Understanding and Coding Cancer Treatment

1. Understanding and Coding Cancer Treatment FCDS 2002 Educational Teleconference Series Jackie Button, MS Steven Peace, CTR Mayra Alvarez, RHIT, CTR October 16, 2002

2. Cornerstones for Treatment Decision-Making

3. First Course of Therapy • For most cancers - Treatment usually begins within four months from the date of initial diagnosis • If treatments begins beyond four months from the date of initial diagnosis please document it & send FCDS a copy of the documentation so we can ‘force’ it

4. First Course of Therapy • Exception to 4-month rule - Leukemia • Treatment begins within two months from the date of initial diagnosis • Why only two months for leukemia? • What about treatment consolidation or maintenance?

5. First Course of Therapy Planned vs. Actual

6. First Course of Therapy Usual Treatment Treatment Interruption Change in Treatment Plan or Regimen

7. First Course of Therapy Treatment Failure Disease Progression Co-Morbid Conditions

8. First Course of Therapy • FCDS Edits • 240 Days - 4 Month Rule / 2 months Leukemia • 365 Days - Prostate & Breast Only • Why have these date edits? • Why can’t FCDS just fix or override these edits?

9. Subsequent Therapy Therapy that starts after the first course of treatment has failed or the cancer has recurred

10. NO Treatment Watch and Wait Patient or Family Refused Contraindicated Due to Other Medical Conditions (Co-Morbidity)

11. Curative Therapy Treatment intent is to eliminate all traces of cancer in the patient Goal is to cure the patient

12. Adjuvant Therapy Treatment intent is to prevent or delay recurrence of original cancer. Treatment is given after other method(s) have destroyed all clinically detectable cancer. Multi-modality Treatment

13. Palliative Therapy Intent is to reduce the size and bulk of cancer and to alleviate symptoms caused by the cancer Treatment is not intended to cure the patient of cancer

14. Ancillary Therapy • Does not attack or destroy cancer cells • Supports the body’s immune system or other body systems without affecting the cancer directly • Examples: Mesna, steroids, Procrit

15. FDA Approval Process • Adult Clinical Trials • Phase I • Phase II • Phase III • Phase IV • Pediatric Clinical Trials • FDA Drug Info - http://www.fda.gov

16. Cancer.gov NCI Cancer Information Web - http://cancer.gov SEER, PDQ & Cancer Information Service NCI - sponsored databases containing extensive and monthly updated information on cancer diagnosis, staging and treatment, including clinical trials. There is also a patient-oriented query available.

17. New DevelopmentsNew FieldsChanged Codesfor 2003 Cases

18. Coding Co-morbidity & Complications • Required for COC-approved cancer programs beginning with January 1, 2003 cancer diagnoses • FCDS will not require this information • Refer to FORDS • http://www.facs.org/dept/cancer

19. Date of First Course of Treatment • Record the date on which treatment (surgery, radiation, systemic, or other therapy) of the patient began at any facility • Record the earliest of the following dates: • Date of First Surgical Procedure • Date Radiation Started • Date Systemic Therapy Started • Date Other Treatment Started

20. Date of First Course of Treatment In cases of non-treatment, in which a physician decides not to treat a patient or a patient or patient’s family declines all treatment, the date of first course of treatment is the date this decision was made

21. Surgery • Date of First Surgical Procedure • Surgical Procedure of Primary Site - Site-Specific • Scope of Regional Lymph Node Surgery • Surgical Procedure/Other Site • Reason for No Surgery of Primary Site

22. Radiation Therapy • COC requires collection and coding of several detail-specific radiation therapy data items including; • Location of Radiation Treatment • Radiation Treatment Volume • Regional Treatment Modality • Regional Dose and other specific radiation dose info • NPCR requires state registries to collect only • - Rx Summ Radiation Therapy

23. Chemotherapy • Change in Field Length to 2 characters • SEER recommends 1-digit historical codes be stored in the second character position preceded by a zero. • COC recommends that historic codes be converted to the current codes, using the algorithm it has developed • SEER/FDA Update to SEER Book 8

24. Hormone Therapy • Change in Field Length to 2 characters • No more coding surgical procedures for orchiectomy, oophorectomy or other surgically-administered hormonal manipulation • Clarification - coding Prednisone & other steroids • SEER/FDA Update to SEER Book 8

25. BRM - Immunotherapy • No change in field length • Anti-angiogenesis agents (endostatin) • Antisense agents • Vaccine therapies • Antibiotic therapy for lymphoma associated with Helicobactor Pylori • SEER/FDA Update to SEER Book 8

26. Hematologic Transplant and Endocrine Procedures • New Data Item • Bone Marrow Transplant • Stem Cell Harvest • Radiation-directed endocrine therapy • Endocrine Surgery • Combination of any of the above

27. Treatment Dates • Some software vendors will modify programs so you do not have to code treatment-specific dates • Some software vendors will not • Code 88888888 for recommended therapy

28. QUESTIONS ???

29. Links to Cancer Information • FCDS - http://www.fcds.med.miami.edu • CDC/NPCR - http://www.cdc.gov/cancer/npcr • NAACCR - http://www.naaccr.org • CAP - http://www.cap.org • SNOMED - http://www.snomed.org • NCI Main Cancer Info - http://cancer.gov • NCI/SEER - http://seer.cancer.gov • ACoS/COC - http://www.facs.org/dept/cancer • Florida DOH - http://www.doh.state.fl.us • Florida C-CRAB - http://www.moffitt.usf.edu/ccrab • Florida Legislature - http://www.leg.state.fl.us/Statutes

30. Thank You