groups, i.e., lymph nodes from levels I
through V (submental, submandibular, cranial jugular, medial jugular, caudal jugular, dorsal cervical nodes along the
accessory nerve, and supraclavicular), and removal of the spinal accessory nerve, internal jugular vein and
sternocleidomastoid muscle.

In a modified radical neck dissection, the same lymph nodes are removed as in a radical neck dissection; however, one or
more non-lymphatic structures are preserved.

A selective neck dissection is a neck dissection with preservation of one or more lymph node groups routinely removed in
radical neck dissection.

D - 36

LARYNX

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Flaps, grafts, any type of “...plasty,”  NOS

2      WITHOUT implant / prosthesis

3      WITH implant / prosthesis

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 37

LUNG

C34.0 - C34.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction or excision, NOS; Photodynamic therapy (PDT)
11   Excision
12   Laser ablation or excision
13   Cautery; fulguration
14   Bronchial sleeve resection ONLY

20   Resection of less than one lobe
21   Wedge resection
22   Segmental resection, including lingulectomy

30   Resection of at least one lobe, but less than the whole lung (partial pneumonectomy, NOS)
31   Lobectomy
32   Bilobectomy

Procedures coded 40 include, but are not limited to:
Complete pneumonectomy Pneumonectomy, NOS Sleeve pneumonectomy Standard pneumonectomy Total pneumonectomy

40   Resection of whole lung

50   Resection of lung WITH an en bloc resection of other organs
51   Wedge resection
52   Lobectomy
53   Bilobectomy
54   Pneumonectomy (less than a radical or extended pneumonectomy)

En bloc resection is the removal of organs in one piece at one time.

60   Radical pneumonectomy  (a complete pneumonectomy WITH removal of mediastinal lymph nodes )

Removal of mediastinal nodes is also coded in the data fields “Scope of Regional Lymph Node Surgery” and “Number of
Regional Nodes Removed.”

D - 38

LUNG

SURGERY OF PRIMARY SITE (cont.)

70   Extended radical pneumonectomy  [a radical pneumonectomy (including removal of mediastinal nodes ) and the
removal of other tissues or nodes]
Removal of mediastinal nodes is also coded in the data fields “Scope of Regional Lymph Node Surgery” and “Number of
Regional Nodes Removed.”

80   Resection of lung, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

Mediastinal nodes are:
Aortic (includes subaortic, aorticopulmonary window, periaortic, including ascending aorta or including azygos) Periesophageal
Peritracheal (including those that may be designated tracheobronchial, i.e., lower peritracheal, phrenic) Pre- and retrotracheal (includes precarinal)

Pulmonary ligament

Subcarinal

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Intrapulmonary (includes interlobar, lobar, segmental), ipsilateral hilar and/or ipsilateral peribronchial nodes

3      Ipsilateral mediastinal and/or subcarinal nodes

4      Combination of 2 and 3

5      Contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene and/or supraclavicular nodes

6      Combination of 5 WITH 2 or 3

9      Unknown; not stated; death certificate only

D - 39

LUNG

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of ribs  (ribs are removed to provide access to the lung).

0      None; no surgery to other regional sites, distant sites or distant lymph nodes

1      Surgery to other site(s)or node(s), NOS; unknown if regional or distant

2      Surgery to a regional site ONLY

3      Removal of a solitary lesion in the same  lung (primary site), different (non-primary) lobe
There is one primary:  Patient has two tumors with the same histology in different lobes of the same lung.

4      Resection of metastasis in a distant site(s) or resection of distant lymph nodes(s), NOS

5      Removal of a solitary lesion in the contralateral lung
Patient has one primary:  There is a primary tumor or tumor(s) in one lung and a solitary metastatic lesion in the contralateral  lung.

6      Removal of a solitary lesion in a distant site or a distant lymph node, NOS

This includes, but is not limited to, the removal of a solitary metastatic brain lesion.

