RESULTS OF CODING & STAGING ASSESSMENT OF
IDAHO REGISTRARS 2017
Presented by, Denise Jozwik, RHIT, CTR
Acknowledgements:NAACCR Webinars – Multiple Presentors
AJCC Presentations – Donna Gress
Quality Assessment Tool
• Consisted of 25 Questions– 19 Multiple Choice– 6 True / False
• Registrars – New to Seasoned• 19 out of 27 took the Assessment• Overall Percentage – Correct 69%
Question #1
• Recurrence – No MPH Rule Applies• The Rt chest wall mass is a metastatic site for breast. The 2016
path did not contain breast tissue, therefore it is not a new primary. SEER Inquiry. metastatic site for breast. The 2016 path did not contain breast tissue, therefore it is not a new primary. SEER Inquiry.
Question #2
• One - Rule M8 - Rt. Forearm and Rt Shoulder C44.6
• MP/H M8 - Note 2: When an invasive melanoma follows and in situ melanoma within 60 days, abstract as a single primary.
Question #3
• Recurrence• MP/H General Rule 7 – “Do not use a physician’s statement to decide
whether the patient has a recurrence of a previous cancer or a new primary. Use the multiple primary rules as written unless a pathologist compares the present tumor to the “original” tumor and states that this tumor is a recurrence of cancer from the previous primary.”e 7 - Use the multiple primary rules as written unless the pathologist
Question #4
• rupT2c pNX cM0 Stg 99
• AJCC - Prostate rules for pathologic staging - " In general, total prostatectomy including regional lymph node dissection with full histologic evaluation is required for complete pathologic classification."
Question #5
• 8523/3 - H17
• Mucinous (8480) is not a type of ductal ca [H12] (8022, 8035,8501 - 8508). Rule H 17 takes you to Table 3 - Infiltrating duct and one or more of the histologies in column 2, which includes mucinous, code to 8523/3
Question #6
• 8140 – H6
• Rule H6 applies because there is no % given. 3rd bullet - The percentage of mucinous/colloid or signet ring cell carcinoma is unknown.
Question #7
• 999
• Weight is collect "at time of diagnosis". Since is a recurrent case you probably do not know their weight at diagnosis, so 999 is appropriate.
Question #8
• 32 • FORDS Surgery codes : 45 - Wide excision or reexcision of lesion or minor (local)
amputation with margins more than 1 cm, NOS. Margins MUST be microscopically negative [SEER Note: Codes 30 to 35 include less than a wide excision. less than or equal to 1-cm margin, or status of margin is unknown. If it is stated to be a wide excision or re-excision, but the margins are unknown, code to 30. Assign a surgery code from the 30-35 range when any margin is less than 1 cm.
Question #9
• TRUE
• AJCC Chapter for Lymphoma, pg 608 - Extralymphatic sites include; bone marrow, GI tract, skin, bone, CNS, lung, gonads, ocular adnexa, liver, kidneys, uterus, etc. (Lymph nodes, Waldeyer's ring, thymus and spleen are considered nodal or lymphatic sites) Also, NAACCR Webinar: Coding Boot Camp 3-2017
Question #10
• c&pT88 c&pN88 c&pM88 Stg 88 SS - 1
• AJCC- Brain has no staging, TNM and Stage all coded to 88. Summary Stage - confined to the parietal lobe is Local. And NAACCR Webinar: Coding Boot Camp 3-2017
Question #11
• 8140/3
• MP/H General Rules - Priority order for using Documents to Code Histology - #1 Pathology report. Also, NAACCR Webinar Liver and Bile Ducts 6-2017 Q&A
Question #12
• 1 - M10 Acinic Ca – 8550 and Adenoca - 8140• MP/H Rules for Lung - 2 tumors both non-small cell - Adenoca and Acinic
cell adenoca. Per Chart 1 the Acinic Cell is more specific. Stop at Rule 10. Do not use physician statement to determine # of primaries, follow rules. NAACCR Webinar MPH 5-2017
Question #13
• 1 - M6
• MPH Rules for Bladder - M6 bladder tumors with any combination of papillary carcinoma (8050), TCCA (8120-8124) or PTCCA (8130-8131), are a single primary. NAACCR Webinar MPH Rules 5-2017.
Question #14
• TRUE
• FORDS Laterality codes > Overview of Coding Principles > Cancer Identification ( on-line) Nasal cavity is on the laterality list.
Question #15
• cT blank cN blank cM blank Stg 99
• AJCC - Presentations - NAACCR Webinar Cancer Staging 1-2017. The prostate cancer was an incidental find while treating the patient for their bladder cancer.
Question #16
• Always assign physician TNM and Stage
• AJCC - Presentations - Donna Gress makes this comment in every AJCC presentations and is included in each presentation summary.
Question #17
• 188
• Round to the nearest tenth. Rules currently found in CS SSF 1 for prostate.
Question #18
• pM1b & pM1b
• 1a = pleural fluid and 1b = bone mets. AJCC Lung webinar and NAACCR Lung webinar 12-6-16 (Assigning the correct cM and pM -M1a microscopically proven, M1b on imaging assign pM1b.
Question #19
• TRUE
• FORDS and NAACCR Webinar Lung 12-2016 coding moment
Question #20
• FALSE• ICD-O 3 - Epidermoid Tumor no code. FORDS reportability and
NAACCR webinar CNS 8-2017
ICD-O
Question #21
• 8343/2
• SEER inquiry #20160040 and NAACCR "What you need to know for 2017"
Question #22
• FALSE
• NAACCR "What you need to know for 2017"
Question #23
• Polypectomy
• AJCC Colon Chapter, AJCC and NAACCR Webinars
Question #24
• 999
• FORDS Tumor Size Summary - Current code 999 - old code 988 (means 988 mm in tumor size summary)
Question #25
• cT1c cN0 cM0 Stg 1 (DRE-inapparent – PSA < 10, GS < 6)
• AJCC manual and AJCC Cancer Case Studies - Page 88
Educational Opportunities• NAACCR Webinars
– Available to ALL Idaho Registrars– CDRI’s Website – www.idcancer.org– Time Commitment - 3 Hours– CE’s 3 Recommended webinars
• 2016 Recommended Webinars– ALL – MPH and CNS – Present by Carol Hahn Johnson– Cancer Staging 2017 – Donna Gress provided input
Educational Opportunities• AJCC Webinars• https://cancerstaging.org/CSE/Registrar/Pages/default.aspx• Seventh Edition – Disease Site Webinars
– Melanoma– Lung– Breast– Prostate– Colorectal
• AJCC Curriculum for Registrars– Modules I – IV
• Presentations – There are 2 that can be used for self-study or group presentations– Chapter 1 – AJCC T, N, and M Category Options for Registry Data Items in 2016
Portland - 2015
Spokane - 2015
The End
