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Cancer Information

Learn to code cancer diagnosis dates, morphology, primary sites, and more. Test your knowledge with real-world examples.

marysherman
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Cancer Information

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  1. Cancer Information Texas Cancer Registry

  2. Objectives By the end of this training, you should be able to discuss coding related to: • Date of initial diagnosis • Morphology and behavior • Primary sites • Grade of tumor • Laterality • Final Diagnosis • Lymphovascular invasion • Diagnostic confirmation • Changing abstract information Texas Cancer Registry | Cancer Information

  3. Date of Diagnosis • Use clinical, histologic, or positive cytologic confirmation as date of diagnosis • Can be based on reportable ambiguous terminology • Exception: based on cytology • Based on date diagnosed by a recognized medical professional • Pathology report is based on date specimen taken • For autopsy and DCO cases, code the date of death • Use the date therapy started if patient receives 1st course of treatment before definitive diagnosis • Positive tumor markers alone are not diagnostic of cancer Texas Cancer Registry | Cancer Information

  4. Date of Initial Diagnosis • Code to the earliest date the primary cancer was diagnosed • At minimum, the year must be coded Texas Cancer Registry | Cancer Information

  5. EstimatingDate of Initial Diagnosis Texas Cancer Registry | Cancer Information

  6. Date of Initial DiagnosisPop Quiz March 12, 2018, a mammogram reveals a mass in the upper outer quadrant of the patient’s right breast. The radiologist’s impression states: compatible with carcinoma. March 20, 2018, the patient has an excisional breast biopsy that confirms infiltrating ductal carcinoma. What is the date of diagnosis? Texas Cancer Registry | Cancer Information

  7. Date of Initial DiagnosisPop Quiz March 12, 2018, a mammogram reveals a mass in the upper outer quadrant of the patient’s right breast. The radiologist’s impression states: compatible with carcinoma. March 20, 2018, the patient has an excisional breast biopsy that confirms infiltrating ductal carcinoma. Record the date of diagnosis as 20180312. Texas Cancer Registry | Cancer Information

  8. Date of Initial DiagnosisPop Quiz Patient admitted to your facility on April 26, 2018 with melanoma but the original date of diagnosis is unknown. What is the date of diagnosis? Texas Cancer Registry | Cancer Information

  9. Date of Initial DiagnosisPop Quiz Patient admitted to your facility on April 26, 2018 with melanoma but the original date of diagnosis is unknown. Code the date of diagnosis as 201804. Record in the Summary Stage Documentation text field “Date of DX Unknown.” Texas Cancer Registry | Cancer Information

  10. Date of Initial DiagnosisPop Quiz June 2018 The patient had a total hysterectomy and bilateral salpingo-oophorectomy (BSO) with pathologic diagnosis of papillary cystadenoma of the ovaries. December 6, 2018 the patient is diagnosed with widespread metastatic papillary cystadenocarcinoma. The slides from June are not reviewed and there is no physician statement saying the previous tumor was malignant. What is the date of diagnosis? Texas Cancer Registry | Cancer Information

  11. Date of Initial DiagnosisPop Quiz June 2018 The patient had a total hysterectomy and bilateral salpingo-oophorectomy (BSO) with pathologic diagnosis of papillary cystadenoma of the ovaries. December 6, 2018 the patient is diagnosed with widespread metastatic papillary cystadenocarcinoma. The slides from June are not reviewed and there is no physician statement saying the previous tumor was malignant. The date of initial diagnosis should be coded 20181206. Texas Cancer Registry | Cancer Information

  12. Morphology and Behavior • Morphology ICD-O-2 (before 01/01/2001) • ICD-O 2nd Edition • Morphology ICD-O-3 • 2018 Solid Tumor Rules • ICD-O-3 updates • ICD-O-3 3rd Edition • Hematopoietic & Lymphoid Neoplasm Coding Manual • Hematopoietic & Lymphoid Neoplasm Database Texas Cancer Registry | Cancer Information

  13. Morphology and Behavior Histology can only be coded after you determine whether you have a single or multiple primaries • Refer to 2018 Solid Tumor Rules to determine the number of primaries for solid tumors https://seer.cancer.gov/tools/solidtumor/STM_2018.pdf • For hematopoietic & lymphoid diseases, refer to the Hematopoietic & Lymphoid Database http://www.seer.cancer.gov/seertools/hemelymph Texas Cancer Registry | Cancer Information

  14. Primary Site • Primary site is where the cancer started. • The structure for coding primary site is Cxx.x • The decimal point is not entered as part of the code • Refer to the 2018 Solid Tumor Rules for coding instructions • Refer to the Hematopoietic & Lymphoid Neoplasm Database/Coding manual • Provide text documentation Texas Cancer Registry | Cancer Information

  15. Primary Site • Use all available information in the medical records • Code the site in which the primary tumor originated • Code the site of the invasive tumor when there is an invasive tumor and in situ tumor in different subsites of same anatomic site • Code the primary site, not the metastatic site • Transplants-code the primary site to the location of the transplanted organ Texas Cancer Registry | Cancer Information

