Clarification of Data Items and Coding Practices - PowerPoint Presentation

Slide1

Clarification of Data Items and Coding Practices

TRAM Educational Conference

March 15, 2013

Anne Arundel Medical CenterSlide2

Clarification of Data Items and Coding Practices

Objectives:

Discuss various data items and increase awareness of accurate coding practices by Maryland Registrars.

Discuss the importance of accurate coding and understanding of data items presented.

Tips on working smarter not harder.

Update from the MCRSlide3

Type Reporting Source

Codes

Hospital inpatient

Radiation Treatment Centers or Medical Oncology Centers

Laboratory only

Physician’s office/private medical practitioner

Nursing/convalescent home/hospice

Autopsy only

Death certificate only

Other hospital outpatient units/surgery centersSlide4

Type Reporting Source

This data item is intended to indicate the completeness of information available to the abstractor.

Code in the following priority order: 1, 2, 8, 4, 3, 5, 6, 7

Sources with ‘2’ usually have complete information on the cancer diagnosis, staging, and treatment. Slide5

Type Reporting Source

Codes

Hospital inpatient

Radiation Treatment Centers or Medical Oncology Centers

Laboratory only – use only if the cases are considered lab only.

Physician’s office/private medical practitioner –

do not use unless you have an agreement w/ physicians’

office

to report for them.

Nursing/convalescent home/hospice

Autopsy only

Death certificate only

Other hospital outpatient units/surgery centersSlide6

Type Reporting Source

Sources coded with ‘8’ would include, but not limited to, outpatient surgery and nuclear medicine services. A physician’s office that calls itself a surgery center should be coded as a physician’s office.

Surgery centers are equipped to perform surgical procedures under general anesthesia. Slide7

Race

If you are entering multiple race codes and one includes ’01’ for white, placement of ’

01’ should be last

in the sequence

Reminder that Hawaiian trumps all other races.Slide8

Dx

Date prior to 1/1/2004

NO CS Data Fields Required

Leave all CS data fields blank

From CS tumor size to

SSF25Slide9

LymphoVascular

Invasion

Use code

8

for cases that have no microscopic examination of a primary specimen and for the following primary sites:

Hodgkin and Non-Hodgkin Lymphoma

Leukemia

Hematopoietic and

reticuloendothelial

disorders

MDS including refractory anemia and refractory

cytopenia

Myeloproliferative disordersSlide10

Summary Stage 2000

Heme

/Lymphoid neoplasms should be coded to

7

to reflect systemic disease.Slide11

CS Mets at Dx

= 00

CS Mets Brain =

0

CS Mets Bone

=

0

CS Mets Liver

=

0

CS Mets Lung

=

0

If Date of Diagnosis is > 2004/1/1 otherwise leave blankSlide12

Lung Cancer SSF2

You MUST have histologic examination of the pleura to code this field. This can only be accomplished with a resection. A biopsy doesn’t provide enough tissue to establish pleural involvement. Imaging doesn’t provide the histologic confirmation.

Use code

998

when there is no histologic examination of the pleura.Slide13

Lung Cancer SSF2

Note 2

: Code results as stated on the pathology report. Code 998 if no histologic examination of pleura to assess pleural layer invasion.

Note 3

: If pleural/elastic layer invasion (PL) is not mentioned on the pathology

report from a resection,

code 999. Slide14

Lung Cancer SSF2

Note

4

: An FNA is not a histologic specimen and is not adequate to assess pleural layer invasion. If only an FNA is available, use code 998.

Note 5

: Metastasis to the pleura, that is pleural tumor foci or nodules separate from direct invasion, are coded in CS Mets at

Dx

(code 24). Slide15

Breast Cancer – SSF 15

CS Site-Specific Factor

15 - HER2

: Summary Result of Testing

This variable is based on CS Site-Specific Factors 9, 11, 13, and 14

.

SSF 15 should reflect the test interpretation of either IHC, FISH, CISH or other/unknown test.

