FEBRUARY 2013

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.

Live viewing of the NAACCR Webinar series is suspended until further notice

The SCCCR office is relocating Links will be provided ASAP after

the live webinar takes place Remember CE hours can be obtained

for viewing via the link provided

Note: we do apologize for the unresolved problem with audio experienced recently.

SCCCR Office relocates on Feb 21.

New physical address is 8911 Farrow Road.

Mailing address remains the same: 2600 Bull St., Columbia, 29201

March Webinar Info & Description – Abstracting & Coding Boot Camp – see announcement

NAACCR Webinar Recorded Links

2012-2013 Remaining NAACCR Webinar Series

2013 ICD-9-CM Casefinding List Available Correctly coding mastectomies? Correctly coding FOLFOX chemotherapy? Errata for ICD-O-3 Site/Type Validation List SEER Updating Training Site

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

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

REGISTRY UPDATES . . .

NEXT WEBINAR ~ will not be shown at SCCCR office – link will be provided ASAP afterwards

Title: Abstracting & Coding Boot Camp with Cancer Case Scenarios

Description: This 3 hour class will present case scenarios on multiple sites and histologies. We will abstract and code each scenario; determine the number of primary tumors; code cancer identification, CSv2, and treatment data items.

NAACCR PREVIOUS WEBINAR RECORDING LINKS AVAILABLE

The following webinars are available for viewing through the SCCCR:

2011-2013 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, Bone & Soft Tissue, CNS.

*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.

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

(as stated: No Live Viewing of the Webinars in Columbia until further notice)

The 2013 Casefinding List for hospitals and central registries was sent to all SC cancer registrars last month.

It may be viewed and/or downloaded at:http://www.seer.cancer.gov/tools/casefinding/

Look at the next page. There are a few exclusions / inclusions which must be followed for SCCCR data reporting requirements.

2013 ICD-9-CM CASEFINDING LIST

Per SCCCR: VINIII, VAINIII, AINIII

Should still be collected!

SEER list includes carcinoma in situ.Please exclude CIS of the cervix unless your facility has decided to collect. SCCCR does not.

The primary skin codes that should be excluded from data collection were not listed.Per ACoS/SCCCR any histology with codes 8000-8110 should be excluded, except any genital primary site.

*All other primary site skin codes (other than 8000-8110) should be collected.

Please provide these codes to your IT dept. for 2013 casefinding!

2013 ICD-9-CM CASEFINDING LIST

Modified radical mastectomy should be:

41: (total simple mastectomy) WITHOUT removal of uninvolved contralateral breast 51: Modified radical mastectomy WITHOUT removal of uninvolved contralateral breast 

A simple qc report will probably find some are coded incorrectly! Rarely would a patient have a mastectomy with removal of the uninvolved contralateral breast!

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?

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?

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

www.seer.training.gov

Basic training and practice modules with hands-on-exercises have been removed for updating.

They were based on older versions of our coding manuals.

Please be patient during this process . . .it will be worth the wait!

We’ll let you know as soon as it’s available.

SEER TRAINING SITE UPDATE

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 as of 2/15/13!

2013 SCCCR REQUIRES GRADE

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

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

QUESTIONS (?)

ANSWERS (!)

CLARIFICATIONS (*)

1

Q: In the absence of any additional information regarding the disease process, is a diagnosis of “polycythemia” reportable even if a patient is treated with phlebotomy?

A: No, this case is not reportable.Polycythemia (also known as polycythaemia or erythrocytosis) is a disease state in which the proportion of blood volume that is occupied by red blood cells increases. Blood volume proportions can be measured as hematocrit level. It can be due to an increase in the mass of red blood cells, “absolute polycythemia”; or to a decrease in the volume of plasma, “relative polycythemia”.The phlebotomy is a treatment for the excessive blood volume; therefore, a diagnosis of “polycythemia” without one of the modifying terms listed in the Heme DB under Alternative Names is not reportable.

Reference: Heme/Lymph DB; Polycythemia lookup; Definition & notes

1/15/13 – Canswer

REPORTABILITY:

2

Q: Patient with history of thyroidectomy on 3/1/12, PET 3/1/12 with 2.1cm non-calcified pulmonary nodule in lll most likely primary or mets. Patient didn’t return for follow-up or bx to confirm or deny malignancy, mets or nodule.Patient now returns 6/15/12 with ct/ch stating “no significant interval change in lll mass since 1/17/12”. Patient again dropped out of system until 8/2012 at which he decided to have a lung bx. This was positive 9/2/12 for primary lung malignancy.

Q: What is the date of diagnosis for the lung?The PET scan does state on by 3/1/12 primary lung vs solitary met. So in retrospect, the patient had the dx of lung cancer at that time, just not proven until 8/12.

Do not include the lung malignancy in thyroid staging since proven to be a single primary.