7      Removal of multiple lesions in dis tant site(s)

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Chest wall reconstruction / restoration, NOS

9      Unknown; not stated; death certificate only

D - 40

BONES, JOINTS, CARTILAGE, NERVES, OTHER CONNECTIVE and SOFT TISSUES

C40.0 - C40.9, C41.0 - C41.9     Bones, Joints, and Articular Cartilage
C47.0 - C47.9                              Peripheral Nerves and Autonomic Nervous System
C49.0 - C49.9                              Connective, Subcutaneous and Other Soft Tissues

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction or excision

20   Partial resection / internal hemipelvectomy (pelvis)

30   Radical excision or resection of lesion with limb salvage

40   Amputation of limb
41   Partial amputation of limb
42   Total amputation of limb

50   Major amputation, NOS
51   Forequarter, including scapula
52   Hindquarter, including ilium/hip bone
53   Hemipelvectomy

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

0      No regional lymph n odes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

D - 41

BONES, JOINTS, CARTILAGE, NERVES, OTHER CONNECTIVE and SOFT TISSUES

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

5      Distant lymph node(s)

6      Distant site(s)

7      Combination of 6 WITH 2 or 5

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstructio n / restoration

1      Flap; graft; any type of “...plasty,”  NOS

2      WITHOUT implant / prosthesis

3      WITH implant / prosthesis

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 42

SPLEEN and LYMPH NODES

C42.2,  C77.0 - C77.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local excision or destruction, NOS;
Lymph node biopsy that is not an excision of a full node chain  (for lymph node primaries)

20   Splenectomy, NOS (for spleen primaries only)
21   Partial splenectomy
22   Total splenectomy

30   Lymph node dissection, NOS (for lymph node primaries only)
31   One chain
32   Two or more chains

40   Lymph node dissection, NOS plus splenectomy
41   One chain
42   Two or more chains

50   Lymph node dissection, NOS and partial / total removal of adjacent organ(s)
51   One chain
52   Two or more chains

60   Lymph node dissection, NOS and partial / total removal of adjacent organ(s) PLUS splenectomy; Staging laparotomy (for lymph node primaries)
61   One chain
62   Two or more chains

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 43

SPLEEN and LYMPH NODES

SCOPE OF REGIONAL LYMPH NODE SURGERY

For lymph node primary sites, use code 9 only.

For spleen primaries, use codes 0, 1 or 9:

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

5      Distant lymph node(s)

6      Distant site(s)

7      Combination of 6 WITH 2 or 5

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Use the following code only:

9      Not applicable  (At this time, reconstructive procedures are not being collected for these sites.)

D - 44

SKIN

C44.0 - C44.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser ablation
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

30   Biopsy o f primary tumor followed by a gross excision of the lesion
31   Shave biopsy followed by a gross excision of the lesion; Mohs' surgery
32   Punch biopsy followed by a gross excision of the lesion
33   Incisional biopsy followed by a gross excision of the lesion

Less than a wide excision, less than 1 cm margin.

40   Wide excision or re-excision of lesion or minor (local) amputation, NOS
Margins of excision are 1 cm or more.  Margins may be microscopically involved. Local amputation is the surgical resection of digits, ear, eyelid, lip, or nose.

50   Radical excision of a lesion, NOS

Margins of excision are greater than 1 cm and grossly tumor-free.  The margins may be microscopically involved.

60   Major amputation, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 45

SKIN

SCOPE OF REGIONAL LYMPH NODE SURGERY

Regional lymph nodes are different for each anatomical subsite.

Head and neck
Cervical
Ipsilateral preauricular Submandibular Supraclavicular

Thorax
Ipsilateral axillary

Arm
Ipsilateral epitrochlear and axillary

Abdomen, loins, buttocks
Ipsilateral inguinal

Anal margin and perianal skin
Ipsilateral inguinal

Leg
Ipsilateral inguinal and popliteal

There are boundary zones between the subsites (i.e., between the thorax and arm, the boundary zone is the shoulder and axilla).  The boundary zones do not belong to either subsite.  If a tumor originates in one of these 4-cm boundary zones, the nodes on either side of the bands are regional.

Between the subsites "Head and neck" and "Thorax", the boundary zone is "clavicula-acromion-upper shoulder blade edge".

Between the subsites "Thorax" and "Arm", the boundary zone is "shoulder-axilla-shoulder".

Between the subsites "Thorax" and "Abdomen, loins, and buttocks", the boundary zones are "middle between navel and costal arch" in the front, and "lower border of thoracic vertebrae (midtransverse axis)" in the back.
Between the subsites "Abdomen, loins, and buttocks" and "Leg", the boundary zone is "groin-trochanter-gluteal sulcus". Between right and left sides, the boundary zone is the midline.

