1. NPCR/CDC DATA QUALITY EVALUATION AUDIT
Claudia Cooksie, CTR,RHIT
Quality Assurance and Training Coordinator
OSCaR Fall Educational Workshop
October 9, 2015
Good morning I wanted to talk with you all today about the Data Quality Evaluation Audit that was done at OSCaR this past year and the results of that study.

2. NPCR/CDC Develop and enhance statewide cancer registries
Operate registries effectively
Develop model legislation
Establish a computerized reporting and data processing system
Monitor the completeness, timeliness and quality of data
Firstly, Some Background information, under the authority of Public Law the National Cancer Registry Amendments Act, the National Program of Cancer Registries (NPCR) in the division of Cancer Prevention and Control (DCPC) in the Centers for Disease Control and Prevention have helped states funded under NPCR to:
Develop and enhance statewide cancer registries
How to Operate registries effectively
Help is to develop model legislation
Establish a computerized reporting and data processing system
And Monitor the completeness, timeliness and quality of data here at OSCaR

3. Population based cancer registries are an essential part of our cancer surveillance system for planning, operating, funding, and evaluating cancer control programs. Complete and accurate data are necessary to estimate statistical variations in population subgroups and changes among population subgroups over time.
All NPCR funded central cancer registries are “required” to participate in an evaluation of compliance with NPCR standards on data quality every 5 years. CDC contracted with Westat Corporation to perform the evaluation on behalf of the NPCR. Just wanted to note that the evaluators were experienced CTR’s.

4. Data Quality Evaluation Audit Confidentiality and Security
All evaluation functions performed under state Confidentiality Statues
DQE staff signed confidentiality agreements
Only De-identified case files sent
Data used only for evaluation purposes
Data destroyed according to the DQE assurance of destruction
All evaluation functions performed under state Confidentiality Statues
The DQE staff all signed confidentiality agreements
All the files were de-identified and no personal identifiers were sent
Data used only for purpose of the evaluation
Upon completion all evaluation-related activities, data was destroyed according to the DQE assurance of destruction

5. Data Quality Evaluation Audit Purpose
Consistency
Interpretation and abstracting
Identify problems
Data collection and interpretation
Assess quality of data
Text Documentation
Data Consolidation
Completeness of treatment information
Purpose there are many but the basics are
Assessing the consistency in interpretation and abstracting the information appropriately
Identify any issues we are having in data collection and interpretation
And the quality of our data- the end product –in reviewing
text documentation
data consolidation
and completeness of treatment information

6. Data Quality Evaluation Audit Criteria for Selection of Cases
Number of cases: 200 cases
Diagnosis year: Diagnosis year 2012
State of Residence: Oregon residents only
ICD-O-3 Behavior Code: 2 or 3
Primary Sites:
Female Breast (C500-C509)
Colon (C180-C189,C26.0)
Rectosigmoid Junction (C199)
Rectum (C209)
Lung (C340-C349)
Prostate (C619)
Corpus Uteri (C540-C549 and C55.9)
Criteria for the selection of cases to be audited
All analytic cases
200 cases in total
Were diagnosis year 2012
Oregon residents only
ICD-0-3 with behavior code of- either in situ (2) or invasive (3)
Primary sites listed on the slide off :
Female Breast, Colon, Rectosigmoid junction, Rectum, Lung, Prostate and Corpus Uteri

7. Data Quality Evaluation Audit OSCaR Prepared 2 Extract Files
First File- “Master Extract File”
Consolidated Record (OSCaR)
Second File-Extract File
Source level documents (raw data files) from reporting sources
OSCaR prepared two extract files for the audit
the first was a master abstract file which is the “consolidated case” that should have all the information from all the reporting source documents
and the second extract file containing the source level data for the specific sites, so this is all your data you send to us before we review it or make changes at OScaR
So backtracking a little about our process at OSCaR, we receive a patients case from multiple sources, could be the physician office, ambulatory surgery center, hospital setting and a free standing treatment center, and Oscar's job is to consolidate all the information from those multiple sources into one complete abstract with all the treatment data items on it and text and what not.

