Cancer Information Texas Cancer Registry.

Cancer Information Texas Cancer Registry

Texas Cancer Registry | Cancer Information
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 This module will cover the Cancer Information section of the Handbook. It will also correspond with the layout of the data fields in WebPlus . It includes coding of the Date of diagnosis, the morphology, the primary site, the grade and laterality of the tumor, lymphovascular invasion, and diagnostic confirmation. You can follow along in the handbook beginning on page 111. 1/27/2020 Texas Cancer Registry | Cancer Information

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 Let’s begin with a the Date of Diagnosis. The date of diagnosis is the month, day, and year the reportable neoplasm was identified. It can be clinical or histological An example of a clinical diagnosis would be , when a radiologist views a chest x-ray and states lung carcinoma. If later confirmed by a pathology specimen, the diagnosis date still remains the date of the initial clinical diagnosis. The date of diagnosis based on a pathology report should be the date the specimen was taken, not the date the pathology report was read or created. Refer to the List of Ambiguous Terms that represents a diagnosis of cancer. When the first diagnosis includes reportable ambiguous terminology, record the date of that diagnosis. If a recognized medical practitioner states that, in retrospect, the patient had cancer at an earlier date, record the date of diagnosis as the earlier date. If a patient receives the first course of treatment BEFORE a definitive diagnosis, use that date. For autopsy- and death-certificate only cases the date of initial diagnosis will be the date of death 1/27/2020 Texas Cancer Registry | Cancer Information

Date of Initial Diagnosis
Code to the earliest date the primary cancer was diagnosed At minimum, the year must be coded If you have: The coding format is: Example: Day, Month and Year YYYYMMDD March 25, 2018= Month and Year YYYYMM March 2018 = Year YYYY 2018 = 2018 Record the date in a YYYYMMDD format. In the absence of an exact date of initial diagnosis, record the best approximation. If all you know are the year and month record the date of diagnosis for month and year as shown on this slide. Document that the exact date of diagnosis is not available in the medical record in Summary Stage Documentation text field. 1/27/2020 Texas Cancer Registry | Cancer Information

Estimating Date of Initial Diagnosis
On the screen is a table for estimating the date. It is also found on page 114 of the handbook. Estimate the month based on terms such as Spring, Summer, Winter or Fall. Estimate the year for terms such as “early in year” ,”middle of year”, or “late in year”. If not date is available, use the date of admission as the date of diagnosis. 1/27/2020 Texas Cancer Registry | Cancer Information

Date of Initial Diagnosis Pop 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? 1/27/2020 Texas Cancer Registry | Cancer Information

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 The date of initial diagnosis is the earliest date this primary reportable neoplasm is diagnosed clinically or microscopically by a recognized medical practitioner, regardless of whether the diagnosis was made at the reporting facility or elsewhere. March 12, 2018 the radiologist states “compatible with carcinoma”. 1/27/2020 Texas Cancer Registry | Cancer Information

Patient admitted to your facility on April 26, with melanoma but the original date of diagnosis is unknown. What is the date of diagnosis? 1/27/2020 Texas Cancer Registry | Cancer Information

Patient admitted to your facility on April 26, with melanoma but the original date of diagnosis is unknown. Code the date of diagnosis as Record in the Summary Stage Documentation text field “Date of DX Unknown.” In the absence of an exact date of initial diagnosis, record the best approximation. For vague dates, estimate the date of diagnosis for month and year using all available information. For this example, we would code and then record “date of dx unknown” in the text field 1/27/2020 Texas Cancer Registry | Cancer Information

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? 1/27/2020 Texas Cancer Registry | Cancer Information

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 Papillary cystadenoma is 8450/0 (benign) and there is no physician statement saying that the previous tumor was malignant. The date of initial diagnosis should be coded December 6, 1/27/2020 Texas Cancer Registry | Cancer Information

