SC CENTRAL CANCER REGISTRY BLAST

SC CENTRAL CANCER REGISTRY

BLAST

NOVEMBER 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.

SCCCR BLASTNOVEMBER, 2012 BLAST includes the following information and updates:

November Webinar Info & Description – Uterus NAACCR Webinar Recorded Links2012-2013 Remaining NAACCR Webinar SeriesCE’s Awarded for Advanced Training Workshop SSDI for Social Security information / follow-up Locating Correct County and Zip Code Correctly Coding Breast Surgery? Correctly Coding “Head & Neck” Cancer, nos? 2013 ICD-9-CM Casefinding List

ALERT: SCCCR required GRADE data item & OCCUPATION & INDUSTRY TEXT in 2013!

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

SCCCR BLAST

REGISTRY UPDATES . . .

SCCCR BLAST

NEXT WEBINAR ~ December 6, 2012

Title: Pharynx

Description: This 3 hour class will present the following information for pharynx: 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, Stomach & Esophagus, Uterus.

• *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.

SCCCR BLAST

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

SCCCR BLAST

Thanks again to everyone that attended the Advanced

Registry Training Workshop 8/27–8/28.

All attendees should have been notified that we receivedrecognition from NCRA of 10.75 credits hours!

CE number is 2012-125

Please contact Kathy Barnes if you did not receive your electronic

CE Certificate

ADVANCED REGISTRY TRAINING WORKSHOP

SCCCR BLAST

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?

SCCCR BLAST

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?

SCCCR BLAST

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?

SCCCR BLAST

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?

SCCCR BLAST

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?

SCCCR BLAST

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.

EXAMPLE: Patient with history of head & neck ca OR only notes in record state head & neck malignancy, etc. There is no code for 14.9, head & neck, nos.

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

HEAD & NECK PRIMARY SITE?

SCCCR BLAST

In anticipation of the 2013 Implementation date for ICD-10-CM, ICD-9-CM was frozen last year, which means there are limited new ICD-9-CM codes this year.

No new codes are cancer codes or conditions that might be included on our supplemental Casefinding list. This is good news for our group, because it will make updating the Casefinding lists much easier.

Plans to have the 2013 Casefinding lists for ICD-9-CM and ICD-10-CM ready by the beginning of November. These will be listed on the SEER website.

SCCCR will send out an email with the new 2013 casefinding list asap!

2013 ICD-9-CM CASEFINDING LIST

SCCCR BLAST

In accordance with the direction from CDC/NPCR for 2013, SCCCR will continue to require the data field “GRADE / DIFFERENTIATION” be collected.

Also Included:

“GRADE PATH VALUE” & “GRADE PATH SYSTEM”

cont.

2013 SCCCR REQUIRES GRADE

SCCCR BLAST

Industry and Occupation

Reporting facilities should abstract text documentation for usual occupation and industry. The National Institute of Occupational Safety and Health (NIOSH) is developing a tool that will read and code text fields for occupation and industry and will also crosswalk between the various years of codes for occupation and industry.

*Reporting facilities will need to view the Industry & Occupation Instruction Webinar. The link is:http://www.cdc.gov/niosh/topics/coding/courses/cancer/

2013 SCCCR REQUIRES I&O TEXT

SCCCR BLAST

This module contains 3 parts:• Background on the importance of collecting information on the

usual (or longest-held) industry and occupation of cancer patients, • Guidelines for collecting industry and occupation (or I&O), and• Examples of adequate and inadequate I & O entries.

There is a test at the end. All of those who complete this activity and pass the test (70% or higher) are eligible for

1.5 CEU from NCRA

2013 SCCCR REQUIRES I&O TEXT

SCCCR BLAST

QUESTIONS (?)

ANSWERS (!)

CLARIFICATIONS (*)

SCCCR BLAST

1

Q: Is hemangioma of the brain reportable?

A: Hemangioma diagnosed in 2004 or later is reportable when it occurs in the brain.Reference: None

10/12/12 – SEER / Ask A Registrar

REPORTABILITY:

SCCCR BLAST

2

Q: “Mass” and “lesion” are synonymous terms with “neoplasm” and “tumor” for the MP/H coding rules.Does this mean they should be interpreted as reportable terms even though they are not on the list of reportable terms?

A: NO.Mass and lesions are synonymous with neoplasm and tumor when it comes to determining one primary or multiple primaries per the MP/H rules.The MP/H rules should not be used to determine reportability.*Neoplasm and Tumor would only be used in reportability of brain and CNS primaries using ambiguous terms.Reference: FORDS; Reportable Terms, pg 4

9/6/12 – NAACCR Coding Pitfalls Webinar

REPORTABILITY / AMBIGUOUS TERMS:

SCCCR BLAST

3

Q: Is FIGO stage the same as FIGO grade? Pathologists at our facility use only grade.

A: No; FIGO stage and FIGO grade are not the same thing.FIGO stage describes the spread of the primary gynecologic cancer.FIGO grade describes the structure and growth patterns of the cancer cells.Reference: None

9/6/12 – NAACCR Coding Pitfalls Webinar

FIGO STAGE VS GRADE:

SCCCR BLAST

4

Q: Patient has 2 separate tumors in 2 different sub-sites in one organ. One is invasive, one is in situ and are considered a single primary per the MP/H Manual.

What is the correct primary site or subsite?

Would it be the invasive sub-site or .9; multiple tumors in a single organ?