8. I just wanted to throw up here the timeline
I just wanted to throw up here the timeline. This was the activity schedule. in a nutshell
What is not on there is that we formally notified back in November of 2015, and we sent the extract files in December 2014,
So they did their evaluation around March 15th,
DQE Findings were delivered to OSCaR on April 13th, 2015
Then OScaR had 2 weeks to review all the recodes and get it back to the evaluators (very tight timeline) April 27, 2015
They did their report writing on May 2, 2015
And final report was delivered approximately 6/23/2015
Final report went to CDC at the end of June
And we did attend via conference call a debriefing to discuss the conclusions

9. Data Quality Evaluation Audit Visual Editing Evaluation Process
Visual Editing evaluation sample
Included 413 cases abstract-level cases
All data elements and corresponding text were reviewed for each abstract-level case
Any abstract-level codes not substantiated by text were recoded by the evaluators
The recoded fields were used for the re-consolidation process
So their visual editing evaluation process consisted of reviewing 413 cases, so even though it started out to be 200 cases remember that all of the cases had multiple reporting sources so increased the numbers.
All the data elements and corresponding text were reviewed for each abstract level case (these are the cases on your end)
Any abstract-level codes not substantiated by text were recoded by the evaluators
And the recoded fields were used for the re-consolidation

10. Data Quality Evaluation Audit Reconsolidation Process
Each abstract-level data element was compared to the corresponding data elements
In the OSCaR “consolidated record”
Reconsolidation was conducted
Customized CRS Plus Utility
Data were imported into
MS Access and discrepant data elements were displayed
Data were provided to OSCaR
Addressed during the reconciliation process
So after the visual review evaluation process was finished,
Each abstract-level data (your date) element was compared to the corresponding data elements in the OSCaR “consolidated record”
Reconsolidation was conducted using the customized CRS Plus Utility (this is a CDC product)
Data were imported into MS Access and discrepant data elements were displayed
Data were provided to OSCaR to be addressed during the reconciliation process

11. Data Quality Evaluation Audit Reconciliation Process
Database with reconsolidated cases with the visual editing changes were provided to OSCaR
OSCaR reviewed cases and provided explanations when they disagreed with the evaluators recode
Evaluators reviewed responses and reversed any recoded data elements resolved by OSCaR
Database with reconsolidated cases with the visual editing changes were provided to OSCaR
OSCaR reviewed cases and provided explanations when they disagreed with the evaluators recode
DQE evaluator reviewed responses and reversed any recoded data elements resolved by OSCaR
I know some states have written this up in their registry and used as a peer review for their CoC records.

12. Number of Data Elements and Cases Reviewed by Site
Number of Data Elements Reviewed
Number of Cases Reviewed
Percentage of Cases Reviewed
Breast 31 40
20%
Colon 39
Corpus Uteri 20
10%
Lung
Prostate 30
15%
Rectosigmoid Junction 10 5%
Rectum
Total
215
199
100%
Site
Number of Data Elements Reviewed
Number of Cases Reviewed
Colon
336 14
Rectum
432 18
Lung
800 32
Female Breast
2,673 81
Corpus Uteri
400 16
Prostate
975 39
Total
5,616
200
This table shows the total number of data elements and the total number and percentage of cases evaluated for each cancer site.
The percentage pretty much mirror s our annual caseload for each of the sites listed.

13. Central Cancer Registry NPCR Treatment Data Edits
Purpose
Evaluate reported prognostic and treatment items for cancer cases with specific tumor characteristics
If the reported treatment does not appear to be consistent with widely recognized standards of care or cases fail to contain known prognostic characteristics, a warning is generated
Just want to briefly note that we recently began running the central cancer registry data edits metafile, and the primary purpose
is to evaluate reported prognostic and treatment items for cancer cases with specific tumor characteristics.
If the reported treatment does not appear to be consistent with widely recognized standards of care or cases fail to contain known prognostic characteristics, a warning is generated.

