SC CENTRAL CANCER REGISTRY BLAST

SC CENTRAL CANCER REGISTRY

BLAST

OCTOBER 2012

SCCCR BLAST

The SCCCR BLAST is an educational training tool provided as a service to you from the SCCCR. This email communication offers specific updates, clarifications, and Q & A’s concerning coding rules and abstracting principles. All registry reference manuals will be utilized and cited. The BLAST is sent to all SC registrars at the beginning of each month.

 Topics originate primarily from questions generated from SCCCR quality control activities or from hospital registrars. Or they may stem from changes in standards that need to be communicated in mass. No names will be included, only the question and answer with reference sources.

Please contact Kathy Barnes, SCCCR Training Coordinator, with your questions, requests for clarification, or information you have discovered that needs to be communicated to your colleagues.

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OCTOBER, 2012 BLAST includes the following information and updates:

November Webinar Info & Description – Uterus NAACCR Webinar Recorded Links2012-2013 Remaining NAACCR Webinar Series CE’s from Advanced Training Workshop SSDI for Social Security information / follow-up Locating Correct County and Zip Code Correctly Coding Breast Surgery? Correctly Coding Head & Neck, nos?

Ten Q & A’s on a myriad of cancer sites and topics

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REGISTRY UPDATES . . .

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NEXT WEBINAR ~ November 1, 2012

Title: Uterus

Description: This 3 hour class will present the following information for uterus: anatomical information needed to abstract and code the cases; how to determine the number of primary tumors; how to code topography and histology; how to code the CSv2 data items; and the treatments and how to code them.

SCCCR BLASTNAACCR PREVIOUS WEBINAR RECORDING LINKS AVAILABLE

The following webinars are available for viewing through the SCCCR:

• 2010-2012 COMBINED SERIES – Endometrium, Hematopoietic Diseases, Liver & Biliary Tract, Brain & CNS System, Testis, Bladder, Breast, Prostate, Complete Case Identification & Ascertainment, Coding Pitfalls, Larynx, Ovary, Thyroid & Adrenal, Lung, Abstracting & Coding Boot Camp, Lower Digestive, Melanoma, Using and Interpreting Data Quality Indicators, ICD-10—CM & Cancer Surveillance, Hematopoietic, Coding Pitfalls.

• *Participants will be required to link to the recording page with a viewer. The free viewer will need to be installed on the desktop playing the recording.  If you are interested in obtaining any subjects above, please email Kathy Barnes at [email protected]

• ATTENTION: All of the recordings are viewed on the following updated player at: https://akamaicdn.webex.com/client/WBXclient-T27L10NSP31-13320/nbr2player.msi

• If you were previously sent a recording and cannot view, please contact Kathy Barnes.

• CE’s are now available by viewing and completing exercises/quizzes.

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Esophagus & Stomach 10/4/12

Uterus 11/1/12

Pharynx 12/6/12

Bone & Soft Tissue 1/10/13

Central Nervous System 2/7/13

Abstracting & Coding Boot Camp: Cancer Case Scenarios

3/7/13

Breast 4/4/13

Bladder & Renal Pelvis 5/2/13

Kidney 6/6/13

Topics in Geographic Information Systems 7/11/13

Cancer Registry Quality Control 8/1/13

Coding Pitfalls 9/5/13

2012-2013 Webinar Schedule for Your Planning

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Thanks again to everyone that attended the Advanced

Registry Training Workshop 8/27–8/28.

We are awaiting one final exercise answer and approval for CE

credits.

You will be notified as soon as they arrive!

ADVANCED REGISTRY TRAINING WORKSHOP

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The following info was given by a fellow registrar:

SSDI has stopped social security number lookup . . .

Try the following website instead for possible follow-up:

http://www.genealogybank.com/gbnk/ssdi/?kbid=9064&m=9

SSDI INFO NO LONGER FOUND?

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BE POSITIVE:

Google the address of your patient, include city and South Carolina.

The following information will be shown by address for correctly coding remaining demographics:

COUNTY

ZIP CODE

Having Trouble Finding County or Zip?

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Here’s another option:

Google name of the county along w/”property tax” (for example, Greenville county property tax) and you should find a link to that county’s property tax website.

Here are a few examples.

