Co ding Pitfa lls 9/ 3/ 15 Coding Pitfalls 2014-2015 NAACCR We b - PDF document

Co ding Pitfa lls 9/ 3/ 15 Coding Pitfalls 2014-2015 NAACCR We b ina r Se rie s Se pte mb e r 3, 2015 Q&A • Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r c o nte nt thro ug h the Q&A pa ne l. Re minde r: • I f yo u ha ve pa rtic ipa nts wa tc hing this we b ina r a t yo ur site , ple a se c o lle c t the ir na me s a nd e ma ils. • We will b e distrib uting a Q&A do c ume nt in a b o ut o ne we e k. T his do c ume nt will fully a nswe r q ue stio ns a ske d during the we b ina r a nd will c o nta in a ny c o rre c tio ns tha t we ma y disc o ve r a fte r the we b ina r. 2 F ABUL OUS PRIZE S 3 NAACCR 2015-2016 We b ina r Se rie s 1

Co ding Pitfa lls 9/ 3/ 15 GUE ST SPE AKE R • Ang e la Ma rtin, BS, CT R • Misso uri Ca nc e r Re g istry 4 AGE NDA • Upda te s • Sta g ing • E pi Mo me nt • Quiz 1 • Que stio ns fro m this ye a r’ s we b ina rs • Othe r • Quiz 2 5 UPDAT E S • 2017 Upda te s • MP/ H • Summa ry Sta g e • AJCC • CS Site Spe c ific F a c to rs • F ORDS • De a th Cle a ra nc e Ma nua l 6 NAACCR 2015-2016 We b ina r Se rie s 2

Co ding Pitfa lls 9/ 3/ 15 T NM a nd Summa ry Sta g e SUMMARY ST AGE 7 SUMMARY ST AGE • Do no t use SS2000 re fe re nc e s to T NM, F I GO o r o the r sta g ing syste ms • Summa ry Sta g e ha s no t b e e n upda te d sinc e 2001 • F IGO a nd T NM ha ve b e e n upda te d sinc e 2001 8 INT RAMUCOSAL 9 NAACCR 2015-2016 We b ina r Se rie s 3

Co ding Pitfa lls 9/ 3/ 15 CNS AND L YMPHOMA • 1 L o c a l • 5 Re g io na l • 7 Dista nt • 8 Be nig n (CNS) • 9 Unkno wn • Co de s 0, 2, 3, 4 a re no t a pplic a b le 10 L UNG- SUPRACL AVICUL AR L YMPH NODE S • Summa ry Sta g e • Dista nt Me ta sta sis • T NM Sta g e • I nc lude d in the N c a te g o ry 11 RE G NODE S POPS/ E XAMINE D • Q: I f AJCC lists a lymph no de a s re g io na l a nd Summa ry lists the lymph no de a s dista nt, ho w do we c o de Re g io na l L ymph No de s Po sitive a nd Re g io na l L ymph No de s E xa mine d? • A: All o f the sta nda rd se tte rs a g re e …g o with AJCC. 12 NAACCR 2015-2016 We b ina r Se rie s 4

Co ding Pitfa lls 9/ 3/ 15 L YMPH NODE INVOL VE ME NT SOL ID L UNG L YMPHOMA T UMORS • Any me ntio n o f • F ixe d ma tte d • E nla rg e d a nd lymph no de s is ma ss in the lympha de no pa thy indic a tive o f me dia stinum, indic a te re g io na l invo lve me nt re tro pe rito ne um invo lve me nt fo r lung a nd/ o r me se nte ry ONL Y (no spe c ific info a s to tissue invo lve d – c o nside r invo lve me nt 13 INVOL VE ME NT T E RMS INVOL VE ME NT NON-INVOL VE ME NT • Adhe re nt • Ab uts • Appe a rs to • Appro a c hing • Co mpa ra b le with • Appro xima te • Co mpa tib le with • Atta c he d • …. • …. Se e pa g e 15 o f the Summa ry Sta g e Ma nua l 14 AJCC ST AGING 15 NAACCR 2015-2016 We b ina r Se rie s 5

Co ding Pitfa lls 9/ 3/ 15 PRIOR T O ASSIGNING ST AGE … • Re g istra rs must ha ve a c c e ss to the ir sta g ing ma nua ls • Are HI GHL Y e nc o ura g e d to vie w the AJCC Curric ulum fo r Ca nc e r Re g istra rs • https:/ / c a nc e rsta g ing .o rg / CSE / Re g istra r/ Pa g e s/ AJC C-Curric ulum.a spx • Unde rsta nd ho w to use the CAnswe r fo rum • http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum 16 QUE ST ION- T E RMINOL OGY • Ca n the te rm “a de no pa thy” b e c o nside re d a s po sitive lymph no de invo lve me nt whe n a ssig ning c N? Are the re a ny prima ry site e xc e ptio ns? 17 ANSWE R • AJCC do e s no t ha ve a mb ig uo us te rmino lo g y lists, a nd do e s no t ma nda te ho w wo rds sho uld b e inte rpre te d. http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum/ a jc c -tnm-sta g ing / g e ne ra l-rule s- c ha pte rs-1-2/ 8603-a d e no p a thy? 9257-Ade no p a thy_%C2%AC= 18 NAACCR 2015-2016 We b ina r Se rie s 6