14. NPCR Treatment Data Checks Examples
Radiation with Breast-Conserving Surgery
Checks that radiation is given within one year (365 days) of diagnosis and fully recorded for non-metastatic breast cancer treated with breast-conserving surgery
Surgical Treated Non-metastatic Colon Cancer
First-checks that at least 12 lymph nodes are examined in surgically resected colon cases. Then, for node-positive patients, checks whether chemotherapy is given within 4 months (120 days) of diagnosis and fully recorded
Radiation with Rectal Cancer Surgery
Reviews whether radiation is given within 6 months (180 days) of diagnosis and fully recorded for selected non-metastatic rectal cancer surgical patients
Radiation with Breast-Conserving Surgery
Checks that radiation is given within one year (365 days) of diagnosis and fully recorded for non-metastatic breast cancer treated with breast-conserving surgery
Surgical Treated Non-metastatic Colon Cancer
First-checks that at least 12 lymph nodes are examined in surgically resected colon cases. Then, for node-positive patients, checks whether chemotherapy is given within 4 months (120 days) of diagnosis and fully recorded
Radiation with Rectal Cancer Surgery
Reviews whether radiation is given within 6 months (180 days) of diagnosis and fully recorded for selected non-metastatic rectal cancer surgical patients
It clues in to make sure all the treatment information is appropriate and sometimes OScaR to make some phone calls to get missing treatment
This is where text is really important, and will save us from calling you for details.

15. Data Quality Evaluation Audit Data Items
Text vs Coded Values
21 Basic items in the abstract
30 Treatment data elements
Completeness of treatment
NPCR “Treatment Data Checks”
Breast
Colon
Rectum
A Summary of the data items reviewed
21 Basic items in the abstract
30 Treatment data elements
The completeness of treatment for Breast, Colon and Rectum cases were also evaluated through utilization of the NPCR “Treatment Data Checks.

16. Data Quality Evaluation Audit Data Elements-Basic
Primary site
Subsite
Laterality
Histology/Behavior
Grade
Date of Diagnosis
Sequence Number-Central
So some the basic data elements they reviewed were- Primary site and subsite, laterality, histology and behavior, Grade, Date of Diagnosis and Sequence Number

17. Data Quality Evaluation Audit Data Elements-Collaborative Stage
CS Tumor Size
CS Extension
CS Tumor Size Ext/Eval
Regional Nodes Positive
Regional Nodes Examined
CS Lymph Nodes
CS Metastasis at Diagnosis
Derived SS2000
The basic collaborative stage elements of CS Tumor Size, CS Extension and CS Evaluation Code
Regional lymph nodes positive and Regional lymph nodes examined
CS Lymph Nodes
And CS mets at dx and the
Derived SEER Summary Stage 2000

18. Data Quality Evaluation Audit Data Elements-SSF’s
CS SSF (Breast) Estrogen Receptor (ER) Assay
CS SSF Progesterone Receptor (PR) Assay
CS SSF Number of + ipsilateral Level I-II axillary LN
CS SSF HER2: IHC Lab Value
CS SSF HER2: IHC Test Interpretation
CS SSF 10- HER2: FISH Lab Value
CS SSF 11- HER2: FISH Test Interpretation
CS SSF 12- HER2: CISH Lab Value
CS SSF 13- HER2: CISH Test Interpretation
CS SSF 14- HER2: Result of Other or unknown test
CS SSF (Corpus Uteri) Peritoneal Cytology
CS SSF (Prostate) Pathologic Extension
CS SSF (Lung)-Separate tumor nodules-Ipsilateral lung
The Site Specific Factors were reviewed, most were breast Site Specific Factors, ssf’s 1-3 and 8-14 which are the Her2 values
For corpus uteri is was the peritoneal cytology
And prostate the pathologic extension
For Lung-SSS1- Separate tumor nodules-ipsilateral lung

19. Data Quality Evaluation Audit Data Elements-Treatment data
Date of 1st course RX-CoC
Date of Surgery Primary Site
RX Summary Surgery Primary Site
RX Summary Scope Regional Lymph Node Surgery
Summary Surgery other Regional/Distant
RX Date Radiation
Radiation Regional RX Modality
RX Summ Radiation and Surgery Sequence
RX Date Chemotherapy
RX Date Hormone
RX Date Biological Response Modifier
RX Date Summary Transplant/Endocrine
RX Date Other
RX Summary Other
These are the data items for treatment data, which are pretty much basic. Dates and modalities of treatment, as I mentioned before, these were run through treatment data edit checks.

