2014 Changes to the Hematopoietic Project
January 17, 2014

On this page:

  1. Major Changes
  2. The Multiple Primary (M) Rules
  3. The Primary Site and Histology (PH) Rules
  4. The Hematopoietic Database

Major Changes

  1. Revised manual effective for cases 1/1/2010 and forward
    • Will no longer be different versions depending on year of diagnosis
    • “Version” no longer applicable
    • Published date will be used
      • Published January 2014
    (Note: The revised Manual and Database are to be used with ALL Hematopoietic and Lymphoid Neoplasms (9590/3-9992/3) with diagnosis date of 1/1/2010 and forward.

    We will be referring to the "published date" for the Manual and Database rather than diagnosis year. The actual final publication date for the revised Manual will be inserted.

    2010 and 2012 Databases and Manuals will no longer be available on the website. If you want “copies” of the previous Manuals, it is recommended that you save the PDF files to your computer or print hard copies of previous versions.)


  2. Review of cases already collected will not be required; however, for those who choose to review data already collected (2010+):
    • Documents will be posted by March 2014, which will show how to update previously collected cases based on the revised manual and database
    (Note: There are some changes in the rules which would effect the code to which the case would have previously been coded. However, it is not anticipated that these changes will have a significant impact.

    Although NCI-SEER will not require registries to review and recode cases, those registries that choose to review previously collected data will be able to utilize comparison documents from NCI-SEER to check where changes were made and what will be needed to clean up older data.)


  3. OBS (obsolete) codes
    • All OBS codes are obsolete as of 1/1/2010
    • OBS codes are now date driven
    • Instruction to use for “DCO’s, path only and minimal information” cases removed from database
      • Currently working on how to handle data already collected where OBS codes are used
    (Note: Obsolete (OBS) codes are no longer in the Database. Since obsolete codes are now date-driven you will no longer see a message instructing you to use these OBS codes for, “DCOs, path-only and minimal information” cases. Some obsolete codes, however, are still being used from 2010 forward because the database allows their use. No decision has yet been made regarding those obsolete codes. Some states (for example a state in a non-SEER region) have already made all obsolete codes “obsolete” as of 2010 and forward.

    Obsolete histologies now have an obsolete tag at the end of the preferred name.)


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The Multiple Primary (M) Rules


This presentation constitutes a brief summary of the major changes in the revised Hematopoietic and Lymphoid Neoplasm Coding Manual and Database. For purposes of this presentation, all references to “previous rules” are from the revised 2012 Manual which was released February 25, 2013.

M Rule Changes


  • For M Rules that have corresponding PH rules, notes have been added to direct you to the PH rule
    • Example: Under Rule M3
      • Note 2: See Module 5, PH9 and PH10 for information regarding primary site and histology
      • Links are included in the manual to go directly to the correct PH rule
    (Note: We have also added Notes to the M Rules that have corresponding PH Rules. This will help you move more quickly through the rules and take you directly to where you need to be. Not all M Rules have corresponding PH Rules. Under Rule M3, for example, you will find information and appropriate links on where to find the corresponding PH Rule(s) for the primary site and the histology.)

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M Rule Changes-Deletion


  • Previous Rule M4: Abstract a single primary when a specific MDS subtype is followed by a different specific MDS subtype
    • This type of situation would now use M15 (Multiple primaries calculator)
    • Multiple primaries calculator fixed to show any combination of MDS histologies is a same primary
    (Note: This is a change: We removed the previous Rule M4 which instructed you to, “Abstract a single primary when a specific MDS subtype is followed by a different specific MDS subtype.” In reviewing SEER data from 2010 and from 2011 it is clear that this rule is not being followed carefully. Additionally, the Multiple Primaries Calculator in the Hematopoietic Database was providing an incorrect answer in this situation. The Multiple Primaries Calculator has been corrected to show that any combination of MDS histologies (9980 through 9992) is the same primary; this is now covered in Rule M15.)

