Co ding Pitfa lls 9/ 3/ 15 Coding Pitfalls 2014-2015 NAACCR We b - - PDF document

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 1

Coding Pitfalls

2014-2015 NAACCR We b ina r Se rie s Se pte mb e r 3, 2015

Q&A

• Ple a se sub mit a ll q ue stio ns c o nc e rning we b ina r

c o nte nt thro ug h the Q&A pa ne l. Re minde r:

• I

f yo u ha ve pa rtic ipa nts wa tc hing this we b ina r a t yo ur site , ple a se c o lle c t the ir na me s a nd e ma ils.

• We will b e distrib uting a Q&A do c ume nt in a b o ut o ne we e k.

T his do c ume nt will fully a nswe r q ue stio ns a ske d during the we b ina r a nd will c o nta in a ny c o rre c tio ns tha t we ma y disc o ve r a fte r the we b ina r.

2

F ABUL OUS PRIZE S

3

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 2

GUE ST SPE AKE R

• Ang e la Ma rtin, BS, CT

R

• Misso uri Ca nc e r Re g istry

4

AGE NDA

• Upda te s
• Sta g ing
• E

pi Mo me nt

• Quiz 1
• Que stio ns fro m this ye a r’ s we b ina rs
• Othe r
• Quiz 2

5

UPDAT E S

• 2017 Upda te s
• MP/ H
• Summa ry Sta g e
• AJCC
• CS Site Spe c ific F

a c to rs

• F

ORDS

• De a th Cle a ra nc e Ma nua l

6

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 3

SUMMARY ST AGE

T NM a nd Summa ry Sta g e

7

SUMMARY ST AGE

• Do no t use SS2000 re fe re nc e s to T

NM, F I GO o r

• the r sta g ing syste ms
• Summa ry Sta g e ha s no t b e e n upda te d sinc e 2001
• F

IGO a nd T NM ha ve b e e n upda te d sinc e 2001

8

INT RAMUCOSAL

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Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 4

CNS AND L YMPHOMA

• 1 L
• c a l
• 5 Re g io na l
• 7 Dista nt
• 8 Be nig n (CNS)
• 9 Unkno wn
• Co de s 0, 2, 3, 4 a re no t a pplic a b le

10

L UNG- SUPRACL AVICUL AR L YMPH NODE S

• Summa ry Sta g e
• Dista nt Me ta sta sis
• T

NM Sta g e

• I

nc lude d in the N c a te g o ry

11

RE G NODE S POPS/ E XAMINE D

• Q: I

f AJCC lists a lymph no de a s re g io na l a nd Summa ry lists the lymph no de a s dista nt, ho w do we c o de Re g io na l L ymph No de s Po sitive a nd Re g io na l L ymph No de s E xa mine d?

• A: All o f the sta nda rd se tte rs a g re e …g o with

AJCC.

12

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 5

L YMPH NODE INVOL VE ME NT

• Any me ntio n o f

lymph no de s is indic a tive o f invo lve me nt

SOL ID T UMORS

• F

ixe d ma tte d ma ss in the me dia stinum, re tro pe rito ne um a nd/ o r me se nte ry (no spe c ific info a s to tissue invo lve d – c o nside r invo lve me nt

13

L YMPHOMA L UNG

• E

nla rg e d a nd lympha de no pa thy indic a te re g io na l invo lve me nt fo r lung ONL Y

INVOL VE ME NT T E RMS

INVOL VE ME NT

• Adhe re nt
• Appe a rs to
• Co mpa ra b le with
• Co mpa tib le with
• ….

NON-INVOL VE ME NT

• Ab uts
• Appro a c hing
• Appro xima te
• Atta c he d
• ….

14

Se e pa g e 15 o f the Summa ry Sta g e Ma nua l

AJCC ST AGING

15

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 6

PRIOR T O ASSIGNING ST AGE …

• Re g istra rs must ha ve a c c e ss to the ir sta g ing

ma nua ls

• Are HI

GHL Y e nc o ura g e d to vie w the AJCC Curric ulum fo r Ca nc e r Re g istra rs

• https:/ / c a nc e rsta g ing .o rg / CSE

/ Re g istra r/ Pa g e s/ AJC C-Curric ulum.a spx

• Unde rsta nd ho w to use the CAnswe r fo rum
• http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum

16

QUE ST ION- T E RMINOL OGY

• Ca n the te rm “a de no pa thy” b e c o nside re d a s

po sitive lymph no de invo lve me nt whe n a ssig ning c N? Are the re a ny prima ry site e xc e ptio ns?

17

ANSWE R

• AJCC do e s no t ha ve a mb ig uo us te rmino lo g y

lists, a nd do e s no t ma nda te ho w wo rds sho uld b e inte rpre te d.

18

http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum/ a jc c -tnm-sta g ing / g e ne ra l-rule s- c ha pte rs-1-2/ 8603-a d e no p a thy? 9257-Ade no p a thy_%C2%AC=

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 7

QUE ST ION

• A physic ia n a ssig ne d a pT

in a situa tio n whe re the pa tie nt c le a rly did no t me e t the rule s fo r c la ssific a tio n fo r a pT ….ho w sho uld I e nte r tha t into the re g istry da ta b a se ?

19

ANSWE R

• T

he ho spita l re g istra r will b e re spo nsib le fo r re c o rding the physic ia n-a ssig ne d sta g e in the re g istry da ta b a se .

• If the sta g e a ssig ne d b y the physic ia n is no t

a c c ura te , the re g istra r sho uld a ssig n the sta g e a nd re c o rd the re g istra r-a ssig ne d sta g e in the re g istry da ta b a se

• If no physic ia n-a ssig ne d sta g e c a n b e fo und in the

me dic a l re c o rd, the re g istra r sho uld a ssig n the sta g e a nd re c o rd it in the re g istry da ta b a se .