20. Graphical Results for
Data Accuracy

21. Frequency of Errors by Primary Site
This pie chart illustrates the number of tumors with major errors by primary site. As shown, lung cases yielded the most tumors with errors, followed by rectum and uterine cases.
Total = 74 Major Errors

22. Frequency of Major Errors across All Sites
CHECK the original speaker notes---is it grade or Scope of Reg ln surg…..The chart presents the frequency of types of errors that were made across all sites.
As shown, tumor grade yielded the most errors overall, followed by the data elements for the removal, biopsy or aspiration of regional lymph node(s) at the time of surgery of the primary site and for Site Specific Factor 1 (in Lung cases).
The section “Other” at the bottom of the list contains 13 different data elements that each provided two or fewer major errors. A full report of the errors of these data elements can be found in of the OSCaR final report. Table 3 As I noted, the final report is up here if anyone wants to review it in detail.
The next three slides are charts illustrate the percentage of major error-free cases by primary site for the data elements depicted here, except the data elements grouped in the “other” section. Major errors in Site Specific Factor 1 only impact lung cases; therefore, this data element will only be displayed in the chart that includes major error in lung cases.

23. Percent of Error-Free Cases by Data Element by Primary Site
This chart shows the percentage of error-free female breast cases by data element. Again this is BREAST only
For female breast cases:
Recording the date of hormonal therapy given as part of first course of treatment created the most major errors; we know this data element is sometime tough to capture as it is done in the outpatient arena
however, 92.5% of breast cases were free of major errors in recording the date of hormonal therapy given as part of first course of treatment.
Following, grading reportable tumors, the removal, biopsy or aspiration of regional lymph node(s) at the time of surgery of the primary site, recording the date of surgery as part of first course of treatment, I will go over that in a minute. and recording the date of radiation therapy given as part of first course of treatment all yielded major errors; nonetheless, 97.5% of breast cases were free of major errors in regards to these data elements.

24. Percent of Error-Free Cases by Data Element by Primary Site
This next chart illustrates the percentages of error-free cases by data element for Colon, Rectosigmoid Junction, and Rectum cases.
For Colon cases, depicted by the light blue column in each of the data element categories:
Grading reportable tumors yielded the most major errors; however, 92.3% of colon cases were free of major errors in grading reportable tumors.
Following, the removal, biopsy or aspiration of regional lymph node(s) at the time of surgery of the primary site, recording the date of chemotherapy as part of first course of treatment, and coding the sequencing of radiation and surgery given as part of the first course of treatment all created major errors; nonetheless, 97.4% of colon cases were free of major errors regarding these data elements.
For Rectosigmoid junction cases in the dark blue column:
No major errors were found in the displayed data elements. Only coding primary site yielded major errors in rectosigmoid junction cases, that is where we need to be using our measurement charts and Deb alluded to that earlier, but 90% of these cases were free of major errors in coding primary site.
For Rectum cases:
Derived SS2000 yielded the most major errors; yet, 85% of rectum cases were free of major errors in Derived SS2000. Following, the removal, biopsy or aspiration of regional lymph node(s) at the time of surgery of the primary site, recording the date of first course of treatment, and reporting the extension of the primary tumor all created major errors; however, 90% of rectum cases were free of major errors in regards to these data elements.