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 The next data field is the Morphology In our ICD-O webinar yesterday I showed you a screen shot of the web plus application. Web plus has two data fields for the coding of morphology. ICDO 2 Morph B/ and ICDO 3 Morph after 2001 2018 Morphology is coded in ICDO-3 Morph after 2001 using the The 2018 Solid Tumor Rules, the 2018 ICD-O-3 updates at the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) the Hematopoietic and Lymphoid Neoplasm Coding Manual, and the Hematopoietic and Lymphoid Neoplasm Database are the standard references for histology codes. The (ICD-O) 2nd Edition, is to be used for coding and reporting the morphology and behavior of tumors diagnosed before January 1, 2001. Adequate documentation of tumor cell type must be provided in the FINAL DIAGNOSIS text field. Use all pathology reports available; and follow the 2018 Solid Tumor Rules site specific rules for determining histology. 1/27/2020 Texas Cancer Registry | Cancer Information

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 018.pdf For hematopoietic & lymphoid diseases, refer to the Hematopoietic & Lymphoid Database It in important to note that Solid tumor histology can be coded only after the determination of a single versus multiple primaries has been made. Refer to the 2018 Solid tumor rules to determine the number of primaries for solid tumors. Refer to the hematopoietic and Lymphoid manual and database for hematopoietic and lymphoid diseases. 1/27/2020 Texas Cancer Registry | Cancer Information

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 Next we have the primary site data item. The primary site is where the cancer started. The structure for coding is C followed by a 2 digit site and 1 digit subsite code. The decimal point in the ICD-O codes is not entered as part of the code Refer to the 2018 Solid Tumor Rules for coding instructions for solid tumors. Hematopoietic and lymphoid neoplasms have their own database and coding manual for determining primary site. Please remember to provide text documentation of the primary site. 1/27/2020 Texas Cancer Registry | Cancer Information

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 For primary site, Use all available information in the medical records. Code the site in which the primary tumor originated. Where there is an invasive tumor and an insitu tumor in different subsites of the same anatomic site, code the invasive. Code the primary site, not the metastatic site When there is a tumor in a site that was a transplanted site, code the location of the transplanted organ as opposed to the origin. For example, in the case where a patient has an esophagectomy or gastric pullup, which is removal of the esophagus and replacement of it with the stomach. If they were to develop cancer in that location. We would code it to esophagus, not stomach. 1/27/2020 Texas Cancer Registry | Cancer Information

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 and the point of origin can’t be determined, code the last digit to 9 If there is a single tumor that overlaps two adjacent subsites and the point of origin can not be determined, we would code the last digit for subsite as an 8. Example: a patient has a 5 cm tumor overlapping the base of tongue and the anterior 2/3 of tongue. Code the primary site to C028 (overlapping lesion of the tongue). For single primaries with multiple tumors in different subsites within the same anatomic site and the point of origin cannot be determined, code the last digit to 9. Example: patient has an infiltrating duct carcinoma in the upper outer quadrant (C504) of the right breast And another infiltrating duct carcinoma in the lower inner quadrant (C503) , we code the site as (C509)-breast, NOS 1/27/2020 Texas Cancer Registry | Cancer Information

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 Here we have a list of common metastatic sites: if the final diagnosis reflects carcinoma of one of these common metastatic sites, carefully review the documentation in the medical record to confirm the primary site. 1/27/2020 Texas Cancer Registry | Cancer Information

Primary Site Pop 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? 1/27/2020 Texas Cancer Registry | Cancer Information

Primary Site Pop 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). Code the site of the invasive tumor when there is an invasive tumor and an in situ tumor in different subsites of the same anatomic site. So we would code C504 for upper outer quadrant) since that is the subsite with the invasive breast tumor. 1/27/2020 Texas Cancer Registry | Cancer Information

Primary Site Pop 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? 1/27/2020 Texas Cancer Registry | Cancer Information

Primary Site Pop 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). Use the site code suggested by ICD-O-3 when the primary site is the same as the site code suggested or the primary site is unknown. Duct carcinoma 8500 (C50_) 1/27/2020 Texas Cancer Registry | Cancer Information

