SC CENTRAL CANCER REGISTRY

BLAST

DECEMBER 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 BLASTDecember, 2012 BLAST includes the following information and updates:

•January Webinar Info & Description – Bone & Soft Tissue•NAACCR Webinar Recorded Links•2012-2013 Remaining NAACCR Webinar Series•Correctly Coding Breast Surgery?•Correctly Coding “Head & Neck” Cancer, nos?•2013 ICD-9-CM Casefinding List•Correctly coding FOLFOX chemotherapy?•Errata for ICD-O-3 Site/Type Validation List

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

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

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REGISTRY UPDATES . . .

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NEXT WEBINAR ~ January 10, 2013

Title: Bone and Soft Tissue

Description: This 3 hour class will present the following information for bone and soft tissue: 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, Pharynx.

• *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 barneskd@dhec.sc.gov

• 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 & test.

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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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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.

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?

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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 soon. These will be listed on the SEER website. (not available as of this newsletter)

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

2013 ICD-9-CM CASEFINDING LIST

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BE CAREFUL . . .

Folfox is incorrectly being coded as Chemotherapy = 02 (single agent)

Folfox is made up of multiple chemo agents per the SEER Rx application.

Chemotherapy data item should be 03 (multiple agents)

CODING FOLFOX CHEMOTHERAPY

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12/5/12: The histology code 9823/3 Chronic lymphocytic leukemia/small lymphocytic lymphoma has been added to ALL primary site groupings.

The following site/histology combinations have been added.

Errata for ICD-O-3 Site/Type Validation List

Primary Site Histology

C540-C543, C548-C5498441/3 Serous cystadenocarcinoma, NOS8460/3 Papillary serous cystadenocarcinoma

C5598441/3 Serous cystadenocarcinoma, NOS8460/3 Papillary serous cystadenocarcinoma

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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”

*Clarification for specific conversion methods pending!

2013 SCCCR REQUIRES GRADE

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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 must view the Industry & Occupation Instruction Webinar. The link is:http://www.cdc.gov/niosh/topics/coding/courses/cancer/

2013 SCCCR REQUIRES I&O TEXT

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Industry & Occupation:

http://www.cdc.gov/niosh/docs/2011-173/pdfs/2011-173.pdf*You may save this link in pdf form for review

CDC & NPCR requires if a person is under the age of 14 we should code:

CHILD (1-14) or INFANT (one year or less)

Code this in both occupation AND industry fields

2013 SCCCR REQUIRES I&O TEXT

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QUESTIONS (?)

ANSWERS (!)

CLARIFICATIONS (*)

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1

Q: Are there any guidelines for coding race for patients who we know are born in Africa (in this case Ethiopia) but for which a specific race is never stated?Are there any guidelines used for other countries as well?I coded birthplace as Ethiopia and race as unknown. ?

A: If race is not stated code 99. Reference: FORDS; Race, pg 63

7/15/11 – CAnswer

RACE:

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2

Q: Patient is stated as "Hispanic-Yes" and "Race-Hispanic" in the hospital medical record.Is the following coded Spanish/Hispanic Origin as "6" for Hispanic, NOS and Race 1 as "01" for white?

A: Yes.Code the item 'Spanish/Hispanic Origin" as 6 if the patient's origin is described as 'Hispanic".Code the item 'Race' for that patient as 01 'White' unless otherwise specified in the record.

Reference: FORDS; Race pg 63, Spanish Origin, pg 69

3/15/11 – CAnswer

RACE / ETHNICITY:

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3

Q: Thyroid with: Hurthle cell 8290 / Papillary Follicular 8340Both are invasive.Our scenario; 2 tumors in same lobe / 8290/3 & 8340/3

MP/H Manual; Other Site / need clarification.

M6: lists follicular & papillary as single primary (but this still leaves the hurthle cell)

M17: this would be the next stop if M6 is not allowedHistology codes different at 1st, 3nd, or 3rd number = Multiple Primaries?

Would this change your answer if the same tumors were in both the right and left lobes?

Also what would be the correct histology?

HISTOLOGY THYROID:

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3

A: Hurthle cell carcinoma is a subtype of follicular.When applying rules for papillary and follicular, you can include hurthle cell.Therefore, Other Rule M6 applies and this is a single primary.

As far as the other scenario of the tumors being in both right and left lobes, M8 could not be used because thyroid is not listed on the table of paired organs.