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M Rule Changes-Modification


  • M4: Two types of NHL occurring simultaneously (same time), same location, one primary
    • M5 (2012 M) previously looked at Follicular/DLBCL
    • M6 (2012 M) previously looked at all other NHL’s
    (Note: Previously, Rule M5 covered follicular and DLBCL occurring at the same time in the same location. This is a rare occurrence. Previously, Rule M6 covered other combinations of NHLs. In the revised Rules and Database, Rule M4 pertains to two types of NHL occurring at the same time in the same location; those are coded as a single primary. Two previous Rules (M5 and M6) have been combined into one new Rule—M4.)

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M Rule Changes-Addition


  • M14: Abstract one primary when PTLD and lymphoma or plasmacytoma diagnosed same time
    • Transformations for PTLD removed from database-found to be in error
    • This rule added to ensure that this situation was coded correctly
      • Using the Multiple primaries calculator (M15) would give you the wrong # of primaries
    (Note: Rule M14 is a new Rule pertaining to PTLD. Since it was learned during the review that PTLD does not transform, all the transformations have been removed. However, if the transformations are removed, an incorrect number of primaries may subsequently be coded. Therefore, Rule M14 has been added to guide the registrar in coding a single primary when PTLD and lymphoma or plasmacytoma are diagnosed at the same time. The corresponding PH Rule(s) provide guidance on coding the histology.)

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The Primary Site and Histology (PH) Rules


PH Rules

  1. 43 PH Rules in 2012 Manual
  2. Now….31 PH Rules
  3. Changes include:
    • Deletion of rules
    • Combination of rules
    • Clarification of rules
    (Note: The biggest changes to the Manual were made in the PH Rules. One of our main goals was to ‘tighten’ up the PH Rules thereby reducing their number. Previously there were 43 PH Rules in the 2012 Manual and now there are just 31 PH Rules. In cleaning up the PH Rules some Rules were deleted, some were combined and some clarifications were added. Information was moved to the Hematopoietic Database from some of the PH Rules that were deleted. NCI- SEER thought some other PH Rules could be moved to the Database-only, but reviewers thought those PH Rules ought to remain in the Manual.

    This presentation will briefly go through each Module and explain the major differences referring to the old and new Rules.)


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Module 1: PTLD (PH1)

  1. Previous rule for PTLD (PH1) removed
    • Information can be found in the database
  2. Rule PH1 (previously PH2) covers PTLD with accompanying lymphoma, etc.
    • See new Rule M14
    (Note:Information from the previous Rule PH1 with instructions on coding PTLD is now only found in the Database; that Rule has been removed from the Manual. Where information can be found in the Database, some Rules have been deleted from the Manual.

    The new Rule PH1 is associated with Rule M14 and pertains to PTLD with accompanying lymphoma, etc.)


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Module 2: Plasmacytomas (PH2-PH4)

  1. Previous rules for Multiple Myeloma (PH6, 7) removed from manual
    • Information in database
  2. Remaining rules (PH2-4) in Module 2 are the same
    • Previously PH3, 4, 5
      • New PH3, Note 3 covers multiple bone sites not in same ICD-O-3 region code (C419)
    (Note: The previous Rules for Multiple Myeloma (Rules PH6 and PH7) with instructions on coding to C421 and alternate names have been deleted from the Manual and are now found only in the Database. All the alternate names listed in those previous Rules are now in the Database.

    There are no other changes to the Plasmacytoma Rules in Module 2 although a Note 3 has been added to the new Rule PH3 to instruct registrars to code C419 if there are multiple bone sites that are not in the same ICD-O-3 region.)

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Module 3: CLL/SLL (PH5-PH6)

  1. CLL/SLL moved to own module
    • Previously in Module 3 with all other lymphoma/leukemia histologies
  2. Previous Rule PH8 divided into two rules for clarification
  3. (Note: There has been much confusion about CLL/SLL. It has been moved to two new Rules (PH5 and PH6) in its own Module (Module 3) rather than being in the same Module with all the other lymphoma/leukemia histologies.)