Primary Site Pop Quiz There is a diagnosis of malignancy in autotransplanted section of colon serving as esophagus. What is the primary site code? 1/27/2020 Texas Cancer Registry | Cancer Information

Primary Site Pop 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. Code the primary site to the location of the transplanted organ when a malignancy arises in a transplanted organ, i.e., code the primary site to where the malignancy resides or lies. So here we would code the primary site as esophagus and document in the text field 1/27/2020 Texas Cancer Registry | Cancer Information

Leukemia & Lymphoma Refer to the Hematopoietic and Lymphoid Neoplasm Database 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) The hematopoietic and lymphoid neoplasm coding manual has specific rules for coding the primary site. Here is a link to the manual provided on the screen. Primary site coding instructions begin on page 33 in the Hematopoietic and Lymphoid Neoplasm Coding Manual. On the screen I have some instructions and tips. They can also be found in the handbook on pg. 128 1. Do not use ambiguous terms to code a specific histology. 2. Solitary plasmacytomas of bone is always coded to primary site C400-C419: 3. Assign primary site to C379 or C383 when the histology is: 9679/3-Primary mediastinal (thymic) large B-cell lymphoma Note: Do not code this histology based only on mediastinal involvement. 4. Assign primary site C421 (Bone marrow) when the histology is one of those on the list. 1/27/2020 Texas Cancer Registry | Cancer Information

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 Our next data items are Grade Clinical and Grade Pathological. TCR only collects these two. We do not collect Grade Post Therapy. Grade is a measure of aggressiveness and is used as a prognostic indicator for some cancers and is also used to assign the Prognostic Stage Group for some sites. Instructions and information regarding the Grade of Tumor can be found beginning on page 129 of the handbook. For cases diagnosed January 1, 2018 and later, Grade Clinical, Grade Pathological and Grade Post Therapy, replaces the data item Grade 1/27/2020 Texas Cancer Registry | Cancer Information

Before surgical, systemic, radiation or neoadjuvant therapy Do not leave blank Grade Pathological Includes clinical workup Surgical resection Grade Clinical records the grade of a solid primary tumor before any treatment (surgical resection or initiation of any treatment including neoadjuvant). For some sites, grade is required to assign the clinical stage group for AJCC staging. This data item must not be blank. Grade Pathological records the grade of a solid primary tumor that has been resected and for which no neoadjuvant therapy was administered. This may include the grade from the clinical workup. This data item must not be blank. 1/27/2020 Texas Cancer Registry | Cancer Information

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) Grade Clinical and Grade Pathological is for cases diagnosed 1/1/2018 and forward. AJCC 8th edition has chapter specific grading codes for some sites. The AJCC 8th Edition Chapter-specific grading systems (codes 1-5, L,H,M,S) take priority over the generic grade definitions (codes A-E, 8, 9). For those cases that are not eligible for AJCC staging, the generic grade definitions would apply. Allowable values: A-E, 8,9. You must go to the Grade Table List in the Grade Manual to identify the schema ID , the AJCC chapter (if applicable) and the correct Grade Table to use when coding Grade data items. 1/27/2020 Texas Cancer Registry | Cancer Information

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) The general guidelines for coding the new grade items (clinical and pathologic for solid tumors begins on page 24 of the Grade manual Code the grade from the primary tumor only a. Do NOT code grade based on metastatic tumor or recurrence. In the rare instance that tumor tissue extends contiguously to an adjacent site and tissue from the primary site is not available, code grade from the contiguous site b. If primary site is unknown, code grade to 9. 2. If there is more than one grade available for an individual grade data item Priority goes to the recommended AJCC grade listed in the applicable AJCC chapter i. If none of the specified grades are from the recommended AJCC grade system, record the highest grade per applicable alternate grade categories for that site. b. If there is no recommended AJCC grade for a particular site, code the highest grade per the applicable grade categories for that site. a. If a grade is given for an in situ tumor only, code it. Do NOT code grade for dysplasia such as high-grade dysplasia. b. If there are both in situ and invasive components, code only the grade for the invasive portion even if its grade is unknown. 4. Systemic treatment and radiation can alter a tumor’s grade. Therefore, it is important to code clinical grade based on information prior to neoadjuvant therapy even if grade is unknown during the clinical timeframe. 1/27/2020 Texas Cancer Registry | Cancer Information

