Agency/Standard Setter Updates

OSCaR Fall Educational Workshop

Claudia Cooksie, RHIT,CTR

October 9, 2015

Portland, Oregon

North American Association of Central Cancer Registries (NAACCR)2015 Implementation and Guidelines

• 2015 Implementation Guidelines and Recommendations– Last Revision May 2015

• Includes all changes effective with cases diagnosed January 1, 2015 • New/Changed Data items• Standard Setters Reporting Requirements for 2015• Summary for Software Developers and Vendors• Summary for Hospital Cancer Registrars and Reporting Facilities• Summary for Central Cancer Registries• http://www.naaccr.org/StandardsandRegistryOperations/Implementation

Guidelines.aspx

CHANGED DATA ITEMS-2015SexNAACCR Standards Volume II, Version 15

• Sex (Item #220)– Code 4 updated

• Transsexual, NOS

– Code 5 added• Transsexual, natal male

– Code 6 added• Transsexual, natal female

CHANGED DATA ITEMS-2015Country CodesNAACCR Standards Volume II, Version 15

• Country codes have been changed for-– Yugoslavia– Czechoslovakia– Brunei– Slovakia– Vanuatu

Question-Czechoslovakia was divided into 2 countries in 1993, I saw a code for Slovakia, but not for the Czech Republic. What would that be?

Answer- The country code for the Czech Republic is CZE. That is documented in the Appendix X of FORDS 2015 and Appendix B of the SEER Program Coding and Staging Manual 2015

New Survival Data ItemsNAACCR Standards Volume II, Version 15

• Data Item Name– Survival-Date Active Follow-up– Survival-Flag Active Follow-up– Survival-Mos Active Follow-up– Survival-DatePresumed Alive– Survival-Flag Presumed Alive– Survival-Mos Presumed Alive– Survival-Date DX Recode

Hematopoietic Conversion/Edits Document

• Published 1/9/2015• Incorporated all changes from:

– 2010 HEME manual and database (cases dx 2010-2011)– 2012 HEME manual and database (cases dx 2012-

forward)

• No significant impact on incidence, histology or multiple primaries – Comparison document on SEER website

– http://www.cancer.gov/tools/heme/comparison.html

HEMATOPOIETIC & LYMPHOID NEOPLASM CODING MANUAL & DATABASE CHANGES

• Update was released on 1/14/2015– Diagnostic Confirmation– New section on First Course of Treatment– Appendix F-Non reportable terms (deleted)– Glossary– Obsolete Hematopoietic Histologies – Hematopoietic Conversion/Edits

• Histology, primary site, and grade

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-2016 forward

• OSCaR officially notified on September 8, 2015• Use with cases diagnosed 1/1/2016 forward• Add new reportable items to your ICD-O-3 manuals • OSCaR responsible for educating reporting sources about

these new updates.• Posted on OSCaR website

https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Cancer/oscar/Pages/reporting.aspx

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-2016 forward

• Non-invasive mucinous cystic neoplasm (MCN) of the pancreas with high grade dysplasia

• Replaces the term mucinous cystadenocarcinoma, non-invasive (8470/2) and is REPORTABLE

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-2016 forward

• Solid pseudopapillary neoplasm of pancreas (8452/3) is synonymous with solid pseudopapillary carcinoma (C25._) and is REPORTABLE

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-2016 forward

• Based on expert pathologist consultation– Metastases have been reported in some CPEN

cases. – With all other pancreatic endocrine tumors now

considered MALIGNANT, CPEN will also be considered malignant, until proven otherwise.

– Most CPEN cases are non-functioning and are REPORTABLE, using histology code 8150/3, unless the tumor is specified as a neuroendocrine tumor, grade 1 (assign code 8240/3), or neuroendocrine , grade 2 (assign 8249/3)

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-2016 forward

• Laryngeal Intraepithelial neoplasia, grade III (LIN III) ,8077/2, C320-C329 is REPORTABLE

• Squamous Intraepithelial neoplasia, grade III (SIN III), 8077/2, (except for cervix and skin) is REPORTABLE

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-1/1/2016

• Mature Teratoma of the testes is malignant and REPORTABLE (9080/3)– Continues to be non-reportable in

prepubescent children (9080/0)

NPCR-CDC-REPORTABILITY DECISIONSHISTOLOGY-1/1/2016• ADDITIONAL GUIDANCE IN DETERMINING REPORTABILITY IN

MATURE TERATOMA

– Adult is defined as post puberty– Pubescence can take place over a number of years– Do not rely solely on age to indicate pre or post puberty status.