Co ding Pitfa lls 9/ 3/ 15 QUE ST ION • A physic ia n a ssig ne d a pT in a situa tio n whe re the pa tie nt c le a rly did no t me e t the rule s fo r c la ssific a tio n fo r a pT ….ho w sho uld I e nte r tha t into the re g istry da ta b a se ? 19 ANSWE R • T he ho spita l re g istra r will b e re spo nsib le fo r re c o rding the physic ia n-a ssig ne d sta g e in the re g istry da ta b a se . • If the sta g e a ssig ne d b y the physic ia n is no t a c c ura te , the re g istra r sho uld a ssig n the sta g e a nd re c o rd the re g istra r-a ssig ne d sta g e in the re g istry da ta b a se • If no physic ia n-a ssig ne d sta g e c a n b e fo und in the me dic a l re c o rd, the re g istra r sho uld a ssig n the sta g e a nd re c o rd it in the re g istry da ta b a se . Collaborative Stage Transition Newsletter August 21, 2015 20 E NT E RING DAT A • Sta g e is a ssig ne d • T he a ssig ne d sta g e is e nte re d in da ta ite ms • Clinic a l sta g e da ta sho uld o nly b e e nte re d into c linic a l da ta fie lds • Pa tho lo g ic sta g e da ta into pa tho lo g ic da ta fie lds Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 1 0 0 I Path 1 0 I c M0 21 NAACCR 2015-2016 We b ina r Se rie s 7

Co ding Pitfa lls 9/ 3/ 15 QUE ST ION • Wha t a re the va lid M va lue s tha t sho uld b e c o nside re d whe n a ssig ning a c linic a l sta g e g ro up? A. c M0 c M1 B. C. pM1 D. A a nd B All o f the a b o ve E . 22 CASE SCE NARIO • A pa tie nt is fo und to ha ve a live r le sio n via ima g ing tha t is suspic io us fo r ma lig na nc y. A CT g uide d b io psy is do ne a nd he is fo und to ha ve me ta sta tic c a nc e r mo st like ly fro m a c o lo n prima ry. Pa tie nt re fuse d a ny furthe r wo rk-up o r tre a tme nt. Ho w wo uld this b e sta g e d? Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin pM1 IV Path 1 IV 23 QUE ST ION • I ma g ing do ne prio r to surg e ry sho we d dista nt me ta sta sis. • T he pa tie nt we nt o n to ha ve surg e ry a nd a t tha t time the dista nt me ta sta sis wa s c o nfirme d mic ro sc o pic a lly. • Wha t is c M a nd pM? 24 NAACCR 2015-2016 We b ina r Se rie s 8

Co ding Pitfa lls 9/ 3/ 15 ANSWE R • I t is a b o ut the time fra me in whic h the info rma tio n wa s kno wn. • Prio r to tre a tme nt we o nly ha d c linic a l e vide nc e o f dista nt me ta sta sis. Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 1 IV Path 1 IV http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum/ a jc c -tnm-sta g ing / a jc c - c urric ulum-fo r-re g istra rs/ mo d ule -iii/ 58339-c m-a nd-p m 25 BL ANKS vs X’S F OR T AND N DAT A IT E MS • Ha s the c rite ria fo r sta g e c la ssific a tio n b e e n me t? • No -Bla nk • Ye s-X o r va lid kno wn va lue (1,2, 3, 4, e tc ) • Wha t if it is “unkno wn” if sta g e c la ssific a tio n rule s ha ve b e e n me t? • Unkno wn to physic ia n-X • One o f the tre a ting physic ia ns kno ws the sta g e , b ut a no the r do e s no t-b la nk • Unkno wn to re g istra r due to po o r do c ume nta tio n- Bla nk BL ANKS vs X’S F OR T AND N DAT A IT E MS • Crite ria fo r Rule s fo r Cla ssific a tio n • E ve ry c ha pte r in the ma nua l ha s rule s fo r c linic a l a nd rule s fo r pa tho lo g ic sta g e • Must a t le a st me e t the c rite ria fo r the T va lue to use a n X 27 NAACCR 2015-2016 We b ina r Se rie s 9

Co ding Pitfa lls 9/ 3/ 15 BL ANKS vs X’S F OR T AND N DAT A IT E MS • Co lo no sc o py with a b io psy. No furthe r c linic a l info rma tio n. • Me t the c rite ria fo r c T . c o de c T X c NX • Cyste c to my fo r b la dde r c a nc e r wa s do ne , pa th sho we d a T 2a tumo r. No lymph no de s we re re mo ve d. • Me t the rule s fo r pT . pT 2a pNx 28 QUE ST ION F ROM CE NT RAL RE GIST RY ST AF F • Pa tie nt c o me s to fa c ility fo r ra dia tio n tre a tme nt a fte r ha ving b io psy a nd pro sta te c to my e lse whe re . • T he o nly info rma tio n in the c ha rt is the da te s o f b io psy, pro sta te c to my, a nd the ra dia tio n tre a tme nt info rma tio n. • Sho uld we use X o r Bla nks fo r the c linic a l a nd pa tho lo g ic a l sta g ing ? 29 ANSWE R • Sinc e T X o r NX indic a te the info rma tio n wa s unkno wn to the physic ia n, yo u c a nno t use this. • T he physic ia n do e s kno w the sta g e o r the y wo uldn't b e a b le to c ho o se the a ppro pria te tre a tme nt fo r the pa tie nt. • In this c a se , a nd it is the o nly o ptio n sinc e yo u c a nno t use X, yo u wo uld le a ve a ll o f the info rma tio n b la nk. http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum/ a jc c -tnm-sta g ing / a jc c -re g istra r-e d uc a tio n- pre se nta tio ns/ e xpla ining -b la nks-a nd-x-a mb ig uo us-te rmino lo g y-a nd-sup po rt-fo r-a jc c - sta g ing / 58490-c la rific a tio n-o n-using -x-vs-b la nks 30 NAACCR 2015-2016 We b ina r Se rie s 10