25. Percent of Error-Free Cases by Data Element by Primary Site
The final chart illustrates the percentages of error-free cases by data element for Lung, Prostate, and Uterine cases.
For Lung cases, depicted by the light blue column in each of the data element category:
Site Specific Factor 1 created the most major errors; however, 85% of lung cases were free of major errors in Site Specific Factor 1.
Following, recording the date of first course of treatment and recording the date of surgery given as part of first course of treatment yielded major errors; nonetheless, 90% of lung cases were free of major errors in these data elements.
For Prostate cases:
Derived SS2000 yielded major errors; however, 96.7% of prostate cases were free of major errors regarding Derived SS2000. That is really commendable to the registrars
For Uterine cases:
Grading reportable tumors yielded the most major errors; however, 90% of uterine cases were free of major errors in grading reportable tumors.
Following, the removal, biopsy or aspiration of regional lymph node(s) at the time of surgery of the primary site, recording the date of first course of treatment, recording the date of surgery as part of first course of treatment, and recording the date of chemotherapy as part of first course of treatment all created major errors; nonetheless, 95% of uterine cases were free of major errors regarding these date elements.

26. Accuracy Rate Consolidated Data Elements
Data Accuracy (%)=
100 subtract
(100* Number of Data Elements with Discrepancies Divided by Total Number of Data Elements)
Accuracy Rate for OSCaR = 98.8%
100 - (74/6139) * 100= 98.8%
So for the good news
Computation is on the slide, For a total of 6,139 possible data elements that could have had errors, 74 data elements were found to have errors. Which is 1.2%
The resultant aggregate data accuracy rate of OSCaR merged data was 98.8 percent
So we were pleased with the results .This couldn’t have happened without you all sending us your quality data.
We cannot feasibly review all cases that are submitted, so the quality of the information really comes forward when a random study like this is performed. And we are very fortunate to have a lot of hardworking, diligent registrars sending us data. We sure appreciate that!
So I would like to commend all of you that send data to us, this commendation includes you all too.

27. Abstracting Practices Text vs Code
Text documentation is required for all coded data elements
This is the process by which the central registry must validate each abstract submitted.
Example- 65 yr old white female-
justifies age, sex and race in only a few words!
With all that good news, we did have some recommendations on areas where we need to focus our training and education needs. That was evident on the graphics.
So I am going to run through those , briefly
Text vs Code is a big thing, Remember text in your abstracts is required for all coded data elements!!! This is a CDC requirement
This is the only way at OSCaR to validate your codes is with accompanying text.
I put up an example of how an abstractor can justify age, sex and race in only a few words , 65 year old white female and you can shorten it up from that, just make sure the reviewer at the other end can decipher it!

28. Abstracting Practices Text vs Code-Grade
Missed coding specific grade
Text specifically stated the grade
Review coding guidelines for grading
“low” or “high” grade tumors
If a lesion is both invasive and in-situ
Code grade for only the invasive portion
Do not record FIGO grade as histologic grade
FIGO is a three-tier system and does not convert into a four-tier grading system
Code grade from the Primary site only
Not from a lymph node or metastatic site
In their recommendations, I just want to point out a few that are significant in our everyday abstracting cases
A review of the final errors demonstrated that lack of supporting documentation or misinterpretation of available text impacted data quality in the following manner:
Missed coding specific grade when text specifically stated the grade
Review coding guidelines for “low” or “high” grade tumors
If a lesion is both invasive and in-situ, code grade for only the invasive portion this is in FORDS
Do not record FIGO grade as histologic grade, FIGO is a three-tier system and not convert into a four-tier grading system
Code grade from the primary site only, not from a lymph node or metastatic site.

29. Abstracting Practices Date of First Course of Treatment
FORDS Manual indicates “For invasive cancers of the uterus, dilation and curettage is coded as an incisional biopsy (02) under the data item Surgical Diagnostic and Staging Procedure”
This is not considered surgical treatment and should not be coded as first course of treatment
Original dates were found to be blank when the text indicated patients either received chemotherapy, had lymph node biopsies, or the decision not to treat was documented
The FORDS Manual states “If a physician decides not to treat a patient, the date of first course of treatment is the date this decision was made”
Date of First Course of Treatment this impacts date of first course of treatment coding surgery fields instead of a biopsy fields
For the corpus uteri FORDS Manual indicates “For invasive cancers of the uterus, dilation and curettage is coded as an incisional biopsy (02) under the data item Surgical Diagnostic and Staging Procedure”.
Remember this procedure is not considered surgical treatment and should not be coded as first course of treatment
Original dates were found to be blank when the text indicated patients either received chemotherapy, had lymph node biopsies, or the decision not to treat was documented. The FORDS Manual states “If a physician decides not to treat a patient, the date of first course of treatment is the date this decision was made”