If SSF9 = 020 then SSF15 should also = 020 Slide16

Breast Cancer – SSF 15

CS Site-Specific Factor

15 - HER2

: Summary Result of Testing

If both an IHC and a gene-amplification test (FISH or CISH) are performed, record the result of the gene-amplification test in this field.

However

, if the gene-amplification test is given first and the result is borderline or equivocal and an IHC test is done to clarify these equivocal results, code the result of the IHC test. Slide17

Breast Cancer – SSF 15

CS Site-Specific Factor 15 - HER2: Summary Result of Testing

If

the results of one test are available, and it is known that a second test is performed but the results are not available, use code 997. Slide18

Prostate Cancer Tumor Size/Ext Eval

Note

7: For CS Extension - Clinical Extension codes 200 - 240 without prostatectomy assign

CS Tumor Size/Ext

Eval

code

0

as these extension codes are based on physical examination and/or imaging only and NOT biopsy. Slide19

Cause of Death

Code 0000 if the patient is alive

Code 7777 if the patient is deceased and the death certificate is not available.

You may use this field to reflect cause of death at your facility. We overwrite when we conduct death follow-back activities. Slide20

ICD Revision Number

Be sure to use the correct ICD revision number for coding Cause of Death. Mortality codes from the death certificate are coded in ICD-

10

, otherwise, this field should be coded to either:

0

– patient is alive

9

– ICD-

9

-CMSlide21

Melanoma – Diagnostic vs. Surgical

A skin biopsy of any technique (shave, punch, incisional) that shows GROSS residual disease is coded in Surgical Diagnostic and Staging Procedure as 02.

A biopsy with positive margins invisible to the eye, but visible by microscope is coded as an excisional biopsy, Primary Surgery codes 20 – 27.

Re-excisions are coded to 30 – 33. Slide22

Melanoma – Diagnostic vs. Surgical

Do not code excisional biopsies with clear or microscopic margins in the Surgical Diagnostic/Staging Procedures field.

Code in Surgery Primary SiteSlide23

Melanoma – SSF3

In-situ Melanoma – SSF 3 should = 005

005 Clinically negative lymph node metastasis

AND

No

pathologic examination performed

Or unknown if pathologic examination performed

Or nodes negative on pathologic examinationSlide24

TURB – Diagnostic vs. Surgical

A diagnostic TURB is considered surgery and should not be coded in the Diagnostic/Staging Procedures.

Use code 27 in the Surgery Primary Site to record TURB’sSlide25

BCG Therapy

BCG Therapy for Bladder cancer should be coded in both the Surgery Primary Site field and the BRM field.

10

Local tumor destruction, NOS

11

Photodynamic therapy (PDT)

12

Electrocautery

; fulguration (includes use of hot forceps for tumor

destruction

)

13

Cryosurgery

14

Laser

15

Intravesical therapy

16

Bacillus

Calmette

-Guerin (BCG) or other immunotherapySlide26

BCG Therapy

Typically, BCG is administered weekly for 6 weeks. Another 6-week course may be administered if a repeat

cystoscopy reveals

tumor persistence or recurrence. Recent evidence indicates that maintenance therapy with a weekly treatment for 3 weeks every 6 months for 1-3 years may provide more lasting results. Periodic bladder biopsies are usually necessary to assess response.Slide27

BCG Therapy

From the

Canswer

Forum:

If

a patient with a urothelial bladder primary has a TURB followed immediately by BCG how would we code treatment. Would we assign surgery as 27 and

immnunotherapy

as 01 or would we assign two surgical procedures and give one a code of 16 and the other a code of 27 and then also code immunotherapy as 01. Could you give some background as to why we code BCG and

intravesicle

chemo in the surgery codes?Slide28

BCG Therapy

This question was answered by Jerri Linn Phillips who is manager of NCDB and editor of FORDS.

"

As to the final question, years ago when I asked why the BCG instillation code was in surgery, I was told that the surgeons on the manual’s update team wanted it there

.”