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Module 3: CLL/SLL (PH5)

  1. If bone marrow or peripheral blood is involved, code to C421
    • Lymph nodes and/or organs may also be involved
  2. If peripheral blood only is involved:
    • Primary site is C421
    (Note: We have received a lot of questions regarding CLL/SLL. The major confusion has been when to use bone marrow as primary site when bone marrow and peripheral blood are involved.

    Rule PH5 pertains to bone marrow involvement or peripheral blood involvement or both. The primary site is C421. Lymph nodes and/or organs may also be involved, but once there is bone marrow or peripheral blood involvement you code C421.

    If ONLY peripheral blood is involved, the primary site is C421. Do not code to blood (C420) or to other hematopoietic codes. Please check your registry for these.

    In checking SEER data for 2010 and 2011, some CLL/SLL cases are coded to 9823/3 with primary site blood, C420. It appears that for some cases the only information available may be from a peripheral blood smear which can be used to diagnose CLL/SLL. For such cases, primary site should still be coded to C421, not to C420. Therefore, cases with histology of 9823/3 and primary site coded to C420 should be reviewed and the primary site code changed to C421.)


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Module 3: CLL/SLL (PH6)

  1. If BM or PB are not/unknown if involved, code to involved lymph node and/or organ
    • This is SLL (previously 9670/3)
  2. Code 9670/3 initially became OBS in 2012
    • These cases should be changed to 9823/3 at some point
    (Note: The only time you are going to code SLL (previously 9670/3) is when bone marrow or peripheral blood are not involved or if it is unknown if they are involved. In that situation, you code primary site to the involved lymph node or organ and your primary site would be something other than bone marrow (or any of the hematopoietic codes, except for spleen, C422).

    For SLL, code 9670/3 was used until 2012 when it was made obsolete. At some point, we will change all the 9670/3’s for 2010 and forward to 9823/3. For now, do not worry about these. We are hoping to develop instructions for global fixes.)


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Module 4: Lymphoma/Leukemia Histologies (PH7-PH8)

  1. The two rules for these histologies are the same (previously PH9, 10)
  2. CLL/SLL (9823/3) removed
  3. List of histologies now in the module heading
    • They are not listed within each rule
    (Note: Module 4 Lymphoma/Leukemia (primarily histologies 9811—9818) has not changed although CLL/SLL has been removed from Module 4 and placed in Module 3. The list of histologies which was previously found in each individual Rule is now simply shown in the Module heading.)

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Module 5: Myeloid and Mast Cell Neoplasms (PH9-PH10)

  1. Primary site instructions for the following were deleted (in database)
    • Mast cell sarcoma only (9740/3)
      • Previously PH13
    • Myeloid sarcoma only (9930/3)
      • Previously PH15
  2. Remaining PH rules same
    • Previously PH12 and PH14
    (Note:In Module 5, Rules with primary site coding instructions pertaining to mast cell sarcoma ONLY and to myeloid sarcoma ONLY were removed. That information can now be found in the Database. The other two PH Rules in Module 5 (now Rules PH 9 and PH10—previously Rules PH12 and PH14) are unchanged and cover mast cell leukemia and mast cell sarcoma or any of the AML leukemias and myeloid sarcoma.)

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Module 6: Coding Primary Site, Specified Lymphomas (PH11-PH17)

  1. For Rules PH11 & PH 15, ALL non-Hodgkin lymphomas are applicable
  2. Heading changed to include:
    • Non-Hodgkin lymphomas (9670/3-9679/3, 9684/3-9729/3, 9735/3-9738/3, 9811/3-9818/3, 9823/3, 9827/3, 9837/3)
    (Note: Module 6 covers all non-Hodgkin lymphomas; this was applicable back to 2010, but wasn’t noticed. A new statement clarifying the fact that Rules PH11 and PH15 pertain to all non-Hodgkin lymphomas has been added.