Iliac, other pelvic, abdominal or intrathoracic lymph nodes are DISTANT.  Code the removal of these nodes under the data item “Surgery of Other Regional Sites, Distant Sites or Distant Lymph Nodes.”

0      No regional lymph nodes removed

1      Sentinel node, NOS  (the first node to receive drainage from a primary tumor, identified by an injection of a dye or radio label at the site of the primary tumor)

2      Regional lymph nodes removed, NOS

9      Unknown; not stated; death certificate only

D - 46

SKIN

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Pedicle flap, free flap, skin g raft, NOS

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 47

BREAST

C50.0 - C50.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

Procedures coded as 10-17 remove the gross primary tumor and some of the breast tissue (breast-conserving or breast-
preserving).  There may be microscopic residual tumor.

10   Partial mastectomy, NOS; less than total mastectomy, NOS
11   Nipple resection
12   Lumpectomy or excisional biopsy
13   Re-excision of the biopsy site for gross or microscopic residual disease.
14   Wedge resection
15   Quadrantectomy
16   Segmental mastectomy
17   Tylectomy

30   Subcutaneous mastectomy  (the removal of breast tissue without the nipple and areolar complex or o verlying skin)

This procedure is rarely performed to treat malignancies.

40   Total (simple) mastectomy , NOS
41   WITHOUT removal of uninvolved contralateral breast
42   WITH removal of uninvolved contralateral breast

A simple mastectomy  removes all breast tissue, the nipple, and areolar complex.  An axillary dissection is not done.

For single primaries only, code removal of involved contralateral breast under the data item “Surgery of Other Regional
Sites, Distant Sites or Distant Lymph Nodes.”

50   Modified radical mastectomy
51   WITHOUT removal of uninvolved contralateral breast
52   WITH removal of uninvolved contralateral breast

Modified radical mastectomy  removes all breast tissue, the nipple, the areolar complex, and variable amounts of breast skin.
 The procedure involves an en bloc resection of the axilla.  The specimen may or may not include a portion of the pectoralis
major muscle; includes an en bloc axillary dissection.

For single primaries only, code removal of involved contralateral breast under the data item “Surgery of Other Regional
Sites, Distant Sites or Distant Lymph Nodes.”

D - 48

BREAST

SURGERY OF PRIMARY SITE (cont.)

60   Radical mastectomy , NOS
61   WITHOUT removal of uninvolved contralateral breast
62   WITH removal of uninvolved contralateral breast

Radical mastectomy  is the removal of breast tissue, nipple, areolar complex, a variable amount of skin, pectoralis minor, and
pectoralis major; includes an en bloc axillary dissection.

For single primaries only, code removal of involved contralateral breast under the data item “Surgery of Other Regional
Sites, Distant Sites or Distant Lymph Nodes.”

70   Extended radical mastectomy
71   WITHOUT removal of uninvolved contralateral breast
72   WITH removal of uninvolved contralateral breast

Extended radical mastectomy  is the removal of breast tissue, nipple, areolar complex, variable amounts of skin, pectoralis
minor, and pectoralis major; includes removal of internal mammary nodes and an en bloc axillary dissection.

For single primaries only, code removal of involved contralateral breast under the data item “Surgery of Other Regional
Sites, Distant Sites or Distant Lymph Nodes.”

80   Mastectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

0      No regional lymph nodes removed

1      Sentinel lymph node(s) removed  (the first node to receive drainage from a primary tumor, identified by an injection of a dye or radio label at the site of the primary tumor)

2      Regional lymph n ode(s) removed, NOS; axillary, NOS (Levels I, II, or III lymph nodes); intramammary, NOS

3      Combination of 1 and 2

4      Internal mammary

5      Combination of 4 WITH any of 1-3

9      Unknown; not stated; death certificate only

D - 49

BREAST

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code removal of fragments or tags of muscles; removal of the pectoralis minor; the resection of pectoralis muscles, NOS; or the resection of fascia with no mention of muscle.

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Removal of involved contralateral breast (single primary only)

6      Combination of 4 or 5 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

(The insertion of a tissue expander is often the beginning of the reconstructive procedure.)

