MP/ H Rule 2014 12/ 4/ 2014 USING THE MULTIPLE PRIMARY AND HISTOLOGY (MP/H) CODING RULES 2014-2015 NAACCR We b inar Se rie s De c e mbe r 4, 2014 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 inar. 2 F ABUL O US PRIZES!!! 3 NAACCR 2014-2015 We b ina r Se rie s 1
MP/ H Rule 2014 12/ 4/ 2014 MP/ H CO DING RUL E S • Rule s re visio n te nta tive ly pla nne d fo r 2016 • Site g ro ups rule s with big g e st c hang e s will be be ta te ste d • So lid tumo r da ta b a se • F re e standing to o l • Co mpre he nsive g lo ssarie s • T ra ining • SE E R*E duc ate 4 MP/ H CO DING RUL E S • Ne w histo lo g y te rms • http:/ / www.na a c c r.o rg / L inkClic k.a spx? file tic ke t=u7d3sB 71t5w%3d&ta b id=126&mid=466 • Using mixe d histo lo g y c o de s • Che c k I CD-O-3 Ma nua l to ma ke sure the re is no t a spe c ific c o de • E xample • Se ro us c ysta de no c a rc ino ma • Assig n c o de 8441/ 3 • Do no t a ssig n c o de 8323/ 3 (mixe d c e ll a de no c a rc ino ma ) • Othe r site s rule s H5, H16, H30 5 MP/ H CO DING RUL E S • Se nd q ue stio ns to : • Ask a SE E R Re g istrar • http:/ / se e r.c anc e r.g o v/ re g istrars/ c o ntac t.html 6 NAACCR 2014-2015 We b ina r Se rie s 2
MP/ H Rule 2014 12/ 4/ 2014 CO L O N MP/ H RUL ES 7 Co lo n MUL T IPL E PRIMARY RUL ES 8 MUL T IPL E PRIMARY RUL E S UNKNOWN IF SINGL E OR MUL T IPL E T UMORS • Rule M1 • Whe n it is no t po ssible to de te rmine if the re is a sing le tumo r o r multiple tumo rs, o pt fo r a sing le tumo r and abstrac t as a sing le primary. SING L E T UMOR • Rule M2 • A sing le tumo r is always a sing le primary. 9 NAACCR 2014-2015 We b ina r Se rie s 3
MP/ H Rule 2014 12/ 4/ 2014 MUL T IPL E PRIMARY RUL E S MUL T IPL E T UMORS • Rule M3 • Ade no c a rc ino ma in a de no ma to us po lypo sis c o li (fa milia l po lypo sis) with o ne o r mo re ma lig na nt po lyps is a sing le prima ry. • Rule M4 • T umo rs in site s with I CD-O-3 to po g ra phy c o de s tha t a re diffe re nt a t the se c o nd (Cxxx), third, (Cxxx) o r fo urth (C18x) c ha ra c te r a re multiple prima rie s. • Rule M5 • T umo rs dia g no se d mo re tha n o ne (1) ye a r a pa rt a re multiple prima rie s. 10 PO P Q UIZ • Wo uld a c o lo n tumo r re po rte d a s "re c urre nt a t the a na sto mo tic junc tio n" just o ve r o ne ye a r a fte r the dia g no sis o f a T 4 c o lo n tumo r to b e c o unte d a s a ne w prima ry? 11 ANSWER • T his is two prima rie s. • Rule M4 applie s. • Whe n a c o lo n re se c tio n has take n plac e , the o rig inal primary site is no lo ng e r pre se nt. 12 NAACCR 2014-2015 We b ina r Se rie s 4
MP/ H Rule 2014 12/ 4/ 2014 MUL T IPL E PRIMARY RUL E S MUL T IPL E T UMORS • Rule M6 • An invasive tumo r fo llo wing an in situ tumo r mo re than 60 days afte r diag no sis are multiple primarie s. • Rule M7 • A fra nk ma lig na nt o r in situ a de no c a rc ino ma a nd an in situ o r malig nant tumo r in a po lyp are a sing le prima ry. • Rule M8 • Abstrac t as a sing le primary whe n o ne tumo r is a mo re spe c ific type o f histo lo g y than the first. 13 MUL T IPL E PRIMARY RUL E S MUL T IPL E T UMORS • Rule M9 • Multiple in situ a nd/ o r ma lig na nt po lyps a re a sing le prima ry. • Rule M10 • T umo rs with I CD-O-3 histo lo g y c o de s tha t a re diffe re nt a t the first (xxxx), se c o nd (xxxx) o r third (xxxx) numbe r a re multiple prima rie s. • Rule M11 • T umo rs tha t do no t me e t a ny o f the a bo ve c rite ria a re a sing le prima ry 14 PO P Q UIZ • He mic o le c to my: 2 tumo rs o f le ft c o lo n I nvasive we ll diffe re ntia te d muc ino us a de no c a rc ino ma 1. a rising in tub ulo villo us a de no ma with pe ric o lo nic sub se ro sa l fa t invasio n, 8.5c m I nfiltra tive mo de ra te ly diffe re ntiate d c o lo nic 2. a de no c a rc ino ma with inva sio n o f musc ula ris pro pria, 4c m • Ho w ma ny prima ry tumo rs a re pre se nt? • 1 prima ry • Wha t M rule wa s use d to de te rmine the numbe r o f prima ry tumo rs? • M7 15 NAACCR 2014-2015 We b ina r Se rie s 5