30. Abstracting Practices- Primary Site-Breast Date of First Surgical Procedure
Review the FORDS rules for recording the “Date of First Surgical Procedure of Primary site”
Surgery of Primary Site
Scope of Regional Lymph Node Surgery
Surgical Procedure/Other Site
If any of these procedures are performed, the Date of Surgery should be the EARLIEST date of any of these procedures occurred
Example: In Breast, if an axillary lymph node biopsy is performed prior to definitive surgery (after the initial biopsy), the date of the axillary lymph node biopsy becomes the date of the first surgical procedure and recorded in the “Scope of lymph node surgery” field and the date of first course treatment field.
Review the rules for recording the date of first surgical procedure of the primary site. The FORDS Manual on page 20:
The following items apply to date of first surgical procedure of primary site, even though it says primary site, it is not always primary sites, Surgical procedures can be
Surgery of Primary Site
Scope of Regional Lymph Node Surgery
Surgical Procedure/Other Site
If any of these procedures are performed, the Date of Surgery should be the EARLIEST date of any of these procedures occurred
Example: In Breast, if an axillary lymph node biopsy is performed prior to definitive surgery (after the biopsy) , the date of the axillary ln biopsy becomes the date of the first surgical procedure In the FORDS manual it says this is rare…. I have seen it on cases in the hospital setting though.

31. Abstracting Practices Regional Nodes Pos/Examined
Regional Lymph Nodes Positive and Regional Lymph Nodes examined were switched between the two data items
00/98 when should be 98/00
Run/Pass Edits
Just a reminder we had errors in regional ln pos and regional ln examined, some software have them data items switched around, so be aware how your software flows.
And remember to always Run and pass edits.

32. Abstracting Practices Regional Nodes Pos/Examined
Question- If AJCC lists a lymph node as Regional and Summary Stage lists the lymph node as Distant, how do we code Regional Lymph Nodes Positive and Regional lymph nodes examined?
This question was answered on September 3, 2015 NAACCR Webinar on “Coding Pitfalls”
FORDS Manual in “Scope of Regional LN Surgery” section- “Refer to the current AJCC Cancer Staging Manual for site-specific identification of regional lymph nodes”
Answer- When there is a difference between the two standard setters on regional lymph nodes, defer to AJCC
I wanted to throw this in here, I attended a NAACCR webinar in the first part of September where this question was asked on a test regarding regional ln pos/regional ln examined.
I wanted to bring this up, because this really is not new information , but it really kind of buried in the “Scope of LN surgery” section of FORDS.
So the question, if AJCC lists a lymph node as regional ln, and summary stage lists the lymph node as distant, how do we now what to code in the reg ln examined and ln pos, and also impacts stage and scope of regional ln surgery.
all the standard setters agree, when there is a difference go with what AJCC says. It is also in the FORDS Manual like I noted, in the Scope of Regional LN section,
I believe this will be rectified in the new Seer Summary stage 2016 manual that will be coming out soon and will be in alignment with AJCC, so this is another transitional thing that should rectify itself with the upcoming new manuals.