Clinical Grade Instructions
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 Note 1: Clinical grade is recorded for cases where a histological (microscopic) exam such as a FNA, biopsy or core bx and tissue is available and t he grade is recorded Note 2: Clinical grade must not be blank. Note 3: Assign the highest grade from the primary tumor assessed during the clinical time frame. Note 4: Code 9 (unknown) when • Grade is not documented • Clinical staging is not applicable (for example, cancer is an incidental finding during surgery for another condition) • Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available • If there is only one grade available and it cannot be determined if it is clinical or pathological, assume it is a clinical grade and code appropriately per clinical grade categories for that Note: review the individual site-specific clinical grade tables in the manual for additional notes 1/27/2020 Texas Cancer Registry | Cancer Information

Pathological Grade Instructions
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 Note 1: Pathological grade is recorded for cases where a surgical resection has been done. Note 2: Pathological grade must not be blank. Note 3: Assign the highest grade from the primary tumor. If the clinical grade is the highest grade identified, use the grade that was identified during the clinical time frame for both the clinical grade and the pathological grade. If a resection is done of a primary tumor and there is no grade documented from the surgical resection, use the grade from the clinical workup If a resection is done of a primary tumor and there is no residual cancer, use the grade from the clinical workup 1/27/2020 Texas Cancer Registry | Cancer Information

Pathological Grade Instructions
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 Note 4: Code 9 (unknown) when • Grade not documented • No resection of the primary site • Neoadjuvant therapy followed by a resection (see post therapy grade) • Clinical case only (see clinical grade) • There is only one grade available and it cannot be determined if it is clinical or pathological • Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available See the individual site-specific Pathological Grade tables for additional notes 1/27/2020 Texas Cancer Registry | Cancer Information

Generic Grade Categories
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) Generic grade categories refer to the grade definitions that have been used by the cancer registry field for many years, In years past, these categories were assigned code numbers 1-4. Beginning with cases diagnosed in 2018, registrars will use codes A-D. Numeric codes are being reserved to record grades recommended by AJCC. However, code 9 will continue to be used for unknown for all cases. • AJCC chapters where the generic grade categories are available if the preferred grading system is not available. are the Breast, Prostate, Soft tissue • AJCC chapters that do not have a recommended grade table Are Nasopharynx, Merkel Cell, Melanoma, Thyroid • Primary sites that do not have an AJCC chapter are Digestive other, Middle ear, Trachea 1/27/2020 Texas Cancer Registry | Cancer Information

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 For the AJCC Chapters that have a AJCC grade codes, those codes take priority. You can use the generic grade codes IF There is no AJCC recommended grade for the site, or there is no AJCC chapter for the site, or if the AJCC grade is not documented in the medical records. Page 20 of manual The following AJCC chapters require grade to assign stage group. • Chapter 16: Esophagus and Esophagogastric Junction (Grade 03) • Chapter 19: Appendix (Grade 05) • Chapter 38: Bone (Grade 08) • Chapter 41: Soft Tissue Sarcoma of the Trunk and Extremities (Grade 10) • Chapter 43: Gastrointestinal Stromal Tumor (Grade 11) • Chapter 44: Soft Tissue Sarcoma of the Retroperitoneum (Grade 10) • Chapter 48: Breast (Grade 12) • Chapter 58: Prostate (Grade 17) 1/27/2020 Texas Cancer Registry | Cancer Information

