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KCR 2014 Spring Training

KCR 2014 Spring Training. Changes in coding grade. Changes in coding grade. Grade has long been a source of confusion…. Changes in coding grade. Several issues complicate matters: in situ vs invasive terminology vs numbers special rules for many sites

cameron-glenn
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KCR 2014 Spring Training

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  1. KCR 2014 Spring Training Changes in coding grade

  2. Changes in coding grade Grade has long been a source of confusion…

  3. Changes in coding grade Several issues complicate matters: • in situ vs invasive • terminology vs numbers • special rules for many sites • FORDS and SEER manual have different instructions

  4. Changes in coding grade • SEER, CDC, and CoC formed a work group to address the problem • No new codes; only clarifications and changes to instructions • New rules apply to cases diagnosed January 1, 2014 forward

  5. Changes in coding grade • Instructions for coding cell indicator in hematopoietic and lymphoid neoplasms (codes 5, 6, 7, 8, 9) have not changed • Determine cell indicator using the “Grade of Tumor Rules” in Hematopoietic and Lymphoid Neoplasm Manual

  6. Changes in Coding Grade • For solid tumors, grade is a measurement of how closely the tumor cells resemble the tissue from the organ of origin • Similarities and differences may be based on pattern (architecture), cytology, nuclear features, or a combination of these • Depends upon which grading system is used

  7. Changes in coding grade • Pathologists describe tumor grade using three systems: • Two levels of similarity (two-grade system) • Three levels of similarity (three-grade system) • Four levels of similarity (four-grade system)

  8. Rules for coding solid tumors 1) Code grade based on information prior to neoadjuvant therapy, even if grade is unknown 2) Code grade from the primary tumor only- NOT mets or recurrence; in the rare instance that the tumor extends contiguously to an adjacent site and tissue from the primary site is not available, code grade from the contiguous site

  9. Rules for coding solid tumor 3) Code the grade (6th digit) for specific histologic terms that imply a grade (i.e., undifferentiated sarcoma 8805/34) 4) For in situ or combined in situ/invasive tumors- if a grade is assigned for an in situ tumor, code it. Do NOT code grade for dysplasia. If there are both in situ and invasive components, code only the grade for the invasive portion, even if it is unknown

  10. Rules for coding solid tumors 5) If more than one grade is given, code the highest grade, even if it is only a focus. Code grade in the following priority order using the first applicable system: • Special grade system for the sites listed in #6 • Differentiation, using instructions in #7 (2, 3, or 4 grade system) • Nuclear grade, using instructions in #7 (2, 3, or 4 grade system) • If it isn’t clear whether the grade assigned is differentiation or nuclear, but a 2, 3, or 4 grade system was used, code it using instructions in #7 • Terminology

  11. Rules for coding solid tumors 6) Use information from the special grade system first; if no special grade can be coded, go on to #7 Grade information based on CS SSF’s for breast, prostate, heart, mediastinum, peritoneum, retroperitoneum, soft tissue, and kidney parenchyma is used to code grade

  12. Rules for coding solid tumors See the rules for each of these SSF’s for details on how to code grade for these sites:

  13. Rules for coding solid tumors 7) Use the two, three, or four grade system information Two grade system

  14. Rules for coding solid tumors Three grade system

  15. Rules for coding solid tumors Four grade system

  16. Rules for coding solid tumors 8) When coding grade from terminology, use the “description” column or the “grade” column. Breast and prostate use the same grade code with a few noted exceptions.

  17. Rules for coding solid tumors

  18. Rules for coding solid tumors

  19. Rules for coding solid tumors 9) If no description fits or grade is unknown prior to neoadjuvant therapy, use code 9 (unknown)

  20. Special grade system rules • Breast uses Bloom Richardson (BR) or Nottingham • Coded in SSF7 • Code in priority order • BR scores 3-9 • BR grade (low, intermediate, high)

  21. Special grade systems rules • BR score is expressed as a range, 3-9. • Based on three morphologic features: degree of tubule formation/histologic grade, mitotic activity, nuclear pleomorphism/nuclear grade of tumor cells

  22. Special grade system rules • If a pathology report uses words such as low, intermediate, or high rather than numbers, use this table to code grade

  23. Special grade system rules • If only a grade of 1 through 4 is given with no information on the score, and it is unclear if it is a Nottingham or BR grade, do not use the conversion table. • Instead, continue on to #7 in the grading rules • If multiple scores are reported, code the highest score

  24. Special grade system rules • Kidney uses Fuhrman nuclear grade • Parenchyma ONLY- not renal pelvis! • Coded in SSF6 • Fuhrman nuclear grade is a four-grade system based on nuclear diameter and shape, the prominence of nucleoli, and the presence of chromatin clumping

  25. Special grade system rules

  26. Special grade system rules • Soft tissue sarcoma uses a three-grade system • French Federation of Cancer Centers Sarcoma Group (FNCLCC) • Coded in SSF1 • In some cases (especially for needle bxs), grade may be specified only as “high grade” or “low grade” • Numeric grade take precedence over high or low

  27. Special grade system rules

  28. Special grade system rules • Prostate uses Gleason grade • Coded in SSF8 (bx/TURP) and SSF10 (prostatectomy/autopsy) • Gleason grade is based on a 5-component system and generally shows two main histology patterns

  29. Special grade system rules • The primary pattern occupies >50% of the cancer • It is usually the first number of the Gleason grade • Secondary pattern is indicated by the second number • These two numbers are added together to create the score, ranging from 2-10

  30. Special grade system rules • If there are two numbers, assume they refer to patterns, and add them together to obtain the score • If only one number is given, and it is < 5, and not specified as a score, do not use the information, because it could refer to either a score or a grade • If only one number is given, and it is >5, assume that is the score and use it

  31. Special grade system rules Change in prostate grading

  32. Special grade system rules • Due to these changes, analysis of prostate grade for cases diagnosed prior to 2014 based solely on the grade field is not recommended

  33. Special grade system rules

  34. Changes in coding grade • The new grading instructions can be found at http://seer.cancer.gov/tools/grade/ • CoCand SEER will incorporate these instructions in their respective coding manual for 2014 • KCR Abstractor’s Manual will be updated

  35. Changes in coding grade • Questions?

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