Clarification of Data Items and Coding Practices

Clarification of Data Items and Coding PracticesTRAM Educational ConferenceMarch 15, 2013Anne Arundel Medical CenterClarification of Data Items and Coding PracticesObjectives:

Discuss various data items and increase awareness of accurate coding practices by Maryland Registrars.

Discuss the importance of accurate coding and understanding of data items presented.Tips on working smarter not harder.

Update from the MCRType Reporting SourceCodesHospital inpatientRadiation Treatment Centers or Medical Oncology CentersLaboratory onlyPhysicians office/private medical practitionerNursing/convalescent home/hospiceAutopsy onlyDeath certificate onlyOther hospital outpatient units/surgery centersType Reporting SourceThis data item is intended to indicate the completeness of information available to the abstractor.

Code in the following priority order: 1, 2, 8, 4, 3, 5, 6, 7

Sources with 2 usually have complete information on the cancer diagnosis, staging, and treatment.

Type Reporting SourceCodesHospital inpatientRadiation Treatment Centers or Medical Oncology CentersLaboratory only use only if the cases are considered lab only. Physicians office/private medical practitioner do not use unless you have an agreement w/ physicians office to report for them.Nursing/convalescent home/hospiceAutopsy onlyDeath certificate onlyOther hospital outpatient units/surgery centersType Reporting SourceSources coded with 8 would include, but not limited to, outpatient surgery and nuclear medicine services. A physicians office that calls itself a surgery center should be coded as a physicians office.

Surgery centers are equipped to perform surgical procedures under general anesthesia. RaceIf you are entering multiple race codes and one includes 01 for white, placement of 01 should be last in the sequenceReminder that Hawaiian trumps all other races.Dx Date prior to 1/1/2004NO CS Data Fields RequiredLeave all CS data fields blank From CS tumor size to SSF25LymphoVascular InvasionUse code 8 for cases that have no microscopic examination of a primary specimen and for the following primary sites:Hodgkin and Non-Hodgkin LymphomaLeukemiaHematopoietic and reticuloendothelial disordersMDS including refractory anemia and refractory cytopeniaMyeloproliferative disordersSummary Stage 2000Heme/Lymphoid neoplasms should be coded to 7 to reflect systemic disease.

CS Mets at Dx = 00CS Mets Brain = 0CS Mets Bone = 0CS Mets Liver = 0CS Mets Lung = 0

If Date of Diagnosis is > 2004/1/1 otherwise leave blankLung Cancer SSF2You MUST have histologic examination of the pleura to code this field. This can only be accomplished with a resection. A biopsy doesnt provide enough tissue to establish pleural involvement. Imaging doesnt provide the histologic confirmation.

Use code 998 when there is no histologic examination of the pleura.Lung Cancer SSF2Note 2: Code results as stated on the pathology report. Code 998 if no histologic examination of pleura to assess pleural layer invasion.

Note 3: If pleural/elastic layer invasion (PL) is not mentioned on the pathology report from a resection, code 999.

Lung Cancer SSF2Note 4: An FNA is not a histologic specimen and is not adequate to assess pleural layer invasion. If only an FNA is available, use code 998.

Note 5: Metastasis to the pleura, that is pleural tumor foci or nodules separate from direct invasion, are coded in CS Mets at Dx (code 24).

Breast Cancer SSF 15CS Site-Specific Factor 15 - HER2: Summary Result of Testing

This variable is based on CS Site-Specific Factors 9, 11, 13, and 14.

SSF 15 should reflect the test interpretation of either IHC, FISH, CISH or other/unknown test.

If SSF9 = 020 then SSF15 should also = 020 Breast Cancer SSF 15CS Site-Specific Factor 15 - HER2: Summary Result of Testing

If both an IHC and a gene-amplification test (FISH or CISH) are performed, record the result of the gene-amplification test in this field.

However, if the gene-amplification test is given first and the result is borderline or equivocal and an IHC test is done to clarify these equivocal results, code the result of the IHC test. Breast Cancer SSF 15CS Site-Specific Factor 15 - HER2: Summary Result of Testing

If the results of one test are available, and it is known that a second test is performed but the results are not available, use code 997. Prostate Cancer Tumor Size/Ext EvalNote 7: For CS Extension - Clinical Extension codes 200 - 240 without prostatectomy assign CS Tumor Size/Ext Eval code 0 as these extension codes are based on physical examination and/or imaging only and NOT biopsy. Cause of DeathCode 0000 if the patient is alive

Code 7777 if the patient is deceased and the death certificate is not available.

You may use this field to reflect cause of death at your facility. We overwrite when we conduct death follow-back activities. ICD Revision Number Be sure to use the correct ICD revision number for coding Cause of Death. Mortality codes from the death certificate are coded in ICD-10, otherwise, this field should be coded to either:

0 patient is alive9 ICD-9-CM

Melanoma Diagnostic vs. SurgicalA skin biopsy of any technique (shave, punch, incisional) that shows GROSS residual disease is coded in Surgical Diagnostic and Staging Procedure as 02.

A biopsy with positive margins invisible to the eye, but visible by microscope is coded as an excisional biopsy, Primary Surgery codes 20 27.

Re-excisions are coded to 30 33.

Melanoma Diagnostic vs. SurgicalDo not code excisional biopsies with clear or microscopic margins in the Surgical Diagnostic/Staging Procedures field.