Example: breast uoq (in situ) & uiq (inv) same cell type = one primary.

A: Code the primary site to the invasive subsite. See the Coding Guidelines for Breast, under Coding Subsites, http://seer.cancer.gov/manuals/2012/AppendixC/breast/coding_guidelines.pdf

Reference: Seer Cancer Manual, 2012, Appendix C, Breast

9/13/12 – SEER / Ask A Registrar

PRIMARY SITE:

SCCCR BLAST

5

Q: The following histology seems difficult to code and clarification is needed.

Path: Breast; left mastectomy:Extensive ductal carcinoma insitu; DCISHistologic Type; Ductal carcinoma in situ, Architectural Pattern: solid, clinging, cribriform, comedo.

Would this be coded H4 / 8501/2 or H6 / 8523/2?

A: Example has; solid, clinging, cribriform, comedo types of DCIS. The first rule that fits is H4:Does the patient have non-infiltrating comedocarcinoma and any other intraductal carcinoma (Table 1)?Yes they do. Code to 8501/2.

Reference: MP/H Manual; Breast Schema

10/4/12 – SEER / Ask A Registrar

HISTOLOGY:

SCCCR BLAST

6

Q: MP/H Manual; Urinary/Bladder:M7 states tumors diagnosed more than 3 years apart are multiple primaries.Does this apply to in situ bladder tumors occurring more than 3 years apart OR an in situ tumor occurring 3 years after an invasive tumor?

A: For cases diagnosed 2007-2013, use the MP/H rules in order. Rule M6 comes before rule M7.

M6 = bladder tumors with certain histologies are a single primary. It’s a single primary regardless of timing if there is any combination of:

*papillary carcinoma (8050)*transitional cell carcinoma (8120-8124)*papillary transitional cell carcinoma (8130-8131)

Rule M7 applies to bladder tumors with histologies other than those listed above. If you have such a case, rule M7 applies to in situ tumors and to an in situ 3 years after and invasive, etc.

Reference: MP/H Manual; Bladder Schema

10/2012 Ask A Registrar Cont.

HISTOLOGY:

SCCCR BLAST

6

A: MP/H Manual; Bladder (cont)

M6 would always apply for those stated histologies and over the course of any amount of time:

EXAMPLE:1)Invasive following an invasive2)In situ following an invasive3)In situ following an in situ

This rule applies for 2 or more tumors over time with one/same histology, also a combination of 2 - 3 of the histologies listed.

The only exception is M5: invasive tumor following a non-invasive or an in situ tumor more than 60 days after diagnosis.

Reference: MP/H Manual; Bladder Schema

10/2012 SCCCR

HISTOLOGY (cont.):

SCCCR BLAST

7

Q: SSF 7: Is melanoma in situ eligible for coding Primary Tumor Mitotic Count/Rate?If, yes, what is the correct code?000 - 0 mitoses per square millimeter (mm) / Mitoses absent / No mitoses present998 - No histologic examination of primary site999 - Unknown or no information / Not documented in patient record

A: Yes. Record the mitotic rate/count as documented in the pathology report.Only use code 998 when there is no histologic examination of the primary site.Use code 000 when the mitotic rate is <1 per square millimeter. If there is no documentation or mention of mitotic rate in the pathology report, use code 999.Reference: CS Manual; Melanoma Schema

6/19/12 – CAnswer

C/S MELANOMA MITOTIC COUNT/RATE:

SCCCR BLAST

8

Q: In order to verify for our surgeons that a patient had a biopsy prior to mastectomy, is it okay to enter:02 (biopsy of primary) if the bx is negative?

A: No, a negative biopsy should never be coded in SD&SP per the coding instructions.Only record positive procedures.For benign and borderline reportable tumors, report biopsies positive for those conditions.For malignant tumors, report procedures only if they were positive for malignancy. Reference: FORDS 2012; pg 123

9/6/12 NAACCR Coding Pitfalls Webinar

SURGICAL DIAGNOSTIC & STAGING PROCEDURE:

SCCCR BLAST

9

Q: Operative report by surgeon states the patient had a lumpectomy. However, the pathology report states a "partial mastectomy".Please advise what code should be used.Should this be 20 for partial mastectomy or 22 lumpectomy?

A: When coding site-specific surgery, the operative report is main source to code surgical procedures. If pathology label does not match the operative report details, use the operative report.It is very important to read the entire operative report to code site-specific surgery correctly. Sometimes the label on the top of operative report does not match the operative report description, so, the code depends on the actual extent of procedure, do not rely on label entirely. Reference: FORDS; Appendix B, Breast

10/25/12: CAnswer

BREAST; SURGICAL PROCEDURE CODE:

SCCCR BLAST

10

Q: FORDS states Systemic Therapy encompasses treatment modalities captured by the items chemotherapy, hormone therapy, and immunotherapy.Is Synthroid considered hormone replacement therapy for thyroid cancer?

A: Synthroid in SEER*Rx is a reportable hormone treatment. Registrars should check SEER*Rx since it’s the source FORDS recommends in coding systemic treatments.Use this application for only drug categorization and re-abbreviation of the multi-agent regimens. Do not use it for determination what primaries are treated by this drug. If the physician prescribed - code it, or ask the physician directly when in doubt.Synthroid treatment post thyroid malignancy should be coded as hormonal.Reference: FORDS; Hormone Therapy

2/15/12 Canswer

HORMONE THERAPY:

SCCCR BLAST

MORE NEWS & UPDATES NEXT MONTH