33. Abstracting Practices- Primary Site-Breast Scope of LN surgery-Example
A patient with a breast primary has a fine needle aspiration (FNA) of an axillary lymph node. The FNA would be coded as:
A) Diagnostic Staging Procedure
B) Surgical Procedure Primary Site
C) Scope of Regional Lymph node surgery
D) Surgical Procedure/Other Site
Patient with a breast primary undergoes an excisional biopsy of a cervical lymph node, the excisional biopsy would be coded as:
So a few examples , on the scope of lymph node surgery using breast as the example.
So the first one is A patient with a breast primary has a fine needle aspiration (FNA) of an axillary lymph node. The FNA would be coded as:
A) Diagnostic Staging Procedure
B) Surgical Procedure Primary Site
C) Scope of Regional Lymph node surgery code , code 1-Bx or aspiration of a reg ln ( we need to make sure it is not a sent ln)
D) Surgical Procedure/Other Site
So the second one has a little different scenario, the Patient with a breast primary has an excisional biopsy of a cervical lymph node, the excisional biopsy would be coded as:
What- so in this case it would be coded as surgical procedure other site, because the cervical ln is a”distant” lymph node , not regional.
C) Scope of Regional Lymph node surgery
These types of scenarios can trip us up pretty easily so have to be real careful

34. Abstracting Practices- Primary Site-Breast Site Specific Factors
Site Specific Factors 8-9 and 10-14
Her2 values and Interpretation
IHC
FISH
CISH
Errors in the Site Specific Factors for breast are in the Her2 values and Interpretation fields. So this is not surprising
Immunohistochemical, Fluorescence In Situ Hybridization and the Chromogenic In Situ Hybridization
I can only hope when the new predictive and prognostic indicators/tests come out in 2017 they will be put in a format that is easier for abstractors to read and put the right information in the right fields. Right now, it is sort of like a train wreck trying to enter the different tests correctly, and it is a shame, that is very needed information
So I am hoping they put some thought into how they are displayed for us as registrars in a more easily understandable way,

35. Abstracting Practices-Primary Site-Breast Collaborative Stage Tumor Size/Ext Eval
Clinical CS Tumor size
Preoperative adjuvant treatment
Incorrect CS Ext/Eval codes
CS LN codes
Use more specific codes
There were a few errors on the coding of clinical tumor size in CS TS on patients that had preoperative treatments and incorrect Eval codes
And more specific coding needed in the LN mets, instead of using the NOS codes. (e.g. micromets, or size of mm for LN mets)

36. Abstracting Practices-Primary Site-Breast Surgery Primary Site Coding
Coded as “50” (Modified Radical Mastectomy)
Use more inclusive code of:
Without removal of uninvolved contralateral breast (51-56)
With removal of uninvolved contralateral breast (52-63)
Surgery Primary Codes not specific – example in the audit was a patient that had a bilateral mastectomy and coded to a MRM and did not indicate whether there was “removal of uninvolved contralateral breast” code, or no removal of an uninvolved contralateral site,. And then you can use the appropriate reconstruction codes too
I know that seems pretty insignificant but on a large scale that will impact our quality of data.

37. Abstracting Practices-Primary Site-Breast Grade
Record the highest grade of tumor regardless of specimen size
Grade used in resection was lower than the grade in the biopsy
Use the highest grade regardless of specimen size
if the lesion is both invasive and in situ code
Grade only from the invasive component (FORDS)
As II mentioned earlier there were grade issues and some involved the primary site breast. So just a few things here.
Remember to use the highest grade, regardless of specimen size. So it could be in the biopsy or the lumpec specimen
Also, There were cases that were both invasive and in situ the highest grade came from the DCIS, so remember it is only the invasive component

38. Abstracting Practices-Primary Site-Colon Miscellaneous
Code CS Tumor Size from Primary site not from a metastatic site
Partial resection liver due to metastases is considered “Surgery Procedure/Other Site”
FORDS describes as “surgical removal of distant lymph node(s) or other tissue(s) or organ(s) beyond the primary site”
If chemotherapy is recommended, but unknown if administered or the treatment was delayed with no further information, use code “88”
For colon-
Code the Collaborative Stage tumor size …from the primary site not from the metastatic site
Partial resec of the liver due to mets is per fords and seer it states-surgical procedure of other site describes the surg removal of distant ln or other tissues or organs beyond the primary site. “surgery of other regional or distant sites.
If chemotherapy is recommended but unk if administered or the treatment was delayed with no further information use code 88.
I kind of went round and round with the evaluation results because sometimes you may have a case that one oncologist says not recommended and another oncologist might recommend it, if the patient doesn’t decide on tx , which category should it go into, not recommended, or contraindicated. So there are varying thoughts on this, so you have the source in your hands, just text what you code.