    All the follicular lymphoma histologies have now been removed from the heading. The heading now includes the list of non-Hodgkin lymphoma histologies (9670/3-9679/3; 9684/3-9729/3; 9735/3-9738/3; 9811/3-9818/3; 9823/3; 9827/3; 9837/3). Those histologies that still have specific PH Rules in this Module are not in this list. They are still listed separately with their specific name and ICD-O-3 code.)


  3. The following case scenario was asked about on NCRA Heme webinar:
    • Marginal zone lymphoma and DLBCL found in the same lymph node at the same time
    • Per previous M rules, same primary
    • Per previous PH rules, code to Marginal Zone
    (Note: During the Hematopoietic Webinar given in December 2013 the following scenario was presented by one of the registrars: Marginal zone lymphoma and DLBCL occurring at the same time in the same lymph node. Per Rule M4, you would code to a single primary. Per the 2012 Manual, you would code to the higher ICD-O-3 code, which would be the marginal zone lymphoma. However, DLBCL is a much more aggressive lymphoma so that ought to be coded over the marginal zone lymphoma. Per the Heme DB, marginal zone transforms to DLBCL, so this appears to be contradictory and problematic.

    After further investigation including reaching out to an expert pathologist, some of the existing rules were modified.)


  4. Previously discussed
    • M4 (previously M5 and M6) states to code one primary when you have two NHL’s at same time same location
    • Note states to go to PH11 and PH15 to code primary site and histology
  5. Rule PH11 (previously PH16)
    • CHANGED to combination of DLBCL and any other NHL at same time, same loc.
      • Previously only DLBCL and Follicular
      • DLBCL ALWAYS take priority when two NHL are present at same time, same location
    • Note: This is not for NHL lymphomas that are in different locations (See M rules)
    (Note: Rule PH11 was previously Rule PH16. This has been changed to a combination of DLBCL and any other NHL at the same time, same location. In other words, the DLBCL always takes precedence. This does not pertain to NHL lymphomas that are in different locations; those are usually the chronic and the acute.)

  6. Rule PH15 (previously PH22)
    • All other combinations of NHL’s at same time/ same location
    • Code to the higher ICD-O-3 code (no rule change)
    • Note: This is not for NHL lymphomas that are in different locations (See M rules)
    (Note: Rule PH15 was previously Rule PH22. It looks at all other combinations of NHLs; you code the higher ICD-O-3 histology code for those. This Rule has not changed.)

  7. Rules for DLBCL (9680/3) with skin infiltration combined into one
    • Previous rules PH19, 20 (now PH13)
  8. Rules for the following histologies had no changes:
    • 9596/3, 9597/3, 9671/3, 9761/3
    (Note: Here are some other changes in Module 6. We took previous PH Rules 19 and 20 and found there was a one word difference between those two Rules. We put those two Rules into one Rule, now Rule PH13. The Rules pertaining to the listed histologies (9596/3, 9597/3, 9671/3, 9761/3) has not changed.)

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Module 7: Coding Primary Site ALL Lymphomas (PH18-PH27)

  1. Rules that covered masses (previously PH26, 27, 28) now in one
    • PH18: Code primary site to lymph node region when site lymphoma described only as mass (mediastinal, pelvic, retroperitoneal, mesenteric, inguinal)
    (Note: The previous primary site coding rules for lymphomas in Module 7 were very confusing. We decided to put all the masses into one rule--Rule PH18--which now combines three previous Rules (PH26, PH27 and PH28). “Retroperitoneal” was added to the list of types of masses found in the previous rules. Rule PH18 now says to code the primary site to the lymph node region when site of lymphoma is described only as mass (mediastinal, pelvic, retroperitoneal, mesenteric, inguinal).)