Template Table of Cancer-Specific Grade
On this screen is a template table of the Cancer-Specific Grade Table. The tables for grade have been re-structured for There may be a combination of numeric and alphabetic codes within the same table Found on page 21 of the grade manual Codes 1-5, H, L, M, S, and 9 all represent AJCC recommended grading systems. Categories L and H are applicable for the AJCC recommended grading systems of “low grade” and “high grade” for those cancers for which these are used (e.g. urinary cancers with urothelial histologies). It also includes M for intermediate grade to be used with L and H for breast in situ cancers. Codes A-E are the generic grade categories that were previously used for many years. If is important to consult the 2018 Grade manual to determine the codes to use. (demo) 1/27/2020 Texas Cancer Registry | Cancer Information

Laterality Our next data field item is laterality. Laterality identifies the side of a paired organ or the side of the body where the tumor originated. Be careful when coding laterality. Some physicians may state right or left for an unpaired organ like right colon or left colon. Also be sure you are coding 1 for right and 2 for left. We see lots of coding errors on this. Refer to the table on pages 132 for table of paired sights. 1/27/2020 Texas Cancer Registry | Cancer Information

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 Non-paired sites are coded to 0. Unknown (C809) and Ill-defined (C760–C768) sites are coded to 0 Assign code 9 when the disease originated in a paired site, but the laterality is unknown AND there is no statement that only one side of the paired organ is involved Assign code 3 if laterality is unknown but the tumor is confined to a single side of a paired organ. Assign code 5 for a midline tumor of a paired site. (C700, C710-C714, C722-C725, C443, C445). Midline for code 5 refers to the point where the right and left sides of paired organs come into direct contact and a tumor forms at that point such as skin of trunk (C445). Most paired sites cannot develop midline tumors. 1/27/2020 Texas Cancer Registry | Cancer Information

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? 1/27/2020 Texas Cancer Registry | Cancer Information

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. Assign code 9 when the disease originated in a paired site, but the laterality is unknown AND there is no statement that only one side of the paired organ is involved 1/27/2020 Texas Cancer Registry | Cancer Information

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? 1/27/2020 Texas Cancer Registry | Cancer Information

Laterality Pop Quiz Pathology report states that Patient has a 2 cm carcinoma in the upper pole of the kidney. Assign code 3. Assign code 3 if laterality is unknown but the tumor is confined to a single side of a paired organ. because there is documentation that the disease exists in only one kidney, but it is unknown if the disease originated in the right or left kidney. 1/27/2020 Texas Cancer Registry | Cancer Information

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? 1/27/2020 Texas Cancer Registry | Cancer Information

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. Assign code 2 the tumor originate in the left lung and has metastasized to the right. 1/27/2020 Texas Cancer Registry | Cancer Information

Laterality Pop Quiz Patient is diagnosed prostate cancer and undergoes a bilateral prostatectomy. What is the Laterality Code? 1/27/2020 Texas Cancer Registry | Cancer Information

Laterality Pop Quiz Patient is diagnosed prostate cancer and undergoes a bilateral prostatectomy. Assign Code 0. Prostate is not a paired site; code 0 1/27/2020 Texas Cancer Registry | Cancer Information

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 Our next data items is the Final Diagnosis Text Field. Text which supports the morphology, behavior, grade, primary site and laterality codes is required in this text field. Examples can be found on pg. 135 Documenting Instructions 1. Record the morphology/behavior, grade, primary site, and laterality descriptions. 2. Do not use the generic ICD-10-CM code statement found on the face sheet. 1/27/2020 Texas Cancer Registry | Cancer Information

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 Here are some examples of what to record in the text field for Final Diagnosis: Example 1. Morphology: Moderately well differentiated mucin-producing adenocarcinoma Primary Site: Colon, ascending Example 2. Morphology: Grade 3, infiltrating ductal and lobular carcinoma Primary Site: Right breast, upper outer quadrant Example 3. Morphology: Anaplastic astrocytoma Primary Site: Brain, frontal-parietal lobe Example 4. Morphology: Intermediate grade large cell carcinoma Primary Site: Left lung lower lobe This text field is confirming the information in the data fields that have been coded; which assists in visual edit or reabstracting edits 1/27/2020 Texas Cancer Registry | Cancer Information