Review all information (H & P) for documentation of pubertal status

– When testicular Teratomas occur in adult males, pubescent status will likely be stated in the EHR

– Do not report if unknown whether patient is pre or post pubescence

• When testicular Teratoma occurs in a male and there is no mention of pubescence, it is likely that the patient is a child, or pre-pubescent and the tumor is benign

ICD-O-3 UPDATES-1/1/2015 Reportability and Behavior Change

• Carcinoid tumor, NOS, of the appendix (C18.1) must be coded to 8240/3 (effective with cases diagnosed 1/1/2015)

• Now Reportable and must be coded with a behavior/3

ICD-O-3 UPDATESRecode Changes -1/1/2015

• Histology Code 8157 is OBSOLETE in 2015 and use Code 8152– Two pancreatic tumors, uncertain behavior and malignant

Enteroglucagonomas (8157/1 and 8157/3) must be recorded as :

• Enterogluagonomas NOS (8152/1) and• Malignant glucagonomas (8152/3)

• Subsequent to the conversion of these pancreatic histology codes, – All cases meeting the criteria described above will use the

new code “regardless of diagnosis year” as the old codes become obsolete effective 2015

ICD-O-3 UPDATESIssues for 2015 diagnosis year

• New codes cannot be used for 2015 diagnosis – They are not acceptable histologies for the

Collaborative Stage algorithms– Use ICD0-3 Histology code crosswalk to code new

terms using the current codes– Appendix A of NAACCR 2015 Implementation Guide

explains this, and this is something is worked out with your software vendor

ICD-0-3 Online Version (IARC)

• Online version of ICD0-3 from International Agency for Research on Cancer at http://codes.iarc.fr/ – Useful Tool– For solid tumors-Use ICD-0-3 (2000), aka the “purple book” for

solid tumors• Do not use ICD-0-3 (2011)

• For non-solid tumors-Use histology rules from Hematopoietic and Lymphoid Neoplasm Coding Manual and Database

– Refer to the NAACCR Guidelines for ICD-0-3 Update implementation for the list of ICD-0-3 changes effective 1/1/2015

– Use the Histology rules in MP/H Manual for solid tumors

Prostate Grade Conversion-2014 forward

• Coding instructions for Grade (NAACCR Item # 440) were modified for cases diagnosed in 2014 and later

• Grade code should be consistent with the codes for Gleason score as coded in the CS Site Specific Factors 8 and 10

• See SEER Coding Grade at http://seer.cancer.gov/tools/grade/

• OSCaR Registrar Toolkit

SEER Reportability Clarifications Not Reportable• Do not report non invasive mucinous cystic neoplasm

(MCN) of the pancreas with low or intermediate grade dysplasia

• Do not report mature Teratoma of the testis when diagnosed before puberty (benign, 9080/0)– Do not report mature Teratoma when it is not known whether the

patient is pre or post pubescent

• Do not report SIN III of cervix• Do not report low grade appendiceal mucinous

neoplasm (LAMN), The WHO classification designates LAMN as /1 with uncertain malignant potential

NPCR-CDC Collaborative Stage Transition-NPCR Requirements

• CS v0205 will continue as the primary staging system method for cases diagnosed beginning January 1, 2015

• CDC requires collection of CSv2 data items needed to derive SEER Summary Stage– SSF1-Lung, Pleura and Retinoblastoma– SSF2-CorpusAdenosarcoma, CorpusCarcinoma and

CorpusSarcoma– SSF3-Prostate

NPCR-CDC Collaborative Stage Transition-NPCR Requirements

• Collection prognostic SSF’s– Breast-SSF’s 1-2, 8-9, 11, SSF 13-16– Brain/CNS/Intracranial-SSF 1

• Required as available, the collection of CSv2 data items needed to derive AJCC, TNM (7th edition)

• Schema Discriminator (SSF 25) for applicable sites

NPCR-CDCCollaborative Stage Transition-2016 forward

• CS Basic data items will go away- CS Ext, CS Eval, LN, LN Eval, Met, Met Eval

• All new cases will be assigned Directly Coded– SEER Summary Stage 2000– AJCC TNM (clinical and pathologic)

• CS Transition Group agreed the SSF’s will continue to be collected through at least 2016

Multiple Primary/Histology RulesSolid Tumor Database

• Revised MP/H rules to be -1/1/2017• Solid Tumor Database

– Standalone reference tool that may be used independent of the rules/manual or a resource for the rules

• WHO Pathology books (Blue Book) – Recently released 4th Edition

Remaining IssuesDiscussed

• High grade neoplasia (breast) • High grade dysplasia (colon)• Reportability guidelines for GIST tumors

– Sentence added to FORDS 2013 and SEER 2013 Coding manual, which indicate that-

• GIST tumors and Thymomas are reportable when there is evidence of multiple foci, lymph node involvement or metastasis

Resource Websites

• http://training.seer.cancer.gov/• http://seer.cancer.gov/registrars/• https://www.facs.org/quality-programs/cancer• http://www.cdc.gov/cancer/npcr/index.htm• http://www.naaccr.org• http://www.ncra-use.org/i4a/pages/index.cfm?pageid=1 • https://educate.fhcrc.org/LandingPage.aspx • http://www.cdc.gov/cancer/npcr/training/ccr.htm

Questions

• Notecards and place in the “Box”

• OSCaR QA Team• Claudia Cooksie claudia.f.cooksie@state.or.us • Deborah Towell deborah.j.towell@state.or.us • Leela Coleman leela.j.coleman@state.or.us • Linda Shan linda.y.shan@state.or.us • Molly Sengvongxay molly.d.sengvongxay@state.or.us