1. Jessica K. Dohler, BS, CTR

3. Need for Change  Complicated Site Specific Grading No easy conversion to available codes Need for special guidelines  FORDS vs. SEER CoC stopped supporting conversion of special codes in 2012 SEER continued support of conversion Confusion was rampant

4. Combination of Efforts  SEER, CoC & NPCR  Rules standardized across the board  EVERYONE follows the same rules now

5. General Rules to Remember  Always pick up highest grade Foci Bx  Code grade from primary site only  Only code grade prior to systemic or radiation treatment  When both in situ and invasive are present code from invasive only

6. Summary of Grade Coding Instructions  2014 cases  Changes mainly affect coding grade for solid tumors  To code grade for Hematopoietic and Lymphoid Neoplasms continue to reference Hematopoietic Database

7. Solid Tumor Grading System Priority 1. Site Specific or Special Grading Nottingham-Bloom-Richardson, Gleason, Fuhrman 2. General Grading Systems Two, three or four tier system Special rules for breast & prostate 3. Terminology only Terms that are not used in general grading systems

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9. Special Grading Systems  Code grade using same info used to code grade site specific factors Breast – SSF7 Prostate – SSF8 & SSF10 Soft Tissue/Sarcoma – SSF1 Kidney – SSF6  Code the special grade even if a general grade system or term is higher

10. Special Grade – Breast Nottingham-Bloom-Richardson  Score takes precedence Score/DescriptionSSF 7 CodeGrade Code Score of 30301 Score of 40401 Score of 50501 Score of 60602 Score of 70702 Score of 80803 Score of 90903 Low Grade, BR Grade 11101 Medium Grade, BR Grade 21202 High Grade, BR Grade 31303

11. Special Grade – Prostate Gleason  Code the grade based on whichever SSF is higher Gleason ScoreSSF 8 or SSF 10 CodeGrade Code Score of 20021 Score of 30031 Score of 40041 Score of 50051 Score of 60061 Score of 70072 Score of 80083 Score of 90093 Score of 100103

12. Special Grading – Soft Tissue/Sarcoma  Numeric grade takes precedence  Be cognizant of unusual grade conversion DescriptionSSF 1 CodeGrade Code Grade 10102 Grade 20203 Grade 30304 Low Grade, NOS1002 High Grade, NOS2004

13. Special Grade – Kidney Fuhrman  Straight forward coding DescriptionSSF 6 CodeGrade Code Grade 10101 Grade 20202 Grade 30303 Grade 40404

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15. General Grading Systems  If there is no special grade look for general grading system  Special codes for breast & prostate Two Tier General Grading System TermDescriptionGrade CodeBreast/Prostate 1/2Low Grade21 2/2High Grade43

16. General Grading Systems Three Tier General Grading System Four Tier General Grading System TermDescriptionGrade CodeBreast/Prostate 1/3Low Grade21 2/3Intermediate Grade32 3/3High Grade43 TermDescriptionGrade Code 1/4Grade I; Well Differentiated1 2/4Grade 2; Moderately Differentiated2 3/4Grade 3; Poorly Differentiated3 4/4Grade 4; Undifferentiated4

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18. Terminology Only  If there is no special grade or general grading system look for terminology  Entire listing of terms can be found in FORDS and on SEER website  Outliers for breast & prostate DescriptionGradeGrade CodeBreast/Prostate Low GradeI-II21 Partially Well DifferentiatedI-II21 Medium or Intermediate GradeII-III32 High GradeIII-IV43

20. Review  Remember general grade coding guidelines  Order of Priority 1. Special Grade 2. General Grade System 3. Terminology  Code unknown if no description fits

21. NCRA Education Committee 2014. Vida, C and Mitchell, S. Free download. http://www.cancerregistryeducation.org/Files/Org/f3f3d382a7a242549a9999654105a63b/site/2014_Grade_Flow_Chart.pdf