Tumor Talk - 2018 Just Got Real - Karen Mace & Janet Vogel, CTR Quality Auditor/Educator-Cancer Registry himagine solutions, inc - South Carolina ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Tumor Talk – 2018 Just Got Real Karen Mace & Janet Vogel, CTR Quality Auditor/Educator-Cancer Registry himagine solutions, inc
Work from Home Uniform CONFIDENTIAL 2 © 2018 himagine solutions inc.
DISCLAIMER This webinar was written early October 2018. This webinar was written with the best information available to us at the time. The 2018 rules are still volatile, we had to make several changes during the course of writing this webinar due to the changes, clarifications, & updates made during the time we started writing the webinar & the time we presented it here today. When abstracting please be sure to note any changes or updates that might be available. CONFIDENTIAL 3 © 2018 himagine solutions inc.
Objectives Highlight some of the New 2018 Changes Identify various resources available to the registrar when coding 2018 cases and how to use them Discuss tips for more efficient abstracting CONFIDENTIAL 4 © 2018 himagine solutions inc.
223 New NAACCR Data Items
137 Site Specific Data Items (SSDI’s) 24 First Course Treatment Data
32 Staging Data Items Items for CoC facilities associated
● 18 AJCC TNM Items
with radiation
● 4 Derived EOD Stage Items 16 Demographic Data Items
(Central Registry use only)
6 Follow-up/Recurrence/Death
● 3 Directly assigned EOD Items
related Data Items
● 1 Summary Stage 2018
● 2 Lymph Node Date Field Items 6 Edit Override/Conversion
● 2 Lymph Node Date Flag Items History/System Admin Data Items
● 2 Sentinel Lymph Node Items 2 Confidential Data Items
(positive/examined)
CONFIDENTIAL 5 © 2018 himagine solutions inc.
2018 Resources
2018 Implementation https://www.naaccr.org/2018-implementation/
2018 Solid Tumor Manual https://seer.cancer.gov/tools/solidtumor/
Hematopoietic and Lymphoid Neoplasm Database https://seer.cancer.gov/seertools/hemelymph/
Hematopoietic and Lymphoid Neoplasm Coding Manual
https://seer.cancer.gov/tools/heme/Hematopoietic_Instructions_and_Rules.pdf
NAACCR Site Specific Data Items and Grade https://apps.naaccr.org/ssdi/list/
SEER*RSA https://staging.seer.cancer.gov/eod_public/list/1.2/
SEER EOD 2018 General Coding Instructions https://seer.cancer.gov/tools/staging/2018-EOD-General-
Instructions.pdf
AJCC Cancer Staging Manual 8th Edition https://cancerstaging.org/Pages/default.aspx
ICD 0 3 Histology Revisions https://www.naaccr.org/implementation-guidelines/#ICDO3
SEER*Rx Interactive Antineoplastic Drugs Database https://seer.cancer.gov/seertools/seerrx/
STORE Manual
https://www.facs.org/~/media/files/quality%20programs/cancer/ncdb/store_manual_2018.ashx
NAACCR http://datadictionary.naaccr.org/
Appropriate State Manual
CONFIDENTIAL 6 © 2018 himagine solutions inc.
Let’s Get Real CONFIDENTIAL 7 © 2018 himagine solutions inc.
On the Hunt for Histology
1/1/2018 biopsy of the prostate shows: acinar adenocarcinoma,
sarcomatoid. After looking in Solid Tumor Rules under Other Site
Histology Rules. Rule H13, tells us to code the most specific histologic
term.
Where do you find the histology code?
Online version of ICD03
2018 ICD03 Coding Table
aka purple book
CONFIDENTIAL 8 © 2018 himagine solutions inc.
Answer
2018 ICD03 Coding Table
CONFIDENTIAL 9 © 2018 himagine solutions inc.
2018 ICD 0 3 Coding Table (alpha) https://www.naaccr.org/implementation-guidelines/#ICDO3 CONFIDENTIAL 10 © 2018 himagine solutions inc.