Lexington Co. http://www.lex-co.com/PCSearch/tb001-pg.asp

Richland Co. https://www4.rcgov.us/TreasurerTaxInfo/Main.aspx

Charleston Co. http://sc-charleston-county.governmax.com/svc

Florence Co. http://web.florenceco.org/cgi-bin/ta/tax-inq.cgi

Having Trouble Finding County or Zip?

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40 vs 41 / 50 vs 51; If patient had any type of mastectomy:

40 total (simple mastectomy) 50 modified radical mastectomy

Codes should correctly be 41 & 51 41 & 51 = WITHOUT removal of uninvolved contralateral breast *unless unusual circumstances apply which would probably be very rare. 

A simple qc report will probably find some are coded incorrectly!

IF the patient had first course planned reconstruction . . . codes could be 43-75 or 53-63 and would be ok.

Are Your Breast SurgeriesCoded Correctly?

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There’s NO code for head & neck, nos C14.9:

Example:•History head & neck cancer•Presents with head & neck cancer•Each with no further info on specific primary

Why?

How are these cases coded correctly?

HEAD & NECK PRIMARY SITE?

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Final CAnswer: The CoC, NPCR, SEER Technical Workgroup have agreed that C14.8should be assigned for head and neck primaries for which a specific sitecould not be identified.

See number 15 under the heading Description of this Neoplasm at:http://seer.cancer.gov/registrars/data-collection.html

HEAD & NECK PRIMARY SITE?

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QUESTIONS (?)

ANSWERS (!)

CLARIFICATIONS (*)

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1

Q: Is a patient with positive genetic markers and probability for developing a certain type of cancer (example: breast cancer in multiple family members) reportable?

A: Genetic findings in the absence of pathologic or clinical evidence of reportable disease are indicative of risk only and do no constitute a diagnosis.Reference: FORDS; Examples of Non-diagnostic Terms, pg 4

9/15/12 – SCCCR

REPORTABILITY:

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2

Q: We are supposed to follow the exact terms from FORDS for Ambiguous Terms. However I keep running "concerning for" xxx carcinoma on imaging reports. and would like to make sure they are not to be accessioned .

A: We don't pick up "concerning for" on imaging reports since it does not appear on list of reportable ambiguous terms.Reference: FORDS; Reportable Terms, pg 4

9/11/12 – CAnswer

REPORTABILITY:

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3

Q: I have a case that was diagnosed in 4/2011 as a multicentric cerebellar lymphoma and was treated w/ Rituxan. The treatment was not working and the same pathology was reviewed in 8/2011 and found to be an anaplastic astrocytoma. The patient was then referred to our facility for further evaluation and treatment

A: The date of initial diagnosis is the date the MALIGNANCY is declared by physician; it is not uncommon when the histology is specified after the date of initial diagnosis.So, in your case, the date of diagnosis is 04/2011. The 1st course of treatment is Rituxan.The class of case at your facility is non-analytic 32 (PERSISTENCE OF DX), since patient appeared at your facility after 1st course of treatment failure.Any treatment after 1st course of treatment is a subsequent treatment. (REGARDLESS OF ANY CIRCUMSTANCES).Reference: FORDS; Revising Original Diagnosis, pg 13

8/15/12 – CAnswer

DATE OF DIAGNOSIS / PREVIOUS DIAGNOSIS INCORRECT:

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4

Q: Patient has a biopsy of mass under the umbilicus, pathology states mesothelioma. Would this possibly be metastatic from the pleura or C76.2 (Abdomen, abdominal wall, intra-abdominal wall, nos)?No further information.

A: Because of lack of information available, it would be reasonable to code the primary site to pleura in this case.Reference: None

9/13/12 – SEER Quality Team / Ask A Registrar

PRIMARY SITE:

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5

Q: What is the histology code for urothelial carcinoma, plasmacytoid variant"?

A: Code the histology to 8082/3 [urothelial carcinoma, plasmacytoid].

The MP/Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007-2013.Unfortunately, there is no current rule that directs you appropriately to Table 1 from Rule H7 to find this histology combination.An example is needed under Rule H7 that instructs you to "See Table 1" for an urothelial carcinoma diagnosis that mentions a more specific cell type (e.g., plasmacytoid).