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 Lymphovascular invasion indicates the presence or absence to tumor cells in the blood vessels or lymphatic channels (not the lymph nodes). It is an indicator or prognosis. Codes and rules are found on pg. 130. TCR only collects LVI for penis and testis 1/27/2020 Texas Cancer Registry | Cancer Information

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 Diagnostic confirmation records the best method of diagnostic confirmation of the cancer being reported at any time in the patient’s history. Coding Instructions for Solid Tumors are as follows: 1. The codes are in priority order; code 1 has the highest priority. Always code the procedure with the lower numeric value when presence of cancer is confirmed with multiple diagnostic methods. 2. Change to a lower code if at ANY TIME during the course of disease the patient has a diagnostic confirmation that has a higher priority. There is no time limit for this field. 3. If diagnosed elsewhere, copies of the previous pathology or radiology reports included in the medical record may be used to code this field. 4. All diagnostic reports in the medical record must be reviewed to determine the most definitive method used to confirm the diagnosis of cancer. This review must cover the entire medical history in regards to the primary tumor. 5. If the information in the medical record indicates a biopsy or resection of the tumor has been performed, assume the diagnostic confirmation is histological even if the pathology report is not available. 1/27/2020 Texas Cancer Registry | Cancer Information

This table shows the codes for Diagnostic Confirmation for solid tumors 6. Assign code 1 when the microscopic diagnosis is based on: a. Tissue specimens from biopsy, surgery, autopsy or Dilatation & Curettage b. Bone marrow specimens (aspiration and biopsy) 7. Assign code 2 when the microscopic diagnosis is based on: a. Examination of cells (rather than tissue) including but not limited to: sputum smears, bronchial brushings, bronchial washings, prostatic secretions, breast secretions, gastric fluid, spinal fluid, peritoneal fluid, pleural fluid, urinary sediment, cervical smears and vaginal smears. b. Paraffin block specimens from concentrated spinal, pleural, or peritoneal fluid. 8. Assign code 4 when there is information that the diagnosis of cancer was microscopically confirmed, but the type of confirmation is unknown. 9. Assign code 5 when the diagnosis of cancer is based on laboratory tests or marker studies with a clinical diagnosis for that specific cancer. 1/27/2020 Texas Cancer Registry | Cancer Information

10. Assign code 6 when the diagnosis is based only on: a. The surgeon’s operative report from a surgical exploration or endoscopy such as colonoscopy, mediastinoscopy, or peritoneoscopy and no tissue was examined. b. Gross autopsy findings (no tissue or cytologic confirmation). 11. Assign code 7 when the only confirmation of malignancy was diagnostic imaging such as computerized axial tomography (CT scans), magnetic resonance imaging (MRI scans), or ultrasounds/sonography. 12. Assign code 8 when the case was diagnosed by any clinical method not mentioned in preceding codes. The diagnostic confirmation is coded 8 when the only confirmation of disease is a physicians' clinical diagnosis. 13. Assign code 9 when it is unknown how the diagnosis was confirmed. Death certificate only cases will be assigned code 9. Important note: if it is an analytic case, the Diagnostic Confirmation cannot be a 9 or unknown. This is something that will be caught by TCR at upload, we will be following back to the facility on these cases. Note: The diagnostic code must be changed to the lower (more specific) code if a more definitive 1/27/2020 Texas Cancer Registry | Cancer Information

