International Classification of Diseases for Oncology (3 rd Edition)

1. International Classification of Diseases for Oncology (3rd Edition)

2. History • Brief History leading to ICD-O- • 1893 WHO responsible for publishing international classification of Mortality • 1948 6th Revision of International Statistical Classification of Diseases, Injuries, and cause of death ICD) (9) Used to code mortality and Morbidity data

3. History cont’d • Classification of Neoplasm was based on site and behavior (whether malignant benign or not otherwise specified). • 1951- 1st coding manual for Morphology by American Cancer Society • 1971 Recommendation for ICDO was approved by WHO- 2nd edition of ICDO published in 1990 to be used by cancer registries

4. What is ICD-O? • Not a true classification system • Includes codes from multiple classification systems • Actually a coded nomenclature for : • Topography (primary site of origin) • Morphology (histology, behavior, grade)

5. Rationale for ICD-O • To standardize cancer data collection • To compare data • Regional • National • International

6. Why a new edition? • Immense changes over the past decade in techniques for diagnosing neoplasms • Science has evolved (cytogenetics, immunophenotyping, etc) • 1998 – IARC task force

7. ICD-10 vs ICD-O • ICD-10 topography code describes the behavior of the neoplasm Ex) Lung neoplasm (ICD-10) C34.9 malignant D02.2 in situ D14.3 benign Ex) Lung neoplasm (ICD-O-3), carcinoma C34.9 lung, NOS 8010 / __ (3, 2, 0 )

8. ICD-10 vs ICD-O Behavior ICD-10 Category Term /0 D10-D36 Benign /1 D37-D48 Borderline /2 D00-D09 In situ /3 C00-C76, Invasive C80-C97 /6 C77-C79 Metastatic

9. Contents of ICD-O-3 pp. 001-044) Introduction & Instructions for Use pp. 045-068) Topography (site) - Numerical List pp. 069-104) Morphology (type) - Numerical List pp. 105-218) Alphabetic Index (site & type) pp. 219-240) Appendices

10. Topography – Numerical List • Structure C__ __ . __ • Example) LIP • Range : C00.0 – C80.9 • Grouped by systems / common organs • Numerical order

11. Major Topography Groups • C00-14 Lip, Oral Cavity, Pharynx • C15-26 Digestive Organs • C30-39 Respiratory System • C40-41 Bones, Joints, Cartilage • C44 Skin • C47 Nerves • C49 Soft Tissues • C50 Breast

12. Major Topography Groups • C51-58 Female Genital Organs • C60-63 Male Genital Organs • C64-68 Urinary Tract • C69-72 Eye, Brain, CNS • C73-75 Thyroid and Endocrine Glands • C76 Other Ill defined sites • C77 Lymph Nodes • C80 Unknown

13. Topography – Numerical List • Preferred terms in boldface • Synonyms indented • Equivalent terms not indented --subdivision of preferred term not sufficiently different to warrant own code Example) C07 Parotid Gland --- page 46

14. Morphology - Numerical List • Structure __ __ __ __ / __ • Example) Neoplasm • Range : 8000/0 to 9989/3 • Grouped by common cell types • Numerical order

15. Major Morphology Groups • 800 Unspecified • 801-867 Carcinomas • 872-879 Melanomas • 880-899 Sarcomas • 906-909 Germ Cell • 938-948 Gliomas • 959-972 Lymphomas • 980-994 Leukemias

16. Morphology – Numerical List • Preferred terms in boldface • Synonyms indented • Equivalent terms not indented --subdivision of preferred term not sufficiently different to warrant own code Example) 8045/3 Combined small cell carcinoma --- page 70

17. Behavior, Grade/Differentiation • Located on pages between numerical topography and morphology lists • Place purple ribbon here for quick reference!

18. Morphology - Behavior • Behavioris the fifth digit (after the “/”) of the morphology code • Behavior code indicates the pathologic behavior of the neoplasm - benign, in situ, malignant • Most registries in the world only collect cancer with behavior codes 2 (in situ) and 3 (malignant)

19. Morphology – Grade/Differentiation • Grade/Differentiation is the sixth digit (after the /) of the morphology code • Describes how much or how little a tumor resembles the normal tissue from which it arose • Code the grade of the primary tumor. Do code the grade if given for an in situ neoplasm. Do not code grade for intraepithelial neoplasias

20. ICD-O-3 Code = 10 Digit Code • TOPOGRAPHY 4 Digits + • MORPHOLOGY 4 Digits + • BEHAVIOR 1 Digit + • GRADE 1 Digit 10 Digits

21. Alphabetic Index • Topography (C) and morphology (M) terms listed together alphabetically but not mixed. Space before and after each group. • Boldface header for any word that appears as part of 3 or more terms (terms indented) • NOS terms listed first

22. Meaning and Use of NOS • Not Otherwise Specified • Printed after a term when it : • lacks a modifying or more explicit word or phase • contains an adjective that is not listed • used in a general sense Examples) Adenocarcinoma & Endocrine Gland

23. General Coding Guidelines -Topography • Code the site in which the primary tumor originated, even if it extends to an adjacent subsite. • Code subsite to .9 for single primaries when multiple tumors arise in different subsites of the same anatomic site. • Infiltrating duct carcinoma in UOQ of R Breast and infiltrating duct carcinoma in LIQ R Breast