  2. Code to specific lymph node region (previously PH25) now PH19
    • After instructions for mass
  3. Rules for coding lymph nodes, NOS (C779) combined into one
    • Previously PH31 & 36 (now 22)
    (Note: We received a suggestion to put the PH Rule covering mass before the PH Rule on the specific lymph node region and we followed-up on that suggestion. Previously Rule PH25 concerned coding to the specific lymph node region; that is now Rule PH19 and comes after the instructions for mass.

    Previously we had two separate Rules—PH31 and PH36—for coding lymph nodes, NOS (C779). We combined those two rules into what is now Rule PH22.)


  4. Described as “mass” (PH18)
  5. Specific lymph node region (PH19)
  6. Multiple lymph node chains (PH20)
  7. Multiple lymph node regions (PH21)
  8. Lymph nodes, NOS (PH22)
  9. (Note: This is a brief description of the revised lymphoma rules.)

  10. Proof of extension from LN (PH23)
  11. Confined to organ (PH24)
  12. Organ/regional lymph nodes (PH25)
  13. Bone marrow only (PH26)
  14. Unknown primary site (PH27)
  15. (Note: This continues the brief description of the revised lymphoma rules. It is hoped that the new order of these rules improves the flow of the content in the rules.)

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Modules 8,9

  1. Previous Module 8: Deleted
    • Duplicate Rules
  2. Module 8 (previously Module 9) & Module 9 (previously Module 10)
    • No changes
    (Note: This is a brief summary of changes to Modules 8 and 9. In the current version of the Manual Module 8 contains duplicate Rules. Therefore, the previous Module 8 has been deleted and the “new” Module 8 contains information previously found in Module 9. The “new” Module 9 contains information previously found in Module 10. The “new” Module 8 covers situations with NOS and more specific histologies. The Rules in the “new” Modules 8 and 9 have not been changed.)

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NEW: Appendix F

  1. List of non-reportable conditions
    • Terms are from questions in Ask SEER CTR
    • Basic definition provided
  2. By mid 2014, these terms will also be added to the Hematopoietic database (as non-reportable)
  3. (Note: Appendix F is new. This Appendix in the Manual contains a list of the non-reportable conditions gleaned from questions submitted via “Ask a SEER CTR.” Content from Appendix F will be added to the Database--probably in the summer of 2014.)

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The Hematopoietic Database


Heme DB: Major Changes

  1. Format changes
    • New USER’s guide will be posted on website. Please review.
  2. Other changes included (majority)
    • Typos fixed
    • Additional information added
    • Information resorted (alphabetical)
    (Note: Thousands of changes have been made to the Database. Most of those changes were minor such as the correction of typographical errors, or the addition or resorting of some information.

    The Database will now be in a different format. IMS is developing a “User’s Guide” for the Hematopoietic Database. That Guide will be posted on the SEER website. The “User’s Guide” is recommended reading for everyone prior to using the Database.)


  3. Multiple primaries corrected for many histologies
  4. Transformations corrected for many histologies
    • Note: Detailed list of these changes will be in the comparison documents
    (Note: Many of the multiple primaries and transformations were reviewed during this update. Some were found to be incorrect and some were not totally correct, i.e. partially incorrect. These have been changed for this version. For the multiple primaries, you will notice changed information in the Multiple Primaries Calculator (Rule M15) which has been corrected and updated. Also, as discussed in prior slides, the previous Rule M4 was deleted for multiple subtypes of MDS. This information has been corrected for the Multiple Primaries Calculator. Also, as noted previously, transformations for PTLD (9971/3) were deleted. These were discovered to be incorrect. Rule M14 was added to ensure that PTLD cases are coded correctly.

    Review of SEER data shows that these changes will not have a huge impact on data already collected. A detailed comparison document will be released in March 2014 which will show you exactly where these changes occurred and provide instructions on how to review your data and change it should you choose to do so. Some cases currently coded as multiple primaries would now be one primary if the review were done and cases were changed according to the corrections in the revised Manual. The biggest area affected by the changes (according to SEER data) would be the MDS histologies even though people previously should have been coding according to Rule M4 and therefore coding only one primary.)