Diagnostic Confirmation: Hematopoietic & Lymphoid Tumors
Priority Order: Microscopic (1-4) takes priority over clinical only (5-8) Use Code 1 if ONLY tissue was used to diagnose Use Code 3 ONLY when both Tissue PLUS POSITIVE immunophenotyping, genetic testing or JAK2 confirmation (not proceeded by ambiguous terminology) Hematopoietic and Lymphoid Neoplasm Database and Coding Manual The diagnostic confirmation code for hematopoietic and lymphoid neoplasms is found on page 145 of the Handbook Other than microscopic confirmation (1-4) taking priority over clinical diagnosis only (5-8), there is no priority order or hierarchy for coding the Diagnostic Confirmation for hematopoietic or lymphoid neoplasms. Use Code 1 when ONLY the tissue, bone marrow, or blood was used to diagnose the specific histology. Do not use code 1 if the provisional diagnosis was based on tissue, bone marrow, or blood and the immunophenotyping or genetic testing on that same tissue, bone marrow, or blood identified the specific disease (that would be a code 3). • .If a neoplasm is originally confirmed by histology (code 1), and later has immunophenotyping, genetic testing or JAK2 which confirms a more specific neoplasm and there is no evidence of transformation, change the histology code to the more specific neoplasm and change the diagnostic confirmation to 3. 1/27/2020 Texas Cancer Registry | Cancer Information

Diagnostic Confirmation: Hematopoietic & Lymphoid Tumors
Here are the codes for hematopoietic or lymphoid tumors 1/27/2020 Texas Cancer Registry | Cancer Information

Diagnostic Confirmation Alphabet Soup=Code 3
B lymphoblastic leukemia/lymphoma with t(9;220(q34;q11.2); BCR-ABL1 Definitive Diagnostic Methods Genetics Data ABL-1 at 9q34 BCR-ABL fusion protein Fusion of BCR at 22q11.2 p190 kd BCR-ABL1 fusion protein p210 kd fusion protein Immunophenotyping CD10+ CD19+ TdT+ A good tip that was presented at the 2019 Statewide Training is the Alphabet Soup Tip. If you see letters, numbers, plus signs in your diagnosis…think alphabet soup. Consult the Heme Database under the histology for definitive diagnostic methods. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis) AND Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme DB AND the testing Confirms the neoplasm OR Identifies a more specific histology (not proceeded by ambiguous terminology) 1/27/2020 Texas Cancer Registry | Hematopoietic Database

Changing Abstract Information
To correct coding or abstracting errors Better information becomes available Earlier or more specific diagnosis date Better histology or grade More specific primary site Higher priority diagnostic code Note: Contact the TCR health service regional office Do NOT resubmit the abstract. These cases will result in duplicate records and require manual resolution. The TCR does not accept modified abstracts. Here is a list of Circumstances in which you need to change information to an abstract already submitted to TCR. Contact your TCR regional representative who will edit the abstract. Web Plus will not allow you to edit an abstract once you release it. Do NOT resubmit the abstract. These cases will result in duplicate records and require manual resolution. For that reason, TCR does not accept modified abstracts. 1/27/2020 Texas Cancer Registry | Cancer Information

Changing Abstract Information
Example: A patient is diagnosed with lung cancer by CT exam alone. An abstract is submitted with the histology of cancer (8000/3) and diagnostic confirmation code 7(Radiography/Imaging). At a later admit the H&P states that the patient has squamous cell carcinoma of the lung diagnosed by fine needle aspiration. The following information should be updated when you contact your regional representative: Histology should be changed from cancer, nos (8000/3) to squamous cell carcinoma (8070/3) Diagnostic Confirmation should be changed to 2, cytology. Example: A patient is diagnosed with lung cancer by CT exam alone. An abstract is submitted with the histology of cancer (8000/3) and diagnostic confirmation code 7(Radiography/Imaging). At a later admit the H&P states that the patient has squamous cell carcinoma of the lung diagnosed by fine needle aspiration. The following information should be updated when you contact your regional representative: Histology should be changed from cancer, nos (8000/3) to squamous cell carcinoma (8070/3) Diagnostic Confirmation should be changed to 2, cytology. 1/27/2020 Texas Cancer Registry | Cancer Information

Summary 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 You should now be able to discuss coding related to: Date of initial diagnosis Morphology and behavior Primary sites Grade of tumor Laterality Codes for lymph vascular invasion Diagnostic information Changing abstract information 1/27/2020 Texas Cancer Registry | Cancer Information

Thank you 1/27/2020 Texas Cancer Registry | Cancer Information

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Cancer Information Texas Cancer Registry.

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