ICD 0 3 Online CONFIDENTIAL 11 © 2018 himagine solutions inc.
ICD 0 3 Online CONFIDENTIAL 12 © 2018 himagine solutions inc.
HUH?! CONFIDENTIAL 13 © 2018 himagine solutions inc.
Steps for Hunting Histology
1. Refer to the 2018 ICD 0 3
coding table to see if histology
is listed.
2. If it is not in the coding table,
check the online version of ICD
0 3 aka online purple book
3. Refer to Solid Tumor Rules
Histology rules or
Hematopoietic and Lymphoid
Database whichever is
appropriate depending on site.
CONFIDENTIAL 14 © 2018 himagine solutions inc.Does this constitute a date of
diagnosis?
Physician states on 1/1/2018 patient presents with mass in the colon
which is consistent with colon cancer. Does this constitute a date of
diagnosis?
Yes No
CONFIDENTIAL 15 © 2018 himagine solutions inc.Answer
Yes
CONFIDENTIAL 16 © 2018 himagine solutions inc.Ambiguous Terms that Constitute a Diagnosis CONFIDENTIAL 17 © 2018 himagine solutions inc.
Can you use this term to code specific
histology?
Patient had biopsy of kidney 1/2/2018 and pathology report showed
carcinoma consistent with renal cell carcinoma. What would the
histology code be?
8010/3 Carcinoma 8012/3 Renal Cell Carcinoma
CONFIDENTIAL 18 © 2018 himagine solutions inc.Answer
8010/3 Carcinoma
CONFIDENTIAL 19 © 2018 himagine solutions inc.Do not code when… CONFIDENTIAL 20 © 2018 himagine solutions inc.
What is the histology?
Patient had biopsy of the right lung 1/2/2018 and pathology report
showed non-small cell carcinoma consistent with adenocarcinoma.
The oncology consult says the patient has adenocarcinoma of the right
lung. What would the histology code be?
8046/3 Non-Small Cell
8140/3 Adenocarcinoma
Carcinoma
CONFIDENTIAL 21 © 2018 himagine solutions inc.Answer
8140/3 Adenocarcinoma
CONFIDENTIAL 22 © 2018 himagine solutions inc.HOT OFF THE PRESS! Solid Tumor Rules-Lung updated 10/12/2018 NEW RULE! H3 & H11 CONFIDENTIAL 23 © 2018 himagine solutions inc.
Other Ambiguous Terms STORE manual Ambiguous Terms Describing Tumor Spread CONFIDENTIAL 24 © 2018 himagine solutions inc.
SEER Summary Staging Ambiguous
Terminology
Note 3: This is not the same
list used for determining
reportability as published in
the SEER manual,
Hematopoietic Manual or in
Section 1 of the Standards for
Oncology Registry Entry
(STORE). This is not the same
list of ambiguous terminology
provided in the Solid Tumors
Rules published and
maintained by the SEER
Program.
CONFIDENTIAL 25 © 2018 himagine solutions inc.Ambiguous Terminology Lists CONFIDENTIAL 26 © 2018 himagine solutions inc.
What is the Tumor Size Summary?
9-15-2018 left uoq breast lumpectomy: 1.4 mm infiltrating ductal
carcinoma, 2 sentinel node nodes(-), margins(-)
001 002
CONFIDENTIAL 27 © 2018 himagine solutions inc.Answer:
002
CONFIDENTIAL 28 © 2018 himagine solutions inc.STORE 2018 Manual CONFIDENTIAL 29 © 2018 himagine solutions inc.
AJCC 8th Edition, Breast, Chapter 48
Definition of Primary Tumor (T)
● The general rules for rounding to the nearest millimeter do not apply for
tumors between 1.0 and 1.5mm, so as to not classify these cancers as
microinvasive (T1mi) carcinomas (defined as invasive tumor foci 1.0 mm or
small). Tumors >1mm andSEER*RSA https://staging.seer.cancer.gov/eod_public/list/1.3/ CONFIDENTIAL 31 © 2018 himagine solutions inc.