0      No reconstruction / restoration

1      Reconstruction, NOS (unknown if flap)

2      Implant; reconstruction WITHOUT flap

3      Reconstruction WITH flap, NOS

4      Latissimus dorsi flap

5      Abdomminus recti flap

6      Flap, NOS + implant

7      Latissimus dorsi flap + implant

8      Abdominus recti + implant

9      Unknown; not stated; death certificate only

D - 50

CERVIX UTERI

C53.0 - C53.9

SURGERY OF PRIMARY SITE

For invasive  cancers, dilation (dilatation) and curettage is coded as an incisional biopsy (02) under the data item “Non
Cancer-Directed Surgery.”

00   None; no cancer-directed surgery o f primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
15   LEEP
No specimen sent to pathology from this surgical event.

20   Local tumor destruction or excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Electrocautery
22   Cryosurgery
23   Laser
24   Cone biopsy WITH gross excision of lesion
25   Dilation (dilatation) and curettage; endocervical curettage (cancer-directed for in situ only)
26   Excisional biopsy, NOS
27   Cone biopsy
28   LEEP
29   Trachelectomy; removal of cervical stump; cervicectomy
Specimen sent to pathology from this surgical event.

30   Total hysterectomy  (simple, pan-) WITHOUT removal of tubes and ovaries

Total hysterectomy removes both the corpus and cervix uteri and may also include a portion of vaginal cuff.

40   Total hysterectomy  (simple, pan-) WITH removal of tubes or ovary

Total hysterectomy removes both the corpus and cervix uteri and may also include a portion of vaginal cuff.

50   Modified radical or extended hysterectomy; radical hysterectomy; extended radical hysterectomy
51   Modified radical hysterectomy
52   Extended hysterectomy
53   Radical hysterectomy; Wertheim’s procedure
54   Extended radical hysterectomy

60   Hysterectomy, NOS, WITH or WITHOUT removal of tubes and ovaries
61   WITHOUT removal of tubes and ovaries
62   WITH removal of tubes and ovaries

D - 51

CERVIX UTERI

SURGERY OF PRIMARY SITE (cont.)

70   Pelvic exenteration
71   Anterior exenteration  (includes bladder, distal ureters, and genital organs WITH their ligamentous attachments and pelvic lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

72   Posterior exenteration  (includes rectum and rectosigmoid WITH ligamentous attachments and pelvic lymph
nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

73   Total exenteration  (includes removal of all pelvic contents and pelvic lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

74   Extended exenteration  (includes pelvic blood vessels or bony pelvis)

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are:

Common iliac
External iliac Hypogastric (obturator) Internal iliac Paracervical
Parametrial Presacral Sacral

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

D - 52

CERVIX UTERI

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of the appendix.  Do not code an omentectomy IF it was the only surgery performed in
addition to hysterectomy.  (Incidental removal is when an organ is removed for a reason unrelated to the malignancy.)

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s), NOS

4      Periaortic lymph nodes

5      Distant site(s)

6      Combinatio ns of 5 WITH 4

7      Combination of 5 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Vaginal reconstruction

2      Urinary reconstruction

3      Bowel reconstruction / restoration

4      Combination of 3 WITH 1 or 2

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 53

CORPUS UTERI

C54.0 - C54.9,  C55.9

SURGERY OF PRIMARY SITE

For invasive  cancers, dilation (dilatation) and curettage is coded as an incisional biopsy (02) under the data item “Non
Cancer-Directed Surgery.”

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
15   LEEP
No specimen sent to pathology from this surgical event.

Procedures in code 20 include, but are not limited to:
Cryosurgery Electrocautery Excisional biopsy Laser ablation Thermal ablation

20   Local tumor destruction or excision, NOS; simple excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Electrocautery
22   Cryosurgery
23   Laser
24   Excisional biopsy
25   Polypectomy
26   Myomectomy
Specimen sent to pathology from this surgical event.

Margins of resection may have microscopic involvement.

30   Subtotal hysterectomy / supracervical hysterectomy / fundectomy WITH or WITHOUT removal of tube(s) and ovary(ies).
31   WITHOUT tube(s) and ovary (ies)
32   WITH tube(s) and ovary (ies)

Cervix is left in place.

40   Total hysterectomy  (simple, pan-) WITHOUT removal of tube(s) and ovary (ies)

Total hysterectomy removes both the corpus and cervix uteri.  It may also include a portion of the vaginal cuff.