A reference will be added to Table 1 in Rule H7 in the updates to MP/H Rules. Reference: MP/H Manual; Bladder Schema

20110078 – SINQ

HISTOLOGY:

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6

Q: MP/H Breast: What is the ICD-0-3 code for a patient diagnosed with pleomorphic lobular carcinoma in situ?

A: Pleomorphic lobular carcinoma is a variant of lobular carcinoma which does not have an ICD-O-3 code. It is still a lobular carcinoma, so the best code you could use would be 8520/2 lobular carcinoma in situ.The variants of lobular carcinoma were a relatively recent discovery and the information was not available when the 2007 rules were written.All of the lobular variants will be included in the revised MPH rules. Reference: MP/H Manual; Breast Schema

20120051 - SINQ

HISTOLOGY:

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7

Q: We are instructed to code sarcoma of the breast to primary site breast, not soft tissue of the breast. The pathology report states "low grade sarcoma".Because this site/histology combination gives us the CS breast schema, are we to interpret "low grade" as a Bloom Richardson Grade?How are we to designate the sarcoma as "low grade"?The CS SSF which is normally found in the soft tissue sarcoma schema is not given to us and highly doubt this should be coded in CS SSF 7 for the breast schema as a Bloom-Richardson Grade.

A: You are correct that this would be coded in the Breast schema.Since this is a sarcoma, Nottingham or BR (SSF 7) would be coded 999 (Neither BR grade nor BR score given, Unknown or no information, Not documented in patient record).

For the sarcoma grade, code 2 for low grade, in the grade field.Grade path value/system would be blank. Reference: CS Manual; Breast Schema

7/27/12 – CAnswer

C/S BREAST GRADE VS SSF:

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8

Q: Patient with primary lung cancer presumed to be of the left upper lobe lung with no positive cytology or histology from the left lung.

Patient has left malignant pleural effusion ,tapped twice and positive for carcinoma. Also a left pleura biopsy positive for poorly diff adenocarcinoma from a lung origin.

What is the correct SSF 2 code for this case?998 (no histologic examination of pleura to assess pleural layer invasion) or999 (unknown if PL present, PL/elastic layer cannot be assessed, not documented in patient record).

A: SSF 2 should only be evaluated from a surgical resection of the primary site. Since there is none, code to 998 (no histo exam of pleura to access pl inv).The malignant pleural effusion and the left pleural biopsy results should be coded in CS Mets at Dx only. Reference: CS Manual; Lung Schema, SSF2

9/24/12: CAnswer

LUNG; SSF2:

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9

Q: Surgical Diagnostic & Staging Procedure:FORDS states: Do not code excisional biopsies with clear or microscopic margins in this data item. Use the data item Surgical Procedure of Primary Site (NAACCR Item #1290) to code these procedures.

Can you provide a few examples for coding correctly?

A: The margins can be clear of tumor or involved by the tumor.

If margin is involved by the tumor, the involvement can be macroscopic (seen by naked eye) or microscopic (seen under microscope).

If the margins are clear microscopically or involved only microscopically, the procedure is qualified for primary site surgical code (cancer directed).

If the margins are involved macroscopically (seen by naked eye), the procedure is qualified only for Surg Diagnostic & Staging Procedure, since the majority of tumor was not removed (visible by naked eye).

If you have both pathology report and operative report – path take preference.Reference: FORDS; pg 126, bullet 6

6/21/12 CAnswer

SURGICAL MARGINS vs SURGICAL PROCEDURE:

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10

Q: Does intra-operative findings affect clinical staging?

Example: liver mets identified during surgical resection of colon cancer with pre-operative workup with a negative ct scan of abdomen.Would this be coded as clinical stage IV?

A: The rules for clinical staging in the AJCC 7th edition chapter 1, page 9, let you include surgical explorations. That is not the same as what you see during the treatment surgery (surgical resection). In fact we go on to clarify that observations made at surgical exploration without resection are part of the clinical staging.

Intraoperative findings during a surgical resection would NOT be included in the clinical staging. Since clinical staging is used to select the surgical treatment, it would not be appropriate to change the clinical stage during the treatment – as then it would make the treatment choice seem inappropriate when analyzing data.

This would not be clinical stage IV

Reference: FORDS; pg 13, Revising the Original Diagnosis

6/1/12 CAnswer

CS METS AT DIAGNOSIS:

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