  16. Primary Site • If there’s a single tumor that overlaps an adjacent subsite and the point of origin can’t be determined, code the last digit to 8 • Exception: Skin cancers in head and neck ONLY, assign primary site code for site with bulk of the tumor or epicenter • For single primaries with multiple tumors in different subsites within the same anatomic site andthe point of origin can’t be determined, code the last digit to 9 Texas Cancer Registry | Cancer Information

  17. Primary Site If the final diagnosis reflects carcinoma of one of the common metastatic sites listed below, carefully review documentation in the medical record to confirm the primary site • Bone • CNS Sites (brain, spinal cord, meninges) • Liver • Lymph Nodes (excluding lymphoma) • Pericardium (excluding mesothelioma) • Pleura (excluding mesothelioma) • Peritoneum • Retroperitoneum Texas Cancer Registry | Cancer Information

  18. Primary SitePop Quiz Patient has an invasive breast tumor in the upper-outer quadrant of the left breast and in situ tumor in multiple quadrants of the left breast. What is the primary site code? Texas Cancer Registry | Cancer Information

  19. Primary SitePop Quiz Patient has an invasive breast tumor in the upper-outer quadrant of the left breast and in situ tumor in multiple quadrants of the left breast. Code the primary site to C504 (upper outer quadrant of breast). Texas Cancer Registry | Cancer Information

  20. Primary SitePop Quiz The patient has an excision of the right axillary nodes which reveals metastatic infiltrating duct carcinoma. The right breast is negative. The ICD-O-3 shows duct carcinoma (8500) with a suggested site of breast (C50_). What is the primary site code? Texas Cancer Registry | Cancer Information

  21. Primary SitePop Quiz The patient has an excision of the right axillary nodes which reveals metastatic infiltrating duct carcinoma. The right breast is negative. The ICD-O-3 shows duct carcinoma (8500) with a suggested site of breast (C50_). Code the primary site as breast, NOS (C509). Texas Cancer Registry | Cancer Information

  22. Primary SitePop Quiz There is a diagnosis of malignancy in autotransplanted section of colon serving as esophagus. What is the primary site code? Texas Cancer Registry | Cancer Information

  23. Primary SitePop Quiz There is a diagnosis of malignancy in autotransplanted section of colon serving as esophagus. Code the primary site as esophagus and document in text field. Texas Cancer Registry | Cancer Information

  24. Leukemia & Lymphoma • Refer to the Hematopoietic and Lymphoid Neoplasm Database https://seer.cancer.gov/seertools/hemelymph/ • Do not use ambiguous terms to code a specific histology • Code Primary Site to C400-C419 for 9731/3 Solitary plasmacytomas of bone • Code Primary Site to C379 or C383 for 9679/3 Primary mediastinal (thymic) large B-cell lymphoma • Code leukemia primaries to bone marrow (C421) Texas Cancer Registry | Cancer Information

  25. Grade Clinical and Grade Pathological • Measure of aggressiveness • Prognostic indicator for some cancers • Used to assign Prognostic Stage Group for some sites • Cases diagnosed 1/1/2018 and forward • Grade Clinical • Grade Pathological • Grade Post Therapy (not collected by TCR) • Grade Coding Instructions and Tables https://www.naaccr.org/SSDI/Grade-Manual.pdf?v=1539866175 Texas Cancer Registry | Cancer Information

  26. Grade Clinical and Grade Pathological • Grade Clinical • Before surgical, systemic, radiation or neoadjuvant therapy • Do not leave blank • Grade Pathological • Includes clinical workup • Surgical resection • Do not leave blank Texas Cancer Registry | Cancer Information

  27. Grade Clinical and Grade Pathological • Cases Diagnosed 1/1/2018 and forward • AJCC 8th Edition Chapter • Specific grading systems • Codes 1-5, L,H,M,S • Take priority over generic grade definitions • Generic Grade Definitions • Codes A-E, 8,9 • Not eligible for AJCC staging • Refer to the Grade Table for site specific codes (page 8) Texas Cancer Registry | Cancer Information

  28. General Grade Coding Instructions • Code from the primary tumor only • More than one grade • Priority goes to applicable AJCC chapter • Highest grade documented • If a grade is given for an in situ tumor, code it • Do NOT code grade for dysplasia • If both in situ and invasive, code invasive component even if it is unknown (9) Texas Cancer Registry | Cancer Information

  29. Clinical GradeInstructions • Allowable values • AJCC chapter-specific (1-5, H, L, M, S, and 9) • Generic codes (A-E) • Histological exam (microscope) • FNA, biopsy, needle core bx • Assign highest grade • Code 9 for unknown • Incidental finding is not applicable • If only one grade available, assume it is clinical (9 for path/blank for post therapy) • Review site-specific clinical grade tables in the manual Texas Cancer Registry | Cancer Information

  30. Pathological GradeInstructions • Allowable values • AJCC chapter-specific (1-5, H, L, M, S, and 9) • Generic codes (A-E) • Surgical resection • Must not be blank • Assign highest grade • Use Clinical Grade If: • Clinical Grade is higher than Path Grade • Path criteria met, but no grade recorded • No residual cancer in resection Texas Cancer Registry | Cancer Information