24. General Coding Guidelines - Site • If a tumor is metastatic and the primary site is unknown, code primary site to C80.9 • If the medical record does not contain enough info to code site: • Consult physician advisor • Use NOS for organ system or ILL defined site code • Code unknown C80.9

25. Coding Guidelines • Topography – p23-24 • Where the tumor arose • No changes from ICD-O-2 • Noun form appears in manual • Glioma of pons vs pontine glioma • Special Codes • Esophagus • Branchial Cleft, Meckel diverticulum

26. Topography - Ill-Defined Sites (A) Codes C76._ • If the diagnosis specifies the tissue of origin, code to the tissue suggested in the alphabetic index in preference to NOS • C76._ codes should be used very rarely as the histology usually will allow you to use a more specific code

27. Example of Possible Codes Use of NOS for Ill-defined Sites Neck C76.0 NOS C44.4 NOS (carcinoma, melanoma, nevus) C49.0 NOS (sarcoma, lipoma) C49.0 adipose tissue C47.0 autonomic nervous system C49.0 connective tissue C44.4 skin C49.1 tendon

28. Example of Rule A Code : Malignant carcinoma of the arm Answer : C44.6 (skin of upper limb)

29. Topography – Prefixes (B) • Prefixes are often used to describe topographic sites and various organs (ex. peri-, para-, pre-, supra-, etc) • Some prefixes modify the topographic site and are listed with specific codes (ex. C77.2 Para-aortic lymph node) • Use Ill-defined site code C76._ for terms such as those above if not specifically listed in ICD-O (only if Rule A does not apply)

30. Example of Rule B Code : periabdominal cystadenocarcinoma Answer : C76.2 (abdomen, NOS)

31. Topography - Overlapping Sites (C) • A single neoplasm that overlaps two contiguous sites and whose point of origin cannot be determined is coded to ‘C__ __ .8’ unless.. • The combination is listed elsewhere Carcinoma of tip and ventral surface of the tongue C02.8 Overlapping lesion of the tongue Carcinoma of esophagus and stomach C16.0 Cardioesophageal junction

32. Example of Rule C Code : Carcinoma overlapping the stomach and small intestine? Answer : C26.8 (overlapping digestive) Code : Overlapping tumor of the cervix and uterus? Answer : C57.8 (overlapping female genital)

33. Topography – Lymphomas (D) • Always code site of origin (extranodal/nodal) • malignant lymphoma of the stomach = C16.9 • malignant lymphoma of lymph node = C77._ • spleen and splenic lymph nodes = C42.2 • spleen and non-regional nodes = consult(C77.9)

34. Topography – Lymphomas (D) • If no site of origin is given, code to lymph nodes, NOS (C77.9);– C80.9 if suspected to be extranodal but site is not stated.

35. Topography – Lymphomas (D) • When multiple lymph node chains are involved: • Code where originated • If all involved chains are in the same lymph node region, code to C77.__ • If involved chains are in different lymph node regions, code to C77.8

36. Example of Rule D Code : Lymphoma of inguinal and iliac lymph nodes Answer : C77.8 (multiple regions)

37. Topography - Bone Marrow C42.1 (E) • All leukemias have a site-specific code of bone marrow (C42.1)except: • Myeloid sarcoma (rare) – leukemic deposit in an organ and should be coded to that organ • Multiple myeloma – code site to C42.1

38. Group Exercise - Topography • Ascending Colon

39. Group Exercise - Topography • Ascending colon • C18.2 • Axillary lymph node

40. Group Exercise - Topography • Ascending colon • C18.2 • Axillary lymph node • C77.3 • UOQ right breast

41. Group Exercise - Topography • Ascending colon • C18.2 • Axillary lymph node • C77.3 • UOQ right breast • C50.4 • Temporal and parietal lobes (1 tumor)

42. Group Exercise - Topography • Ascending colon • C18.2 • Axillary lymph node • C77.3 • UOQ right breast • C50.4 • Temporal and parietal lobes (1 tumor) • C71.8

43. Individual Exercises Practice Topography Coding

44. General Coding Guidelines - Histology • Histology can only be coded after multiple primary determination has been made • If there is no tissue, code the histology the medical practitioner uses to describe the tumor • Use the histology stated in the final diagnosis from the pathology report, unless a more specific histology is definitively described elsewhere (i.e. micro, comment)

45. General Coding Guidelines - Behavior • Collect in situ and malignant always • Collect benign and borderline intracranial and CNS effective 1/1/2004 • Code the behavior as /3 if any portion of the primary tumor is invasive

46. General Coding Guidelines - Grade • Code the grade from the final diagnosis of the pathology report. • Code grade from primary tumor, not from a metastasis or recurrence • If tumor has invasive and in situ components, code grade of invasive component of tumor. If invasive component unknown then code 9

47. Morphology – Matrix Concept (F) • Use the appropriate 5th digit behavior code even if the exact term is not listed in ICD-O • It is okay to over-ride suggested code if pathology report says something different (“Matrix Principle”)

48. Example of Rule F Code : Benign chordoma Answer : 9370/0

49. Morphology-Grade/Differentiation (G) • If a pathology report gives more than one grade/diff, code to the highest grade/diff • If the morphology code includes grade, repeat grade code as sixth digit

50. Example of Rule G Code : moderately to poorly differentiated ` adenocarcinoma Answer : 8140/33 Code : anaplastic malignant teratoma Answer : 9082/34