50   Total hysterectomy  (simple, pan-) WITH removal of tube(s) or ovary (ies)

Total hysterectomy removes both the corpus and cervix uteri.  It may also include a portion of the vaginal cuff.

D - 54

CORPUS UTERI

SURGERY OF PRIMARY SITE

60   Modified radical or extended hysterectomy; radical hysterectomy; extended radical hysterectomy
61   Modified radical hysterectomy
62   Extended hysterectomy
63   Radical hysterectomy; Wertheim’s procedure
64   Extended radical hysterectomy

70   Hysterectomy, NOS, WITH or WITHOUT removal of tube(s) and ovary(ies)
71   WITHOUT removal of tube(s) and ovary(ies)
72   WITH removal of tube(s) and ovary(ies)

80   Pelvic exenteration

81   Anterior exenteration  (includes bladder, distal ureters, and genital organs WITH their ligamentous attachments and pelvic lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

82   Posterior exenteration  (includes rectum and rectosigmoid WITH ligamentous attachments and pelvic lymph
nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

83   Total exenteration  (includes removal of all pelvic contents and pelvic lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

84   Extended exenteration  (includes pelvic blood vessels or bony pelvis)

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are: Common iliac and external iliac Hypogastric (obturator)
Para aortic Parametrial Sacral

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Pariaortic WITH or WITHOUT other regional lymph nodes

9      Unknown; not stated; death certificate only

D - 55

CORPUS UTERI

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of the appendix.  Do not code an omentectomy IF it was the only surgery performed in
addition to hysterectomy.  [Incidental removal is when an organ is removed for a reason unrelated to the malignancy.]

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Vaginal reconstruction

2      Urinary reconstruction

3      Bowel reconstruction / restoration

4      Combination of 3 WITH 1 or 2

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 56

OVARY

C56.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Total removal of tumor or (single) ovary, NOS
11   Resection of ovary  (wedge, subtotal, or partial) ONLY, NOS; unknown if hysterectomy done
12   WITHOUT hysterectomy
13   WITH hysterectomy
14   Unilateral (salpingo-) oophorectomy; unknown if hysterectomy done
15   WITHOUT hysterectomy
16   WITH hysterectomy

20   Bilateral (salpingo-)oophorectomy; unknown if hysterectomy done
21   WITHOUT hysterectomy
22   WITH hysterectomy

30   Unilateral or bilateral (salpingo-) oophorectomy WITH OMENTECTOMY, NOS; partial or total; unknown if hysterectomy done
31   WITHOUT hysterectomy
32   WITH hysterectomy

60   Debulking; cytoreductive surgery, NOS
61   WITH colon (including appendix) and/or small intestine resection (not in cidental)
62   WITH partial resection of urinary tract (not incidental)
63   Combination of 61 and 62

Debulking  is a partial removal of the tumor mass and can involve the removal of multiple organ sites.  It may include
removal of ovaries and/or the uterus (a hysterectomy).  The pathology report may or may not identify ovarian tissue.  A
debulking is usually followed by another treatment modality, such as chemotherapy.

70   Pelvic exenteration, NOS

71   Anterior  (includes bladder, distal ureters, and genital organs WITH their ligamentous attachments and pelvic
lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

72   Posterior  (includes rectum and rectosigmoid WITH ligamentous attachments and pelvic lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

73   Total  (includes removal of all pelvic contents and pelvic lymph nodes )

The removal of pelvic lymph nodes is also coded under the data item “Surgery of Other Regional Sites, Distant
Sites or Distant Lymph Nodes.”

74   Extended  (includes pelvic blood vessels or bony pelvis)

80   (Salpingo-) oophorectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 57

OVARY

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are:

Common iliac
External iliac Hypogastric (obturator) Inguinal
Lateral sacral Paraaortic Pelvic, NOS

Retroperitoneal, NOS

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code an incidental removal of the appendix.  (Incidental removal is when an organ is removed for a reason unrelated
to the malignancy.)

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Urinary reconstruction

2      Bowel reconstruction / restoration

3      Combination of 1 and 2

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 58

PROSTATE

C61.9

SURGERY OF PRIMARY SITE

Do not code an orchiectomy  in this field.  For prostate primaries, orchiectomies are coded in the field “Hormone Therapy.”

