1. Agency/Standard Setter Updates OSCaR Fall Educational Workshop Claudia Cooksie, RHIT,CTR October 9, 2015 Portland, Oregon

2. North American Association of Central Cancer Registries (NAACCR) 2015 Implementation and Guidelines 2015 Implementation Guidelines and Recommendations –Last Revision May 2015 Includes all changes effective with cases diagnosed January 1, 2015 New/Changed Data items Standard Setters Reporting Requirements for 2015 Summary for Software Developers and Vendors Summary for Hospital Cancer Registrars and Reporting Facilities Summary for Central Cancer Registries http://www.naaccr.org/StandardsandRegistryOperations/Implementation Guidelines.aspxhttp://www.naaccr.org/StandardsandRegistryOperations/Implementation Guidelines.aspx

3. CHANGED DATA ITEMS-2015 Sex NAACCR Standards Volume II, Version 15 Sex (Item #220) –Code 4 updated Transsexual, NOS –Code 5 added Transsexual, natal male –Code 6 added Transsexual, natal female

4. CHANGED DATA ITEMS-2015 Country Codes NAACCR Standards Volume II, Version 15 Country codes have been changed for- –Yugoslavia –Czechoslovakia –Brunei –Slovakia –Vanuatu Question-Czechoslovakia was divided into 2 countries in 1993, I saw a code for Slovakia, but not for the Czech Republic. What would that be? Answer- The country code for the Czech Republic is CZE. That is documented in the Appendix X of FORDS 2015 and Appendix B of the SEER Program Coding and Staging Manual 2015

5. New Survival Data Items NAACCR Standards Volume II, Version 15 Data Item Name –Survival-Date Active Follow-up –Survival-Flag Active Follow-up –Survival-Mos Active Follow-up –Survival-DatePresumed Alive –Survival-Flag Presumed Alive –Survival-Mos Presumed Alive –Survival-Date DX Recode

6. Hematopoietic Conversion/Edits Document Published 1/9/2015 Incorporated all changes from: –2010 HEME manual and database (cases dx 2010-2011) –2012 HEME manual and database (cases dx 2012- forward) No significant impact on incidence, histology or multiple primaries –Comparison document on SEER website –http://www.cancer.gov/tools/heme/comparison.htmlhttp://www.cancer.gov/tools/heme/comparison.html

7. HEMATOPOIETIC & LYMPHOID NEOPLASM CODING MANUAL & DATABASE CHANGES Update was released on 1/14/2015 –Diagnostic Confirmation –New section on First Course of Treatment –Appendix F-Non reportable terms (deleted) –Glossary –Obsolete Hematopoietic Histologies –Hematopoietic Conversion/Edits Histology, primary site, and grade

8. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-2016 forward OSCaR officially notified on September 8, 2015 Use with cases diagnosed 1/1/2016 forward Add new reportable items to your ICD-O-3 manuals OSCaR responsible for educating reporting sources about these new updates. Posted on OSCaR website https://public.health.oregon.gov/DiseasesConditions/Chroni cDisease/Cancer/oscar/Pages/reporting.aspx https://public.health.oregon.gov/DiseasesConditions/Chroni cDisease/Cancer/oscar/Pages/reporting.aspx

9. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-2016 forward Non-invasive mucinous cystic neoplasm (MCN) of the pancreas with high grade dysplasia Replaces the term mucinous cystadenocarcinoma, non-invasive (8470/2) and is REPORTABLE

10. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-2016 forward Solid pseudopapillary neoplasm of pancreas (8452/3) is synonymous with solid pseudopapillary carcinoma (C25._) and is REPORTABLE

11. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-2016 forward Based on expert pathologist consultation –Metastases have been reported in some CPEN cases. –With all other pancreatic endocrine tumors now considered MALIGNANT, CPEN will also be considered malignant, until proven otherwise. –Most CPEN cases are non-functioning and are REPORTABLE, using histology code 8150/3, unless the tumor is specified as a neuroendocrine tumor, grade 1 (assign code 8240/3), or neuroendocrine, grade 2 (assign 8249/3)

12. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-2016 forward Laryngeal Intraepithelial neoplasia, grade III (LIN III),8077/2, C320-C329 is REPORTABLE Squamous Intraepithelial neoplasia, grade III (SIN III), 8077/2, (except for cervix and skin) is REPORTABLE

13. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-1/1/2016 Mature Teratoma of the testes is malignant and REPORTABLE (9080/3) –Continues to be non-reportable in prepubescent children (9080/0)

14. NPCR-CDC-REPORTABILITY DECISIONS HISTOLOGY-1/1/2016 ADDITIONAL GUIDANCE IN DETERMINING REPORTABILITY IN MATURE TERATOMA –Adult is defined as post puberty –Pubescence can take place over a number of years –Do not rely solely on age to indicate pre or post puberty status. Review all information (H & P) for documentation of pubertal status –When testicular Teratomas occur in adult males, pubescent status will likely be stated in the EHR –Do not report if unknown whether patient is pre or post pubescence When testicular Teratoma occurs in a male and there is no mention of pubescence, it is likely that the patient is a child, or pre- pubescent and the tumor is benign

15. ICD-O-3 UPDATES-1/1/2015 Reportability and Behavior Change Carcinoid tumor, NOS, of the appendix (C18.1) must be coded to 8240/3 (effective with cases diagnosed 1/1/2015) Now Reportable and must be coded with a behavior/3