11/2012 – SCCCR

DATE OF DIAGNOSIS:

3

Q: Physician states “grapefruit size” tumor with no other information. Previous FORDS 2004 gave a conversion table to use when physician only referred size to common objects.Is this still applicable?

A: The following CS Manual 02.04 has a table applicable for converting tumor size

See example “grapefruit” size tumor would be coded to 10cm / 100mm.

Reference: CS 02.04; pg 94

1/2012 – CAnswer

TUMOR SIZE CONVERSION:

4

Q: MP/H Rules/Histology: Where in the manual is documentation indicating "focal" is not a term that can be used to code a specific histology?

A: For the purposes of the MP/H rules, the term "focal" is not used to indicate a more specific histology. Terms that may be used to indicate a more specific histology are listed in the relevant histology rules. For example, see Breast histology rule H3. Notice the terms listed in the note for this rule are "type, subtype, predominantly, with features of, major, with ___ differentiation, architecture or pattern.“The term "focal" is not included.This concept will be clarified in future revisions to MP/H rules.

Reference: MP/H Manual; Histology

2011/0079 – Ask A Registrar

HISTOLOGY:

5

Q: Patient is diagnosed with transitional cell carcinoma of the bladder in 2010.Record states history of invasive bladder cancer.Is this a new primary since it is unknown what type of cancer the previous diagnosis was?

A: For cases diagnosed 2007-2013, apply rule M6. The 2010 diagnosis is not a new primary.Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it’s highly likely it would be mentioned in the medical record.

Reference: MP/H Manual; Bladder Module

2010/0009 – Ask A Registrar

MULTIPLE PRIMARY:

6

Q: Can you explain the correct process for determining multiple primaries when a patient already has two primaries and develops another tumor?Is the third tumor compared to the first or second primary?Definite instructions cannot be found in the MP/H Manual.

A: The third tumor must be compared to each of the others to decide if it’s truly a third primary.But the time from one lesion to another, types of histology, laterality all may influence if there is a new primary.

Reference: MP/H Manual

1/2013 – SEER / Ask A Registrar

MULTIPLE PRIMARY:

7

Q: When a patient is treated with TURB how are margins determined?There are conflicting answers on Canswer between:

7: Margins not evaluable / cannot be assessed (indeterminate)9: Unknown or not applicable

Can you clarify what rule would apply?

There are exceptions for lymphoma’s, unknown or ill-defined sites.

Shouldn’t there be an exception and allow the operative report to be used for TURB & TURP since the specimens are always “chips” or “pieces”?Otherwise, I don’t see how we could ever have a code other than 9, unknown.

(Answer next page)

SURGICAL MARGINS TURB / TURP:

7

A: “Where there is no mention of margin status, 9 is the correct code. Registrars should not be afraid of 9 where it is applicable.You are not showing any lack of quality by using it. Registrars aren’t the only people who know it’s highly unlikely that margins will be identified in TURB; I can’t imagine an investigator who’d be wanting to see margins in that type of surgery.This chain of communication, however, suggest to me a filter we can consider in the future for the Completeness Report.Thanks you for your feedback.

Reference: FORDS; Surgical Margins

10/2012 CAnswer

SURGICAL MARGIN TURB / TURP:

8

Q: If a patient receives BCG, is it coded both in surgery and immunotherapy?

A: If it is done during the same surgical event (TURB followed by BCG instillation), code TURB, code BCG as immunotherapy and do not code BCG as surgery.If BCG is done during separate surgical events, it’s coded as a surgery and as immunotherapy.

Reference: FORDS; Surgery & Immunotherapy coding rules

12/2012: CAnswer

IMMUNOTHERAPY:

9

Q: First course treatment/Chemotherapy:If a specific primary site / histology is listed in SEER*Rx for a given drug, are we only allowed to code that drug as treatment for only those identified Primary sites / Histologies?

A: SEER*Rx lists the approved sites / histologies for each drug.If you have a physician statement documenting that the drug was given for another site/histology, code as treatment for that site/histology.

Reference: SEERx

20120090: Ask A Registrar

TREATMENT:

10

Q: Patient with a breast cancer diagnosis had an oophorectomy.What is the correct treatment code for this procedure?

A: Hematologic Transplant and Endocrine Procedures; bullet 3.Endocrine irradiation and/or endocrine surgery are procedures which suppress the naturally occurring hormonal activity of the patient and thus alter or affect the long-term control of the cancer’s growth.These procedures must be bilateral to qualify as endocrine surgery or endocrine radiation.If only one gland is in tact at the start of treatment, surgery and/or radiation; to that remaining gland qualifies as endocrine surgery or endocrine radiation.*The same would apply for orchiectomy for prostate cancer Reference: FORDS; pg 267 ; Hematologic Transplant and Endocrine Procedures

10/10/12: CAnswer

HORMONE THERAPY:

MORE NEWS & UPDATES NEXT MONTH