Cancer Registry References Review Part II of II

1. Cancer Registry References ReviewPart II of II FCDS 2001 Educational Telephone Conference Series November 14, 2001 Steven Peace, CTR

2. Data Items

3. Difficult Data Items • Accession Number • CCYY – first four digits of the number correspond to the admission year • Registrar must enter the correct full year • No edit checks on this data item • Sequence Number • Must sequence cases chronologically in order of date of diagnosis

4. Difficult Data Items • Type of Reporting Source • Code ‘2’ is no longer a valid code • Was used only by Florida for Ambulatory Center Reporting until 6/30/01 • All old FCDS Reporting Source = 2 cases were converted to Reporting Source = 1 • FCDS uses Facility Number to identify ambulatory care centers instead of report source

5. Difficult Data Items • Race 1 • Enter the race as you always have • Race 2 through Race 5 • Used when more than one race is documented • Enter 88 if no additional race is documented • If Race 1 = 99, then all Race 2, Race 3, Race 4 and Race 5 must also = 99 • Vendors might default differently if left blank • FCDS will insert 88 in fields left blank by vendors

6. Difficult Data Items • Address @ Dx and Address Current • Partial year residents • No known residence • Zip coding for Canadian residences • Geocode/Zip code combinations if state is known but zip code is not for Class of Case = 3

7. Difficult Data Items • Diagnostic Confirmation for Myelodys-plastic Syndromes • No rules as of yet by standard setting organizations • Until rules are written, we are supposed to treat these the same as we treat leukemia cases • This includes all related data items – value them as if they are leukemia cases

8. Difficult Data Items • Histology coding when Date of Diagnosis is unknown • Code based on admission year as proxy, even if you know that the Dx Date is prior to 2001 • NAACCR Uniform Data Standards Rule • If you must approximate (software requires a date) then use the approximated date to make this decision

9. Difficult Data Items • Grade – Implied Grade & Interpretation of ICD-O-3 Errata & Clarifications • Important to read these errata carefully in order to assign the correct grade code • T-Cell, B-cell, Null-cell, Grade 1, Grade 2, Grade 3 – coding depends on what is written in the path report • Be careful with implied grade & assigning grade values

10. Difficult Data Items • Regional Nodes Examined and RX Summ – Regional Nodes Examined/Removed ?????? • One is for use in assigning Summary Stage • One is for use in assigning Treatment • They do NOT have the same meaning, yet they MIGHT be the same value

11. Difficult Data Items • Stage at Diagnosis & Stage at First Contact • Use correct manual based on Dx Date • Use correct manual based on Date 1st Admit • 4 separate data items • Summary Stage @ DX 1977 • Summary Stage @ DX 2000 • FCDS Stage @ First Contact 1977 • FCDS Stage @ First Contact 2000

12. Difficult Data Items • FCDS is a voluntary participant in a developing NAACCR study which will examine the impact of the new staging manual on comparative cancer statistics • We will share details on the study as they develop • It will take at least 1-2 years to complete & analyze study findings

13. Surgery

14. Difficult Data Items • Surgical Treatment Data Items • Numerous difficulties in writing the FCDS Edits for these new data items • We think that we finally have the edits working as they should • Many minor exceptions to the general rules for coding these fields have made creating edits very difficult. • NAACCR has few standard edits for these items

15. Difficult Data Items • Site or Type Requirements for Surgery Data • If C80.9 (Unknown Primary) then Surg Prim Site must = 00 • If C80.9, C42.1, C70.0-C72.9 or Lymphoma then Scope Reg LN Surgery must = 9 • If C77.* then RX Summ Reg LN Exam/Removed must = 99

16. Difficult Data Items • Coding Regional LN Examined/Removed is a particular problem with some sites that we are used to coding the staging Reg LN Examined automatically as 99. This is not necessarily the case for these sites. • Brain - C70.*, C71.*, C72.* • Leukemia & MDS – C42.* • Multiple Myeloma - C42.*