SEER*RSA CONFIDENTIAL 32 © 2018 himagine solutions inc.
SEER*RSA –Breast Tumor Size Summary CONFIDENTIAL 33 © 2018 himagine solutions inc.
Tumor Size Summary
1/12/2018 Mammogram: 4.5 cm mass RUOQ consistent with ductal
carcinoma.
1/27/2018 Patient undergoes neoadjuvant chemotherapy
4/30/2018 Patient undergoes Right Modified Radical Mastectomy
which showed 4.8cm invasive Ductal Carcinoma
What is the Tumor Size Summary?
045 048
CONFIDENTIAL 34 © 2018 himagine solutions inc.Answer
045
CONFIDENTIAL 35 © 2018 himagine solutions inc.Tumor Size Summary Neoadjuvant CONFIDENTIAL 36 © 2018 himagine solutions inc.
READ THIS!!!!!!!!!!!!!!!!!!!!!!!! CONFIDENTIAL 37 © 2018 himagine solutions inc.
What is the primary site?
9-1-2018 CT Chest: 2.5 cm mass right base of lung
C343 Lower Lobe,
C349 Bronchus or Lung Nos
Bronchus or Lung
CONFIDENTIAL 38 © 2018 himagine solutions inc.Answer
C343 Lower Lobe,
Bronchus or Lung
CONFIDENTIAL 39 © 2018 himagine solutions inc.Lung Solid Tumor Rules 2018 Updated 8/23/2018 CONFIDENTIAL 40 © 2018 himagine solutions inc.
FNAs –To Code or Not to Code CONFIDENTIAL 41 © 2018 himagine solutions inc.
Let’s Get Real with FNAs
1/15/2018 Patient presented to Staff physician with a nodule in the
left thyroid.
1/18/2018 US thyroid showed a nodule left thyroid
2/6/2018 FNA cytology of the thyroid nodule suspicious for carcinoma.
2/10/2018 patient presented to the facility for Total Thyroidectomy,
pathology reveals papillary carcinoma.
What is the Date of Diagnosis?
2/6/2018 2/10/2018
CONFIDENTIAL 42 © 2018 himagine solutions inc.Answer
2/10/2018
CONFIDENTIAL 43 © 2018 himagine solutions inc.STORE Example page 132 CONFIDENTIAL 44 © 2018 himagine solutions inc.
SEER Cytology Exception CONFIDENTIAL 45 © 2018 himagine solutions inc.
What is an abstractor to do when the standard setters disagree? CONFIDENTIAL 46 © 2018 himagine solutions inc.
FNA Cytology of Primary Site
▪ 1/15/18 Patient presented to Staff physician with a nodule in the left
thyroid.
▪ 1/18/18 US thyroid showed a nodule left thyroid
▪ 1/26/2018 FNA cytology of the thyroid nodule showed papillary
carcinoma.
▪ 1/31/2018 patient presented to the facility for Total Thyroidectomy,
pathology reveals papillary carcinoma.
How do you code the 1/26/2018 FNA of the Thyroid Nodule?
Code 02 in in the Diagnostic Do not code the procedure, but
& Staging Procedure list it in the text.
CONFIDENTIAL 47 © 2018 himagine solutions inc.Answer
Do not code the procedure, but
list it in the text.
CONFIDENTIAL 48 © 2018 himagine solutions inc.Surgical Diagnostic and Staging Procedure STORE MANUAL PG. 148 • Do not code brushings, washings, cell aspiration, and hematologic findings (peripheral blood smears). These are not considered surgical procedures and should not be coded. However you can use this information to code Diagnostic confirmation. CONFIDENTIAL 49 © 2018 himagine solutions inc.
FNA Cytology Regional Lymph Nodes
1/12/2018 patient is diagnosed with Adenocarcinoma of the RUL of the
lung.
1/28/2018 patient has FNA of a right hilar lymph node which was
negative for adenocarcinoma.
How do you code the FNA Cytology of the Regional Lymph Node?