16. ICD-O-3 UPDATES Recode Changes -1/1/2015 Histology Code 8157 is OBSOLETE in 2015 and use Code 8152 –Two pancreatic tumors, uncertain behavior and malignant Enteroglucagonomas (8157/1 and 8157/3) must be recorded as : Enterogluagonomas NOS (8152/1) and Malignant glucagonomas (8152/3) Subsequent to the conversion of these pancreatic histology codes, –All cases meeting the criteria described above will use the new code “regardless of diagnosis year” as the old codes become obsolete effective 2015

17. ICD-O-3 UPDATES Issues for 2015 diagnosis year New codes cannot be used for 2015 diagnosis –They are not acceptable histologies for the Collaborative Stage algorithms –Use ICD0-3 Histology code crosswalk to code new terms using the current codes –Appendix A of NAACCR 2015 Implementation Guide explains this, and this is something is worked out with your software vendor

19. ICD-0-3 Online Version (IARC) Online version of ICD0-3 from International Agency for Research on Cancer at http://codes.iarc.fr/http://codes.iarc.fr/ –Useful Tool –For solid tumors-Use ICD-0-3 (2000), aka the “purple book” for solid tumors Do not use ICD-0-3 (2011) For non-solid tumors-Use histology rules from Hematopoietic and Lymphoid Neoplasm Coding Manual and Database –Refer to the NAACCR Guidelines for ICD-0-3 Update implementation for the list of ICD-0-3 changes effective 1/1/2015 –Use the Histology rules in MP/H Manual for solid tumors

20. Prostate Grade Conversion-2014 forward Coding instructions for Grade (NAACCR Item # 440) were modified for cases diagnosed in 2014 and later Grade code should be consistent with the codes for Gleason score as coded in the CS Site Specific Factors 8 and 10 See SEER Coding Grade at http://seer.cancer.gov/tools/grade/ http://seer.cancer.gov/tools/grade/ OSCaR Registrar Toolkit

21. SEER Reportability Clarifications Not Reportable Do not report non invasive mucinous cystic neoplasm (MCN) of the pancreas with low or intermediate grade dysplasia Do not report mature Teratoma of the testis when diagnosed before puberty (benign, 9080/0) –Do not report mature Teratoma when it is not known whether the patient is pre or post pubescent Do not report SIN III of cervix Do not report low grade appendiceal mucinous neoplasm (LAMN), The WHO classification designates LAMN as /1 with uncertain malignant potential

22. NPCR-CDC Collaborative Stage Transition-NPCR Requirements CS v0205 will continue as the primary staging system method for cases diagnosed beginning January 1, 2015 CDC requires collection of CSv2 data items needed to derive SEER Summary Stage –SSF1-Lung, Pleura and Retinoblastoma –SSF2-CorpusAdenosarcoma, CorpusCarcinoma and CorpusSarcoma –SSF3-Prostate

23. NPCR-CDC Collaborative Stage Transition- NPCR Requirements Collection prognostic SSF’s –Breast-SSF’s 1-2, 8-9, 11, SSF 13-16 –Brain/CNS/Intracranial-SSF 1 Required as available, the collection of CSv2 data items needed to derive AJCC, TNM (7 th edition) Schema Discriminator (SSF 25) for applicable sites

24. NPCR-CDC Collaborative Stage Transition-2016 forward CS Basic data items will go away- CS Ext, CS Eval, LN, LN Eval, Met, Met Eval All new cases will be assigned Directly Coded –SEER Summary Stage 2000 –AJCC TNM (clinical and pathologic) CS Transition Group agreed the SSF’s will continue to be collected through at least 2016

25. Multiple Primary/Histology Rules Solid Tumor Database Revised MP/H rules to be -1/1/2017 Solid Tumor Database –Standalone reference tool that may be used independent of the rules/manual or a resource for the rules WHO Pathology books (Blue Book) –Recently released 4 th Edition

26. Remaining Issues Discussed High grade neoplasia (breast) High grade dysplasia (colon) Reportability guidelines for GIST tumors –Sentence added to FORDS 2013 and SEER 2013 Coding manual, which indicate that- GIST tumors and Thymomas are reportable when there is evidence of multiple foci, lymph node involvement or metastasis

27. Resource Websites http://training.seer.cancer.gov/ http://seer.cancer.gov/registrars/ https://www.facs.org/quality-programs/cancer http://www.cdc.gov/cancer/npcr/index.htm http://www.naaccr.org http://www.ncra-use.org/i4a/pages/index.cfm?pageid=1 https://educate.fhcrc.org/LandingPage.aspx http://www.cdc.gov/cancer/npcr/training/ccr.htm

28. Questions Notecards and place in the “Box” OSCaR QA Team Claudia Cooksie claudia.f.cooksie@state.or.usclaudia.f.cooksie@state.or.us Deborah Towell deborah.j.towell@state.or.usdeborah.j.towell@state.or.us Leela Coleman leela.j.coleman@state.or.usleela.j.coleman@state.or.us Linda Shan linda.y.shan@state.or.uslinda.y.shan@state.or.us Molly Sengvongxay molly.d.sengvongxay@state.or.usmolly.d.sengvongxay@state.or.us