The purpose of the primary site surgery codes is to describe what was removed from the patient. BCG instillation is grouped with the

‘10s’

numeric series (no pathology) because it does not itself involve tissue removal though a surgeon and surgical prep may be part of the procedure. The BCG itself should be coded in

immunotherapy,

so that information is retrievable under any circumstances. Only if no other surgery was performed should the BCG instillation code be

used.Slide29

BCG Therapy

Therefore, if any surgery with a code 20 or above also applies, it should be coded for surgery and the applicable

BRM

code

assigned

. If a hospital performs multiple primary site surgeries, each successively is coded so that it includes all tissue previously surgically removed (BCG does not do its thing surgically). See the first full paragraph at the top of page 22 in FORDS: Revised for 2011. The code given when the last surgery was performed will include the earlier surgery, and therefore it will include the TURB even if it is followed by the BCG. That is why 16 is not coded when something 20 or higher has been coded. This is because we want to know what was removed from the patient; the codes were not designed to capture series of multiple intervening surgeries.Slide30

Adenocarcinoma – intestinal type

Adenocarcinoma, intestinal type (

8144)

is

a form of stomach cancer.

Do

not

use this

code when the tumor arises

in

the colon

.Slide31

Working smarter not harder Slide32

Working smarter not harder

Social Media – Facebook

I am a

manager of a medium to large sized registry (1400+ cases a year)

in

the process of training two non-CTRs (no other CTRs except myself). One is 6 months into the job the other is

1.5

yrs. They are fairly independent at this point and are producing abstracts that need to be QA'd for accuracy and completeness. I have been doing 100% QA but am finding it

more

difficult to keep up with the volume. Can anyone offer some ways to cut down the time it is taking to QA (we

re-abstract

for the most part) without jeopardizing the importance of receiving meaningful feedback that lends to effective learning. Any suggestions are welcome!Slide33

Working smarter not harder

RUN REPORTS!!!

Take a day and set up and save some QA reports that can be used to check the quality of individual abstractors data.

For example:

Query on one abstractors initials and see if they’re coding histology correctly for papillary carcinoma of the thyroid.

8050 vs. 8260 for C739Slide34

Working smarter not harder

Benign Brain tumors

Check meningiomas to confirm behavior code of ‘0’ and sequence number 60.

Lung Cancer

Check SSF 2 against the surgery codes. If surgery codes are less than a wedge resection, then SSF 2 should = 998Slide35

Working smarter not harder

Use

GenEdits

Create a file with cases from each abstractor, individually.

Run that file through

GenEdits

and see what the results are.

Be sure to log or maintain some documentation of your QA activities!!

You can manage 10% re-abstractingSlide36

Working smarter not harder

You can manage 10%

re-abstracting if you’re running some type of edits reports and documenting the findings.

By having the abstractors correct their own work, it’s a great learning tool. Slide37

Clarification of Data Items and Coding Practices

QUESTIONS??Slide38

Updates from MCR

Passwords

Stronger passwords will be requested on and after April 1, 2013

8 – 20 characters

Must contain at least one digit

Must contain at least one upper and one lower case letter

Must contain at least one special character (!@#$%)Slide39

Updates from MCR

Disease Indices

Reinstatement of annual submission of disease indices

WHY???

Completeness

Death Follow-backSlide40

Updates from MCR

Disease Indices

Submission by March 1st each year (since we’ve missed the deadline this year, please submit by May 1

st

)

Reminders will be sent via email

Call us if this will be delayed or if assistance is neededSlide41

Updates from MCR

Disease Indices

Submission by May 1 each year

Reminders will be sent via email

Call us if this will be delayed or if assistance is neededSlide42

Updates from MCR

Disease Indices

Format

Excel - .

xls

or .

xlsx

CSV – comma separated valueSlide43

Updates from MCR

Disease Indices

MUST include all elements outlined in the instructions.

MUST include Jan – Dec of the previous year.Slide44

Updates from MCR

QUESTIONS??