Code Scope of Regional
Do not code the procedure,
Lymph Nodes to 1 (Bx or
but list it in the text.
Aspiration of Regional LN)
CONFIDENTIAL 50 © 2018 himagine solutions inc.Answer
Code Scope of Regional
Lymph Nodes to 1 (Bx or
Aspiration of Regional LN)
CONFIDENTIAL 51 © 2018 himagine solutions inc.Coding Cytology of Regional Lymph Node CONFIDENTIAL 52 © 2018 himagine solutions inc.
Code Negative or Positive results in
Scope for Regional Lymph Nodes
http://cancerbulletin.facs.org/fo
rums/forum/fords-national-
cancer-data-base/fords/initial-
diagnosis/scope-of-regional-
lymph-nodes/65014-do-we-
code-negative-results-in-scope-
of-regional-lymph-nodes
CONFIDENTIAL 53 © 2018 himagine solutions inc.To Code or Not to Code? If the specimen other than lymph node is obtained using FNA technique and issued in as a cytology report, it is not coded in the item Surgical Diagnostic and Staging Procedure. If the specimen other than lymph node is obtained using FNA technique and issued in a pathology report, it is coded in the item Surgical Diagnostic and Staging Procedure. Use the data item Scope of Regional Lymph Node Surgery to code Surgical procedures which aspirate, biopsy, or remove regional lymph nodes in an effort to diagnose and/or stage disease in this data item. CONFIDENTIAL 54 © 2018 himagine solutions inc.
Lymphovascular Invasion pgs. 150-156 CONFIDENTIAL 55 © 2018 himagine solutions inc.
LVI new codes 2, 3, & 4 CONFIDENTIAL 56 © 2018 himagine solutions inc.
CYA Policy (Cover Your Abstracting) TIP: In your Text Include the rationale for case coding. MP-Rule M7 H-Rule H5 CONFIDENTIAL 57 © 2018 himagine solutions inc.
2018 Implementation Webinar Series
https://education.naaccr.org/
2018-implementation
CONFIDENTIAL 58 © 2018 himagine solutions inc.Conclusion
USE THE MANUALS!
Refer to CAnswer Forum
● Refer Site-Specific Data Items/Grade 2018
● AJCC TNM Staging 8th Edition
● STORE
Refer to SINQ
● Hematopoietic Rules
● ICD-0-3 Updates (for cases diagnosed 2018+)
● Solid Tumor Rules (for cases diagnosed 2018+)
● EOD 2018
● Summary Stage 2018
CONFIDENTIAL 59 © 2018 himagine solutions inc.Questions? CONFIDENTIAL 60 © 2018 himagine solutions inc.
Ownership of Webinars
You may download one copy of the slides for the Webinars for your personal, non-commercial
internal use only unless specifically licensed to do otherwise by himagine in writing. This is a
license, not a transfer of title, and is subject to the following restrictions: you may not:
• Modify the webinars or use them for any commercial purpose, or any public display,
performance, sale or rental
• Remove any copyright or other proprietary notices from the Webinars
• Transfer the Webinars to another person
The educational webinars and the printed materials made available pursuant thereto
(collectively, the “Webinars”) are the property of himagine solutions Inc. (“himagine”), are
provided as a service to our employees and our clients, and may be used for informational
purposes only. himagine has prepared the Webinars using official Centers for Medicare and
Medicaid Services (CMS) documents, Federal Register, and recognized input from the
Cooperating Parties. While himagine has made reasonable efforts to ensure the content of the
Webinars is accurate, himagine makes no representation, warranty, or guarantee that this
information is error-free, or that the use of information within the Webinars will prevent
differences of opinion with payers. The ultimate responsibility for correctly using the coding
system lies with the user. The Webinars may or may not qualify for Continuing Education Units
(CEUs). While himagine may offer assistance to a participant with processing CEUs, it is up to
the participant to ensure that this is completed. The Webinars are copyrighted and any
unauthorized use of any Webinars may violate copyright, trademark, and other laws.
CONFIDENTIAL 61 © 2018 himagine solutions inc.You can also read
