V.4.2 Mets at Diagnosis – Bone, Brain, Distant Lymph Nodes, Liver, Lung, and Other

The following data items record the specific site(s) of metastatic disease present at diagnosis. This field identifies whether bone, brain, distant lymph nodes, liver, lung or other discontinuous or distant metastatic site(s) are involved.

Coding Instructions:

• Metastatic involvement may be single (one focus of metastatic disease) or multiple (multiple foci of metastatic disease in the same site or multiple sites). Information may be clinical or pathologic.

• Code this field for metastasis even if the patient had neoadjuvant (preoperative) systemic therapy, unless it is determined to be disease progression.

• This field should be coded for all solid tumors, Kaposi’s sarcoma, Unknown primary site and Other and Ill-defined primary sites.  

• In the data field for each site below, enter the code that demonstrates involvement of that site.

• Mets at DX – Bone

• Mets at DX – Brain

• Mets at DX – Distant LN

• Use the AJCC definition of distant lymph node for site.

• Confirm lymph node involvement is distant.  Regional Lymph node involvement should not be coded in this field.

Exception: Lymph nodes for placenta which are M1.

• Mets at DX – Liver

• Mets at DX – Lung

• Mets at DX – Other

• Code metastatic involvement of the following sites in this data field:

• Bone Marrow

• Spinal Cord

• Other CNS

• Adrenal Gland

• Pleura

• Malignant Pleural Effusion

• Peritoneum

• Skin

• Carcinomatosis

• This is not intended to be an inclusive list

Coding Guidelines for Lymphoma Malignancies

• Each of the Mets at DX fields should be coded for Lymphoma: (9590-9699, 9702-9727, 9735, 9737-9738 (All sites) and 9811-9818, 9823, 9827, 9837 (All sites EXCEPT C420, C421, and C424).

• Code all Mets at DX fields to 0 when TNM Stage Group is I, II, or III.

• Always code Mets at Dx-Distant Lymph Nodes to 0 (none; no distant LN Mets).

• For lymphoma, any lymph node involvement is included in the TNM Stage Group and is not based on whether LNs are regional or distant.

• When Stage Group for Lymphoma is Stage IV:

• One of the Mets at DX fields (other than Mets at DX-Distant Lymph Nodes) needs to be coded to 1.

• Stage IV indicates the presence of involvement in one or more extralymphatic organs.

• Code Bone, Brain, Liver and Lung as 1 when any of these sites are involved and they are not the primary site. This is the same instruction for a solid tumor neoplasm.

• Code Mets at DX-Other to 1 when there is associated bone marrow involvement with lymphoma OR if there is other extralymphatic involvement (which is not bone, brain, liver or lung).

• Example: Cerebral spinal fluid

• Do not use code 8 for lymphoma primaries.

Coding Guidelines for Hematologic Malignancies

• Use code 8 (Not applicable) for the following hematologic site/histology combinations for which a code for distant metastasis is not clinically relevant:

Codes:

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