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction or excision, NOS
11   Transurethral resection (TURP), NOS
12   TURP - cancer is incidental finding during surgery for benign disease
13   TURP - patient had suspected/known cancer
14   Cryoprostatectomy
15   Laser
16   Hyperthermia
17   Other method of local resection or destruction

30   Subtotal or simple prostatectomy, NOS  (a segmental resection or enucleation leaving the capsule intact)

40   Less than total prostatectomy, NOS  (an enucleation using an instrument such as a Vapotrode which may leave all or part of the capsule intact)

50   Radical prostatectomy, NOS Total prostatectomy, NOS
These procedures include excision of prostate, prostatic capsule, ejaculatory ducts, seminal vesicle(s), and may include a narrow cuff of bladder neck.

70   Prostatectomy WITH en bloc resection of other organs; pelvic exenteration

Surgeries coded 70 are any prostatectomy WITH an en bloc resection of any other organs.  The other organs may be
partially or totally removed.  En bloc resection is the removal of organs in one piece at one time.   Procedures that may
involve an en bloc resection include, but are not limited to:  cystoprostatectomy, radical cystectomy, prostatectomy.

80   Prostatectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 59

PROSTATE

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are:

Hypogastric
Iliac, NOS (internal and external) Obturator
Pelvic, NOS Periprostatic

Sacral, NOS (lateral presacral, promontory [Gerota's] or NOS)

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code orchiectomy  here.  For prostate primaries, code orchiectomies under “Hormone Therapy.”

The most commonly removed distant lymph nodes are:  aortic (para-aortic, peri-aortic, lumbar); common iliac; inguinal;
superficial inguinal (femoral); supraclavicular; cervical; and scalene.

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Reconstruction / restoration, NOS

2      Collagen injection for incontinence

3      Penile prosthesis

4      Artificial urinary sphincter

5      Combinations of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

D - 60

TESTIS

C62.0 - C62.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local or partial excision of testicle

30   Excision of t esticle, NOS WITHOUT cord

40   Excision of testicle, NOS WITH cord, /or cord not mentioned

80   Orchiectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are:
Interaortocaval Paraaortic (Periaortic) Paracaval
Preaortic Precaval Retroaortic Retrocaval

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS; not stated if bilateral or unilateral

2      Unilateral regional lymph nodes

3      Bilateral regional lymph nodes

9      Unknown; not stated; death certificate only

D - 61

TESTIS

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS;  unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Testicular implant

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 62

KIDNEY, RENAL PELVIS, and URETER

C64.9,  C65.9,  C66.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

Procedures coded 30 include, but are not limited to:
Cryosurgery Electrocautery Excisional biopsy Laser
Segmental resection Thermal ablation Wedge resection

30   Partial or subtotal nephrectomy (kidney or renal pelvis) or partial ureterectomy (ureter)

Margins of resection are grossly negative.  There may be microscopic involvement.

40   Complete / total / simple nephrectomy - for kidney parenchyma
Nephroureterectomy

These procedures include bladder cuff for renal pelvis or ureter.

50   Radical nephrectomy  (may include removal of a portion of vena cava, adrenal gland(s), Gerota’s fascia, perinephric fat, or partial / total ureter)

D - 63

KIDNEY, RENAL PELVIS, and URETER

SURGERY OF PRIMARY SITE (cont.)

70   Any nephrectomy (simple, subtotal, complete, partial, simple, total, radical) PLUS an en bloc resection of other organ(s) (colon, bladder)

The other organs, such as colon or bladder, may be partially or totally removed.

80   Nephrectomy, NOS Ureterectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional nodes for each site are:

Kidney
Aortic (para-aortic, periaortic, lateral aortic) Paracaval
Renal hilar
Retroperitoneal, NOS

Renal Pelvis
Aortic Paracaval Renal hilar
Retroperitoneal, NOS

Ureter
Iliac [common, internal (hypogastric), external] Paracaval
Pelvic, NOS Periureteral Renal hilar

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS; not stated if bilateral or unilateral

2      Unilateral regional lymph nodes

3      Bilateral regional lymph nodes

9      Unknown; not stated; death certificate only

D - 64

KIDNEY, RENAL PELVIS, and URETER

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the incidental removal of ribs during the operative approach  (ribs removed to provide access).