MP/ H Rule 2014 12/ 4/ 2014 PO P Q UIZ • T o ta l c o le c to my: Dista l tumo r: U lc e ra ting mo de ra te ly diffe re ntiate d c o lo nic 1. a de no c a rc ino ma , 3.2 c m in g re a te st dime nsio n. T umo r inva de s thro ug h the musc ula ris pro pria into the sub se ro sa (pt3). Pro xima l tumo r: E xo phytic mo de ra te ly diffe re ntiate d 2. c o lo nic a de no c a rc ino ma , 2.9 c m in g re a te st dime nsio n. T umo r inva de s sub muc o sa (pt1). Multiple tub ula r a de no ma s pre se nt thro ug ho ut the c o lo n, a ppro xima te c o unt g re a te r tha n 200. • Ho w ma ny prima ry tumo rs a re pre se nt? • 1 prima ry • Wha t M rule wa s use d to de te rmine the numbe r o f prima ry tumo rs? • M3 16 Co lo n HIST O L O G Y RUL ES 17 HIST O L O G Y RUL ES SING L E T UMOR • Rule H1 • Co de the histo lo g y do c ume nte d b y the physic ia n whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ila b le . • Rule H2 • Co de the histo lo g y fro m a me ta sta tic site whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site . • Rule H3 • Co de 8140 (a de no c a rc ino ma , NOS) whe n pa tho lo g y de sc rib e s o nly inte stina l type a de no c a rc ino ma o r a de no c a rc ino ma , inte stina l type . 18 NAACCR 2014-2015 We b ina r Se rie s 6
MP/ H Rule 2014 12/ 4/ 2014 HIST O L O G Y RUL ES SING L E T UMOR • Rule H4 • Co de 8210 (a de no c a rc ino ma in a de no ma to us po lyp), 8261 (a de no c a rc ino ma in villo us a de no ma ), o r 8263 (a de no c a rc ino ma in tub ulo villo us a de no ma ) whe n: • T he fina l dia g no sis is a de no c a rc ino ma in a po lyp • T he fina l dia g no sis is a de no c a rc ino ma a nd a re sidua l po lyp o r po lyp a rc hite c ture is re c o rde d in o the r pa rts o f the pa tho lo g y re po rt. • T he fina l dia g no sis is a de no c a rc ino ma a nd the re is re fe re nc e to a re sidua l o r pre -e xisting po lyp o r • T he fina l dia g no sis is muc ino us/ c o llo id o r sig ne t ring c e ll a de no c a rc ino ma in a po lyp o r • T he re is do c ume nta tio n tha t the pa tie nt ha d a po lype c to my 19 PO P Q UIZ • Co lo n: T he fina l dia g no sis o n a pa th re po rt fo r a c o lo n spe c ime n sa ys: c a rc ino ma in situ in a se rra te d a de no ma . Sho uld I c o de it to : • 8010/ 2 • 8210/ 2 • 8213/ 2 SI NQ I D 20120089 20 HIST O L O G Y RUL ES- SING L E T UMO R SING L E T UMOR • Rule H5 • Co de 8480 (muc ino us/ c o llo id ade no c arc ino ma) o r 8490 (sig ne t ring c e ll c arc ino ma) whe n the final diag no sis is: • Muc ino us/ c o llo id (8480) o r sig ne t ring c e ll c a rc ino ma (8490) o r • Ade no c a rc ino ma , NOS a nd the mic ro sc o pic de sc riptio n do c ume nts tha t 50% o r mo re o f the tumo r is muc ino us/ c o llo id o r • Ade no c a rc ino ma , NOS a nd the mic ro sc o pic de sc riptio n do c ume nts tha t 50% o r mo re o f the tumo r is sig ne t ring c e ll c a rc ino ma 21 NAACCR 2014-2015 We b ina r Se rie s 7
MP/ H Rule 2014 12/ 4/ 2014 HIST O L O G Y RUL ES- SING L E T UMO R SING L E T UMOR • Rule H6 • Co de 8140 (ade no c arc ino ma , NOS) whe n the final diag no sis is ade no c arc ino ma and: • T he mic ro sc o pic dia g no sis sta te s tha t le ss tha n 50% o f the tumo r is muc ino us/ c o llo id o r • T he mic ro sc o pic dia g no sis sta te s tha t le ss tha n 50% o f the tumo r is sig ne t ring c e ll c a rc ino ma o r • T he pe rc e nta g e o f muc ino us/ c o llo id o r sig ne t ring c e ll c a rc ino ma is unkno wn 22 PO P Q UIZ • I a m a little c o nfuse d a b o ut whe n yo u sho uld use c o de 8480 (muc ino us) ve rsus 8140 (a de no c a rc ino ma ). • Do e s the pa tho lo g y ha ve to sta te a pe rc e ntag e o f muc in/ c o llo id in o rde r to use the c o de 8480? I f it is sta te d to be muc ino us c a rc ino ma o r muc ino us ade no c arc ino ma sho uld it b e c o de d to 8480? • I have re vie we d rule H5 and H6 in the MPH manual and am still c o nfuse d. 23 ANSWER • I f the fina l dia g no sis is muc ino us a de no c a rc ino ma , use c o de 8480 e ve n if the pe rc e nta g e o f muc ino us tumo r is no t do c ume nte d. 24 NAACCR 2014-2015 We b ina r Se rie s 8
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