39. Abstracting Practices-Primary Site-Colon Surgery/Radiation Sequence
If the patient undergoes an exploratory laparotomy and the decision that no additional surgery would be recommended, impacts Surgery/Radiation sequence
The exploratory lap is not considered surgery of the primary site. If no surgery was performed, then sequence of surgery/radiation would equal zero.
From an actual case they reviewed, “given the findings of the explor laparotomy and the decision that no additional surgery would be recommended, surgery primary site was not done,… because of that, this impacts the surgery/radiation sequence.
Explor lap is not considered surg of the primary site, if no surgery was performed than the sequence of surg/radiation would be 0

40. Abstracting Practices-Primary Site-Colon Miscellaneous edits
CS Extension
Subserosal fat invasion confused with pericolic fat invasion
Changes Stage (Localized vs Regional Dir Ext)
Surgery Primary Site
Coding a partial colectomy (30) when it should be hemicolectomy (40)
Surgery Primary Site and Date First Course Treatment
If polypectomy is done with negative margins and then followed by a part Colectomy, date of first course should be polypectomy
Missed coding specific grade
Text indicated Moderately or Poorly Differentiated
Some errors across the board, in Colon CS Extension, where subserosal fat invasion is confused with pericolic fat invasion, this was considered a major error in the study as this will impact the stage of the patient. Subserosal fat is localized for seer and pericolic fat invasion is Regional direct extension, this is really important to look at the choices in your manuals
Surgery Primary Site-
There was some Coding a partial colectomy (30) when it should be hemicolectomy (40)
Surgery Primary Site and Date First Course-
If polypectomy is done with negative margins on the pathology, and then followed by a part colectomy, date of first course should be polypectomy (because that is a surgical procedure in the surgery primary site codes in FORDS)
Missed coding specific grade
when text indicated moderately or poorly differentiate

41. Abstracting Practices-RectoSigmoid Junction Primary site Code
An illustrated reference for mapping the colon, Rectosigmoid and Rectum by centimeters may be helpful to insure accurate coding
When the pathology report describes the mass as 6cm from the anus or if the mass is located 6-8cm from the dentate line. The rectum occupies the space between 4-16 cm from the anus.
One thing all of us need is an illustrated reference for mapping the correct site for colon, rectosigmoid and rectum by centimeters . When the pathology report describes the mass as 6cm from the anus or if the mass is located 6-8cm from the dentate line. The rectum occupies the space between 4-16 cm from the anus.
If you look in debs packet for after the break she has put a wonderful copy of the locations on a laminated sheet in the packet.

42. I received this summary of the DQE audits overall- there were 10 registries reviewed in the nation at the same time were one of the ten, , the overall the data accuracy rate was 97.0%, so we all here in Oregon can feel like we are at the top of our game with a data accuracy rate of 98.8% we can really be proud of ourselves and all our hospital registrars.

43. Training Resources
These are a list of training resources that we’ve found to be very useful during case ascertainment, abstracting, and coding. This list is not inclusive, so you may have others that you and your staff refer to, routinely.

44. OSCaR and Registrars
It really is putting the puzzle pieces together! It takes all of us working together to create success!!!!
Thank you and if I have several copies of the report on the table if you are interested in pursing it, or I can send a copy via .

45. Questions? Claudia.f.cooksie@state.or.us
This is my helper at my home office…..and my is at the bottom, please feel free to me with questions and also you have the notecards in the folders to write down your question. I will be compiling all the questions, and getting the answers out to you soon. Thank you for your attention and I know it isn't the most stimulating information in the world. Before we break ..real fast

46. Now I would like to take a moment before our lunch break, and introduce Linda shan and Molly Sengvongxay and they will be presenting briefly a Registrar Toolkit packet for our working lunch, which will be really helpful reference material. Welcome Molly and Linda. Thank you