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Heme DB: Transformation field

  1. Transformations to
    • Only applicable chronic diseases will have histologies listed in this field
    • If there are no histologies listed, then this is not a chronic disease that transforms
  2. Transformations are used with M Rules M8-M13 (Chronic/acute)
  3. (Note:Transformations continue to be a problematic area for registrars. To help registrars with these cases, we have changed the transformation field. There are now two fields: “Transformations To” and “Transformations From” whereas previously there was just a “Transformation” field. The “Transformations To” field (the current “Transformation” field) is for “chronic” diseases. Not all histologies have transformations. Only those that have transformations will have something listed. The “Transformation To” field will have entries for those chronic diseases that transform to an acute disease. If no histologies are listed, then the disease is not a chronic disease that transforms. For example, DLBCL is listed as a transformation for many of the non-Hodgkin lymphomas. When you have diseases in these fields, review Rules M8-M13 to help determine if you have a new or same primary. (Note: This does not apply when you have two histologies occurring at the same time in the same location).

    Reminder: Rules M8 through M13 are the chronic/acute rules (currently Rules M10 through M15).)


  4. Transformations from
    • Only applicable acute diseases will have histologies listed in this field
    • If there are no histologies listed, then this is not an acute disease that transforms
  5. Transformations are used with M Rules M8-M13 (Chronic/acute)
  6. (Note: We were getting questions from registrars looking at the acute form of a disease and asking if that were the same primary as the chronic form mentioned in the history. Registrars were not getting information on transformations for these cases and often thought the particular disease did not transform. Both the chronic and the acute histologies that transform have information in the Database. This information will help registrars to better understand when a case may be a transformation and to use Rules M8-M13.

    The “Transformations From” field is for “acute” diseases and is new for the Database. Not all histologies have transformations. Only those that have transformations will have something listed. The “Transformation From” field will have entries for those acute diseases that have chronic forms (chronic diseases that transform to the acute disease.) For example, DLBCL is listed as a transformation for many of the non-Hodgkin lymphomas. If you look at the “Transformations” field for DLBCL, you will see all the diseases (non-Hodgkin lymphomas) that transform to DLBCL.)


  7. No histologies have both “transformation to” and “transformation from” entries
  8. Applicable histologies will have one or the other
  9. If there are no histologies listed in either field, then the disease does not transform
  10. (Note: This information is accurate at this point in time, but may need to be updated as medical knowledge advances in the future.)

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Heme DB: Same primaries

  1. For histologies that have same primaries, the ICD-O-3 code AND the name are now listed
  2. Links are provided to the same primary codes
  3. (Note: One of the other changes we have made to the Database concerns the same primaries. Right now only the ICD-O-3 code is listed. In the revised Database, both the ICD-O-3 code and the name are listed. In addition, the same primaries also have links which means you can click on the link and the DB will take you directly to the other code.

    The Transformation fields also have links to the codes that are listed.)


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Upcoming Projects

  1. Detailed comparison documents for the manual and database
  2. Updated training materials
    • Updating applicable presentations currently on the SEER website
    (Note: Again, it is anticipated that the comparison documents will be available in March or April 2014. Relevant education/training presentations will also be updated.)

  3. OBS codes:
    • Redoing edits
    • Determining how to fix cases that have OBS histologies
  4. Reviewing multiple primaries
    • Quick review of SEER data shows some multiple primaries that should be only one primary (per 2010 rules)
    (Note: Edits related to obsolete codes will be redone.

    In reviewing SEER 2010 and 2011 data, errors have been found in the coding of multiple primaries based upon the 2010 Rules. Registries will receive information from NCI-SEER during the year about corrections they may want to make to their data, e.g. coding of primary site and coding of MDS subtype.)


Thank you.

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