0      None; no s urgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Kidney transplant (primary site)

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 65

BLADDER

C67.0 - C67.9

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery; fulguration (includes use of hot forceps for tumor destruction)
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy (TURB)
Specimen sent to pathology from this surgical event.

30   Partial cystectomy

50   Simple / total / complete cystectomy

60   Radical cystectomy  (male only)

This code is used only for males.  A radical cystectomy in a male involves the removal of the bladder and prostate, with or
without urethrectomy.  (If a radical cystectomy is performed on a female, use code 71.)

70   Pelvic exenteration, NOS
71   Radical cystectomy  (female only); anterior exenteration

A radical cystectomy in a female includes removal of the bladder, uterus, ovaries, entire vaginal wall and entire
urethra.  (If a radical cystectomy is performed on a male, use code 60.)

72   Posterior exenteration
73   Total exenteration  (includes removal of all pelvic contents and p elvic lymph nodes)
74   Extended exenteration  (includes pelvic blood vessels or bony pelvis)

80   Cystectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 66

BLADDER

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are:

Hypogastric
Iliac (internal, external, NOS) Obturator
Pelvic, NOS Perivesical, pericystic Presacral

Sacral [lateral, sacral promontory (Gerota's)]

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS; not stated if bilateral or unilateral

2      Unilateral regional lymph nodes

3      Bilateral regional lymph nodes

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

Do not code the partial or total removal of a ureter during a cystectomy.

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Combinatio n of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

D - 67

BLADDER

RECONSTRUCTION - FIRST COURSE

0      No reconstruction / restoration

1      Conduit diversion

2      Continent reservoir (a bladder substitute)

Types of continent reservoirs  include, but are not limited to:

Hemi-Kock

Ileal reservoir
Ileocecal reservoir Indiana or Mainz pouch Koch

Studer pouch

W-shaped ileoneobladder by Hautmann

8      Reconstruction / restoration recommended, unknown if performed

9      Unknown; not stated; death certificate only

D - 68

BRAIN and OTHER PARTS OF CENTRAL NERVOUS SYSTEM

C70.0 - C70.9      Meninges
C71.0 - C71.9      Brain
C72.0 - C72.9      Other Parts of Central Nervous System

SURGERY OF PRIMARY SITE

DO NOT CODE laminectomies for spinal cord primaries.

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction

20   Excision of tumor, lesion, or mass
21   Subtotal resection, NOS
22   Partial resection (more than half of tumor resected, but less than total resection)
23   Debulking (more than 5%  of tumor removed, but less than half)

30   Excision of tumor, lesion, or mass, NOS
31   Total resection
32   Gross resection

40   Partial resection, NOS
41   Partial lobe
42   Partial meninges
43   Partial nerve(s)

50   Total resection (lobectomy of brain)

60   Radical resection  (resection of primary site plus partial or total removal of surrounding organs / tissue)

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

D - 69

BRAIN and OTHER PARTS OF CENTRAL NERVOUS SYSTEM

SCOPE OF REGIONAL LYMPH NODE SURGERY

There are NO regional lymph nodes  for the brain.  Code "unknown" (9) for all brain primaries  (C70.0, C71._).

Central nervous system sites, however, do have regional lymph nodes.

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

5      Distant lymph node(s)

6      Distant site(s)

7      Combination of 6 WITH 2 or 5

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Use the following code only:

9      Not applicable  (There are no known reconstructive procedures for this site.)

D - 70

THYROID GLAND

SURGERY OF PRIMARY SITE

C73.9

00   None; no cancer-directed surgery of primary site

10   Removal of less than a lobe, NOS
11   Local surgical excision
12   Removal of a partial lobe ONLY

20   Lobectomy and/or isthmectomy
21   Lobectomy ONLY
22   Isthmectomy ONLY
23   Lobectomy WITH isthmus

30   Removal of a lobe and partial removal of the contralateral lobe

40   Subtotal or near total thyroidectomy

50   Total thyroidectomy

80   Thyroidectomy, NOS

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

The regional lymph nodes are the cervical and upper mediastinal lymph nodes.