17. Difficult Data Items • How to code surgeries that are performed at different times and with different degrees of surgery of primary site & surgery of regional lymph nodes & surgery of other, regional or distant sites • Be sure to follow the site-specific sections carefully • Call us with questions

18. Difficult Data Items • Basically, you are instructed to code the most extensive surgery performed at any time with regard to the individual surgery data item. • The most extensive Surgery of Primary Site • The most extensive Scope Reg LN Surg • The most extensive Surg Oth/Reg/Dist Sites

19. Difficult Data Items • Remember that all surgeries are supposed to be ‘cancer-directed’ surgery • This means that the surgery is intended to remove some or all of what is felt is or could be cancerous tissue. • Intent of surgery is as important as what is actually removed • Some may actually be diagnostic in nature with lesser intent for tumor tissue removal

20. Difficult Data Items • Surgery Date is coded as the first surgery that is at least an excision of the primary site or removal of some cancerous tissue from a regional or distant site • Surgery Date is not the date of the first needle biopsy or biopsy that is less than an excision of tumor • Check the path report for a specimen size. If it is measurable, then it was an excision.

21. Difficult Data Items • You still code a surgery date when there was no surgery of primary site but there is surgery of regional nodes or distant sites

22. Difficult Data Items • Reason for No Surgery = 0 means that some surgery was performed • It sounds like the opposite of what it should be, so there has been quite a bit of confusion over this data item and the edits that go with it.

23. Difficult Data Items • All other RX Summ (including Chemo, Hormones, Radiation, BRM and Other) • Code 7 used to indicate treatment was refused • No other changes

24. Difficult Data Items • Text • Please review text requirements and suggestions for what qualifies as sufficient text • NAACCR is in process of establishing text guidelines and they will be similar to what FCDS is requesting and may be more stringent so it is easier to get used to supplying good text now and creating good text habits now rather than changing them once standards are set

25. EDITS

26. FCDS Edits • NAACCR EDITS Logic • Standard National Edits • FCDS-Defined Edits • FCDS Edit Message Master List • FCDS Edit Message Master List by Category • FCDS Edits have been mailed out to all vendors

27. FCDS Edits • Many old edit messages have been reworded to be more clear • Many old edit messages have been reworded to indicate which manual to reference (ICD-O-2 or ICD-O-3, Stage, etc)

28. New FCDS Edits • Edits 171 through Edit 255 are all NEW !!! • Many correspond to old FCDS Edits except that they apply to new data items such as address at diagnosis and the zip code/county edits • Others correspond to old FCDS Edits except that they apply to new data items and new validation tables such as the ICD-O-3 site/type tables • Some edits are entirely new for entirely new data items such as Race 2 thru Race 5 edits

29. New Force-Able Edits • The new Force-able edits are essentially the same as the old Force-able edits, except that they correspond to the new data items • Example: Edit 190 – ICD-O-3 Morphology not valid with Site or not reportable to FCDS

30. Old Warning is now a full edit which requires a Force • Edit 40 – Site equals C80.9 or C76.* and Sequence greater than 00 • Why does Edit 40 now require a Force? • Now is a NAACCR Standard Edit and CDC/NPCR requires an Edit Override

31. Problem Edits • Edits 251 through 255 have been very difficult to figure out… • These edits apply to particular tumor types and sites and some inconsistencies have surfaced in how the data items were established and the intent behind the data item’s meaning and coding structure

32. FCDS IDEA and Edits • How do the new on-line FCDS Edits work? • Can I enter a case that will require a Force without getting an edit message? • What if I get hung up in a case while entering it?

33. Questions or Suggestions • As always…PLEASE contact us with any questions and/or suggestions for improving our new system. It belongs to you as much as it belongs to us… • …and THANK YOU for being so patient with us as we have worked through the rather minor problems that we have encountered during our transition with manuals, software, new upload procedures, new edits and the whole works…