Code in Surgery Primary Site

Melanoma SSF3In-situ Melanoma SSF 3 should = 005

005 Clinically negative lymph node metastasisAND No pathologic examination performedOr unknown if pathologic examination performedOr nodes negative on pathologic examinationTURB Diagnostic vs. Surgical

A diagnostic TURB is considered surgery and should not be coded in the Diagnostic/Staging Procedures.

Use code 27 in the Surgery Primary Site to record TURBsBCG TherapyBCG Therapy for Bladder cancer should be coded in both the Surgery Primary Site field and the BRM field.

10 Local tumor destruction, NOS11 Photodynamic therapy (PDT)12 Electrocautery; fulguration (includes use of hot forceps for tumor destruction)13 Cryosurgery14 Laser15 Intravesical therapy16 Bacillus Calmette-Guerin (BCG) or other immunotherapyBCG TherapyTypically, BCG is administered weekly for 6 weeks. Another 6-week course may be administered if a repeat cystoscopy reveals tumor persistence or recurrence. Recent evidence indicates that maintenance therapy with a weekly treatment for 3 weeks every 6 months for 1-3 years may provide more lasting results. Periodic bladder biopsies are usually necessary to assess response.BCG TherapyFrom the Canswer Forum:

If a patient with a urothelial bladder primary has a TURB followed immediately by BCG how would we code treatment. Would we assign surgery as 27 and immnunotherapy as 01 or would we assign two surgical procedures and give one a code of 16 and the other a code of 27 and then also code immunotherapy as 01. Could you give some background as to why we code BCG and intravesicle chemo in the surgery codes?BCG TherapyThis question was answered by Jerri Linn Phillips who is manager of NCDB and editor of FORDS. "As to the final question, years ago when I asked why the BCG instillation code was in surgery, I was told that the surgeons on the manuals update team wanted it there.

The purpose of the primary site surgery codes is to describe what was removed from the patient. BCG instillation is grouped with the 10s numeric series (no pathology) because it does not itself involve tissue removal though a surgeon and surgical prep may be part of the procedure. The BCG itself should be coded in immunotherapy, so that information is retrievable under any circumstances. Only if no other surgery was performed should the BCG instillation code be used.

BCG TherapyTherefore, if any surgery with a code 20 or above also applies, it should be coded for surgery and the applicable BRM code assigned. If a hospital performs multiple primary site surgeries, each successively is coded so that it includes all tissue previously surgically removed (BCG does not do its thing surgically). See the first full paragraph at the top of page 22 in FORDS: Revised for 2011. The code given when the last surgery was performed will include the earlier surgery, and therefore it will include the TURB even if it is followed by the BCG. That is why 16 is not coded when something 20 or higher has been coded. This is because we want to know what was removed from the patient; the codes were not designed to capture series of multiple intervening surgeries.

Adenocarcinoma intestinal typeAdenocarcinoma, intestinal type (8144) is a form of stomach cancer.

Do not use this code when the tumor arises in the colon.Working smarter not harder

31Working smarter not harder Social Media Facebook

I am a manager of a medium to large sized registry (1400+ cases a year) in the process of training two non-CTRs (no other CTRs except myself). One is 6 months into the job the other is 1.5 yrs. They are fairly independent at this point and are producing abstracts that need to be QA'd for accuracy and completeness. I have been doing 100% QA but am finding it more difficult to keep up with the volume. Can anyone offer some ways to cut down the time it is taking to QA (we re-abstract for the most part) without jeopardizing the importance of receiving meaningful feedback that lends to effective learning. Any suggestions are welcome!Working smarter not harder RUN REPORTS!!!

Take a day and set up and save some QA reports that can be used to check the quality of individual abstractors data.

For example:

Query on one abstractors initials and see if theyre coding histology correctly for papillary carcinoma of the thyroid. 8050 vs. 8260 for C739Working smarter not harder Benign Brain tumorsCheck meningiomas to confirm behavior code of 0 and sequence number 60.

Lung CancerCheck SSF 2 against the surgery codes. If surgery codes are less than a wedge resection, then SSF 2 should = 998

Working smarter not harder Use GenEdits

Create a file with cases from each abstractor, individually.

Run that file through GenEdits and see what the results are.

Be sure to log or maintain some documentation of your QA activities!!

You can manage 10% re-abstractingWorking smarter not harder You can manage 10% re-abstracting if youre running some type of edits reports and documenting the findings.

By having the abstractors correct their own work, its a great learning tool.

Clarification of Data Items and Coding PracticesQUESTIONS??

37Updates from MCRPasswords

Stronger passwords will be requested on and after April 1, 2013

8 20 charactersMust contain at least one digitMust contain at least one upper and one lower case letter Must contain at least one special character (!@#$%)Updates from MCRDisease Indices

Reinstatement of annual submission of disease indices

WHY???CompletenessDeath Follow-backUpdates from MCRDisease Indices

Submission by March 1st each year (since weve missed the deadline this year, please submit by May 1st)Reminders will be sent via email

Call us if this will be delayed or if assistance is neededUpdates from MCRDisease Indices

Submission by May 1 each yearReminders will be sent via email

Call us if this will be delayed or if assistance is neededUpdates from MCRDisease Indices

FormatExcel - .xls or .xlsxCSV comma separated valueUpdates from MCRDisease Indices

MUST include all elements outlined in the instructions.

MUST include Jan Dec of the previous year.Updates from MCRQUESTIONS??

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