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

2      Neck dissection, NOS

3      Selective, limited; nodal sampling; “berry picking”

4      Modified / modified radical

5      Radical

9      Unknown; not stated; death certificate only

Terminology of neck dissection (Robbins et al. 1991):

A radical neck dissection includes the removal of all ipsilateral cervical lymph node groups, i.e., lymph nodes from levels I
through V (submental, submandibular, cranial jugular, medial jugular, caudal jugular, dorsal cervical nodes along the
accessory nerve, and supraclavicular), and removal of the spinal accessory nerve, internal jugular vein and
sternocleidomastoid muscle.

In a modified radical neck dissection, the same lymph nodes are removed as in a radical neck dissection; however, one or
more non-lymphatic structures are preserved.

A selective neck dissection is a neck dissection with preservation of one or more lymph node groups routinely removed in
radical neck dissection.

D - 71

THYROID GLAND

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional site(s)

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Use the following code only:

9      Not applicable  (There are no known reconstructive procedures for this site.)

D - 72

ALL OTHER SITES

C14.2;  C14.8        Waldeyer ring;  Overlapping lesion of lip, oral cavity and pharynx
C17.0 - C17.9        Small Intestine
C23.9                      Gallbladder
C24.0 - C24.9        Other and Unspecified Parts of Biliary Tract
C26.0 - C26.9        Other and Ill-Defined Digestive Organs
C30.0 - C30.1        Nasal Cavity and Middle Ear
C31.0 - C31.9        Accessory Sinuses
C33.9                      Trachea
C37.9                      Thymus
C38.0 - C38.8        Heart, Mediastinum, and Pleura
C39.0 - C39.9        Other and Ill-Defined Sites Within Respiratory System and Intrathoracic
Organs
C42.0,  C42.1        Blood,  Bone marrow
C42.3,  C42.4        Reticuloendothelial system,  Hematopoietic system
C48.0 - C48.8        Retroperitoneum and Peritoneum
C51.0 - C51.9        Vulva
C52.9                      Vagina
C57.0 - C57.9        Other and Unspecified Female Genital Organs
C58.9                      Placenta
C60.0 - C60.9        Penis
C63.0 - C63.9        Other and Unspecified Male Genital Organs
C68.0 - C68.9        Other and Unspecified Urinary Organs
C69.0 - C69.9        Eye and Adnexa
C74.0 - C74.9        Adrenal Gland
C75.0 - C75.9        Other Endocrine Glands and Related Structures
C76.0 - C76.8        Other and Ill-Defined Sites
C80.9                      Unknown Primary Site

SURGERY OF PRIMARY SITE

00   None; no cancer-directed surgery of primary site

10   Local tumor destruction, NOS (WITHOUT PATHOLOGY SPECIMEN)
11   Photodynamic therapy (PDT)
12   Electrocautery’ fulgura tion
13   Cryosurgery
14   Laser
No specimen sent to pathology from this surgical event.

20   Local tumor excision, NOS  (WITH PATHOLOGY SPECIMEN)
21   Photodynamic therapy (PDT)
22   Electrocautery
23   Cryosurgery
24   Laser ablation
25   Laser excision
26   Polypectomy
27   Excisional biopsy
Specimen sent to pathology from this surgical event.

D - 73

ALL OTHER SITES

SURGERY OF PRIMARY SITE (cont.)

30   Simple / partial surgical removal of primary site

40   Total surgical removal of primary site; enucleation

50   Surgery stated to be “debulking”

60   Radical surgery  (partial or total removal of the primary site WITH an en bloc resection (partial or total removal) of other organs)

90   Surgery, NOS

99   Unknown if cancer-directed surgery performed; death certificate only

SCOPE OF REGIONAL LYMPH NODE SURGERY

For an unknown primary site (C80.9) and leukemias, enter code 9 only.

0      No regional lymph nodes removed

1      Regional lymph node(s) removed, NOS

9      Unknown; not stated; death certificate only

SURGERY OF OTHER REGIONAL SITES, DISTANT SITES OR DISTANT LYMPH NODES

0      None; no surgery to other regional or distant sites

1      Surgery to other site(s) or node(s), NOS; unknown if regional or distant

2      Other regional sites

3      Distant lymph node(s)

4      Distant site(s)

5      Combination of 4 WITH 2 or 3

9      Unknown; not stated; death certificate only

RECONSTRUCTION - FIRST COURSE

Use the following code only:

D - 74

ALL OTHER SITES

9      Not applicable  (At this time, reconstructive procedures are not being collected for these sites.)