  31. Pathological GradeInstructions • Code 9 when: • Grade not documented • No resection of the primary site • Neoadjuvant therapy followed by resection • Clinical case only • There is only one grade documented and not sure if Clinical or Pathological Grade • Grade “not applicable” on CAP Protocol and no other information is available • Review site-specific clinical grade tables in the manual Texas Cancer Registry | Cancer Information

  32. Generic GradeCategories • AJCC chapters where the generic grade is available (Breast, Prostate, Soft tissue) • AJCC chapters that do not have a recommended grade table (Nasopharynx, Merkle cell, Melanoma, Thyroid) • Primary sites that do not have an AJCC chapter (Digestive other, Middle ear, Trachea) Texas Cancer Registry | Cancer Information

  33. AJCC Chapter Grade Categories • AJCC Chapter Grade Codes take priority • Use Generic Grade Code if: • No AJCC recommended grade for the site • No AJCC chapter for the site • If AJCC Grade is not documented • AJCC chapter requiring grade to assign Stage Group • Esophagus and Esophagogastric Junction • Appendix • Bone • Soft Tissue Sarcoma of the Trunk and Extremities • Gastrointestinal Stromal Tumor • Soft Tissue Sarcoma of the Retroperitoneum • Breast • Prostate Texas Cancer Registry | Cancer Information

  34. Template Table of Cancer-Specific Grade Texas Cancer Registry | Cancer Information

  35. Laterality Texas Cancer Registry | Cancer Information

  36. Laterality • Code 0 • Non-paired sites • Unknown site C809 • Ill-defined site C760-C768 • Code 9 • Laterality unknown AND no statement that only one side of paired organ is involved • Code 3 • Laterality unknown, confined to single side of paired organ • Code 5 • Midline Organ Texas Cancer Registry | Cancer Information

  37. Laterality Pop Quiz Admitting history says patient was diagnosed with lung cancer based on positive sputum cytology. Patient is treated for painful bony metastases. What is the Laterality Code? Texas Cancer Registry | Cancer Information

  38. Laterality Pop Quiz Admitting history says patient was diagnosed with lung cancer based on positive sputum cytology. Patient is treated for painful bony metastases. Assign code 9. Texas Cancer Registry | Cancer Information

  39. Laterality Pop Quiz Pathology report states that Patient has a 2 cm carcinoma in the upper pole of the kidney. What is the Laterality Code? Texas Cancer Registry | Cancer Information

  40. Laterality Pop Quiz Pathology report states that Patient has a 2 cm carcinoma in the upper pole of the kidney. Assign code 3. Texas Cancer Registry | Cancer Information

  41. Laterality Pop Quiz Patient is diagnosed with adenocarcinoma of the left lung and the physician states patient has metastasis to the right lung. What is the Laterality Code? Texas Cancer Registry | Cancer Information

  42. Laterality Pop Quiz Patient is diagnosed with adenocarcinoma of the left lung and the physician states patient has metastasis to the right lung. Assign code 2. Texas Cancer Registry | Cancer Information

  43. Laterality Pop Quiz Patient is diagnosed prostate cancer and undergoes a bilateral prostatectomy. What is the Laterality Code? Texas Cancer Registry | Cancer Information

  44. Laterality Pop Quiz Patient is diagnosed prostate cancer and undergoes a bilateral prostatectomy. Assign Code 0. Texas Cancer Registry | Cancer Information

  45. Final Diagnosis – Text Fields • Must document the Morphology/Behavior, Grade, Primary Site, and Laterality in the appropriate text fields to support the codes • Do not use the generic ICD-10-CM code Texas Cancer Registry | Cancer Information

  46. Final Diagnosis – Text Fields • Morphology: Moderately well differentiated mucin-producing adenocarcinoma Primary Site: Colon, ascending • Morphology: Grade 3, infiltrating ductal and lobular carcinoma Primary Site: Right breast, upper outer quadrant • Morphology: Anaplastic astrocytoma Primary Site: Brain, frontal-parietal lobe • Morphology: Intermediate grade large cell carcinoma Primary Site: Left lung lower lobe Texas Cancer Registry | Cancer Information

  47. Lymphovascular Invasion (LVI) • Tumor cells in lymphatic channels or blood vessels • Primary tumor • Coded from the Pathology Report (microscopic) • Do not code perineural invasion • Code 0-includes in situ carcinoma • Code 9-No microscopic examination Cytology only or FNA Not possible to determine, small sample Not mentioned in report • Code 8 for Lymphoma and Hematopoietic Texas Cancer Registry | Cancer Information

  48. Diagnostic Confirmation: Solid Tumors • Priority order; code 1 the highest priority • Change code ANY TIME patient has a higher priority diagnostic confirmation; no time limit • Include medical records from other facilities if diagnosed elsewhere • Review all diagnostic reports • If information indicates a bx or resection, assume diagnostic confirmation is histological Texas Cancer Registry | Cancer Information

  49. Diagnostic Confirmation: Solid Tumors Texas Cancer Registry | Cancer Information

  50. Diagnostic Confirmation: Solid Tumors Texas Cancer Registry | Cancer Information

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