Reference: MP/H Manual; Other Sites Schema

11/2012 – SEER Data Quality Team / Ask A Registrar

HISTOLOGY THRYROID:

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4

Q: What is the correct class of case when: Example:Patient has lesion by mammogram with positive incisional biopsy at our hospital facility.No further information as to what happened afterwards.Unknown if lumpectomy done, etc.

A: In 2012 FORDS p86, the 3rd bullet ends with the statement- If it is not known that the patient actually went somewhere else, code Class of Case 10. FORDS p88 also gives an example for Class of case 10- Reporting hospital found cancer in a biopsy, but was unable to discover whether the homeless patient actually received any treatment elsewhere. Code as Class of case 10 since only an incisional biopsy was done.Reference: 2012 FORDS; pg 86

11/29/12 – CAnswer

CLASS OF CASE:

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5

Q: How are Multiple Tumors / Multiplicity Counter / Date Multiple Tumors fields coded in the following example situation?11/2007: Multiple (2) bladder tumors present at the time of diagnosis and another (1) bladder tumor diagnosed 12/2009.According to the MP/H Rules Bladder Schema, this new tumor is determined to be the same primary based on primary and histology.

A: Multiplicity Counter field was initially coded 02 for two tumors at diagnosis. Change 02 to 03 because the subsequent additional tumor (12/2009) was determined to be the same primary.Update the Multiplicity Counter field only once. If additional tumors are determined to be the same primary for this case, it’s not necessary to update this field again.Date of Multiple Tumors field was initially coded 11/2007 when multiple tumors were present at the time of initial diagnosis. Do not change the date in this field when additional tumor are subsequently diagnosed. This data item reflects the earliest date that multiple tumors were present.This is applicable to both invasive or in situ when counting multiple tumors.Remember, there has to be a rule within that particular primary site schema that determines it’s the same primary site when a subsequent/recurrence occur.Reference: SEER Manual; pg 81, example 2 under bullet 3

11/2012 – SEER / Ask A Registrar

MULTIPLICITY COUNTER / DATE MULITPLE TUMORS:

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6

Q: Patient has right outer quadrantectomy for breast cancer with en-bloc resection of pectoralis muscle.Should the pectoralis muscle be coded under “surgery other sites” in this instance because surgery code 24 does not cover this?Code 24: Segmental mastectomy (including wedge resection, quadrantectomy, tylectomy)*Removes all gross primary tumor and some of the breast tissue (breast-conserving or preserving). There may be microscopic residual tumor.

A: The surgical code is 24 (quadrantectomy); explains the amount of breast tissue resected but it does not explain the farthest extent of resection to pectoralis muscle.FORDS 2011; pg 21 states: surgical Procedure/Other Site describes first course resection of distant lymph node(s) and/or regional or distant tissue or organs beyond the Surgical Procedure of the Primary Site code.I believe that to reflect the resection of the pectoralis muscle you can code it in Surgical Procedure to Other Sites; the fact it was resected en-bloc does not play a role in this particular procedure.Reference: FORDS 2011; Appendix B, Breast Surgical Codes

11/9/12 Canswer

SURGICAL PROCEDURE BREAST:

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7

Q: If lymphoma involves the thymus and mediastinal lymph nodes, is it considered one lymph node region or two?

A: Since the thymus is nodal, this would be involvement of two lymph node regions.Reference: None

8/2012 – NAACCR Heme/Lymph Webinar

C/S LYMPHOMA STAGING:

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8

Q: How do we interpret spleen involvement if physician information is unavailable?Example: spleen enlargement on exam or radiology.Is this enough to consider involvement?

A: According to AJCC 7th edition, spleen involvement is demonstrated by equivocal palpable splenomegaly and demonstrated by radiologic confirmation (u/s or ct), by multiple focal defects that are neither cystic or vascular.Radiologic enlargement alone is adequate.Reference: AJCC 7th Edition; Lymphoma Schema

8/2012 NAACCR Heme/Lymph Webinar

CS LYMPHOMA STAGING:

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9

Q: Patient with advanced cancer is given prednisone.Is this coded as hormone treatment?

A: When prednisone is given to stimulate the appetite and improve nutritional status it’s not coded as hormone therapy.Reference: FORDS; Treatment, Hormone

12/2012: SCCCR

HORMONE THERAPY:

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10

Q: Patient with advanced cancer and brain mets is given decadron.Is this coded as hormone treatment?

A: When decadron is given to reduce edema in the brain and relieve neurological symptoms it’s not coded as hormone therapy.Reference: FORDS; Treatment / Hormone Therapy

2/2012: SCCCR

HORMONE THERAPY:

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MORE NEWS & UPDATES NEXT MONTH