20

Collaborative Stage Transition Newsletter August 21, 2015

E NT E RING DAT A

• Sta g e is a ssig ne d
• T

he a ssig ne d sta g e is e nte re d in da ta ite ms

• Clinic a l sta g e da ta sho uld o nly b e e nte re d into

c linic a l da ta fie lds

• Pa tho lo g ic sta g e da ta into pa tho lo g ic da ta fie lds

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Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 1 I Path 1 I c M0

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 8

QUE ST ION

• Wha t a re the va lid M va lue s tha t sho uld b e

c o nside re d whe n a ssig ning a c linic a l sta g e g ro up?

• A. c M0

B.

c M1

• C. pM1
• D. A a nd B

E .

All o f the a b o ve

22

CASE SCE NARIO

• A pa tie nt is fo und to ha ve a live r le sio n via

ima g ing tha t is suspic io us fo r ma lig na nc y. A CT g uide d b io psy is do ne a nd he is fo und to ha ve me ta sta tic c a nc e r mo st like ly fro m a c o lo n prima ry. Pa tie nt re fuse d a ny furthe r wo rk-up o r tre a tme nt. Ho w wo uld this b e sta g e d?

23

Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin IV Path 1 IV pM1

QUE ST ION

• I

ma g ing do ne prio r to surg e ry sho we d dista nt me ta sta sis.

• T

he pa tie nt we nt o n to ha ve surg e ry a nd a t tha t time the dista nt me ta sta sis wa s c o nfirme d mic ro sc o pic a lly.

• Wha t is c M a nd pM?

24

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 9

ANSWE R

• I

t is a b o ut the time fra me in whic h the info rma tio n wa s kno wn.

• Prio r to tre a tme nt we o nly ha d c linic a l e vide nc e o f

dista nt me ta sta sis.

25

Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 1 IV Path 1 IV

http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum/ a jc c -tnm-sta g ing / a jc c - c urric ulum-fo r-re g istra rs/ mo d ule -iii/ 58339-c m-a nd-p m

BL ANKS vs X’S F OR T AND N DAT A IT E MS

• Ha s the c rite ria fo r sta g e c la ssific a tio n b e e n

me t?

• No -Bla nk
• Ye s-X o r va lid kno wn va lue (1,2, 3, 4, e tc )
• Wha t if it is “unkno wn” if sta g e c la ssific a tio n

rule s ha ve b e e n me t?

• Unkno wn to physic ia n-X
• One o f the tre a ting physic ia ns kno ws the sta g e , b ut

a no the r do e s no t-b la nk

• Unkno wn to re g istra r due to po o r do c ume nta tio n-

Bla nk

BL ANKS vs X’S F OR T AND N DAT A IT E MS

• Crite ria fo r Rule s fo r Cla ssific a tio n
• E

ve ry c ha pte r in the ma nua l ha s rule s fo r c linic a l a nd rule s fo r pa tho lo g ic sta g e

• Must a t le a st me e t the c rite ria fo r the T

va lue to use a n X

27

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 10

BL ANKS vs X’S F OR T AND N DAT A IT E MS

• Co lo no sc o py with a b io psy. No furthe r c linic a l

info rma tio n.

• Me t the c rite ria fo r c T

. c o de c T X c NX

• Cyste c to my fo r b la dde r c a nc e r wa s do ne ,

pa th sho we d a T 2a tumo r. No lymph no de s we re re mo ve d.

• Me t the rule s fo r pT

. pT 2a pNx

28

QUE ST ION F ROM CE NT RAL RE GIST RY ST AF F

• Pa tie nt c o me s to fa c ility fo r ra dia tio n tre a tme nt

a fte r ha ving b io psy a nd pro sta te c to my e lse whe re .

• T

he o nly info rma tio n in the c ha rt is the da te s o f b io psy, pro sta te c to my, a nd the ra dia tio n tre a tme nt info rma tio n.

• Sho uld we use X o r Bla nks fo r the c linic a l a nd

pa tho lo g ic a l sta g ing ?

29

ANSWE R

• Sinc e T

X o r NX indic a te the info rma tio n wa s unkno wn to the physic ia n, yo u c a nno t use this.

• T

he physic ia n do e s kno w the sta g e o r the y wo uldn't b e a b le to c ho o se the a ppro pria te tre a tme nt fo r the pa tie nt.

• In this c a se , a nd it is the o nly o ptio n sinc e yo u

c a nno t use X, yo u wo uld le a ve a ll o f the info rma tio n b la nk.

30

http:/ / c a nc e rb ulle tin.fa c s.o rg / fo rums/ fo rum/ a jc c -tnm-sta g ing / a jc c -re g istra r-e d uc a tio n- pre se nta tio ns/ e xpla ining -b la nks-a nd-x-a mb ig uo us-te rmino lo g y-a nd-sup po rt-fo r-a jc c - sta g ing / 58490-c la rific a tio n-o n-using -x-vs-b la nks

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 11

QUE ST ION

• A pa tie nt is fo und to ha ve a 2c m sq ua mo us

c e ll c a rc ino ma o f the lung a nd e nla rg e d hila r lymph no de s.

• A me dia stino sc o py wa s do ne a nd 2 hila r lymph

no de s we re re mo ve d a nd fo und to b e po sitive fo r ma lig na nc y.

• T

he pa tie nt wa s tre a te d with ra dia tio n (no furthe r surg e ry).

• Wha t is the pa tho lo g ic sta g e ?

31

ANSWE R

• Must e sta b lish pT

in o rde r to a ssig n the pN if the pN is no t the hig he st N c a te g o ry. T a nd N a re b la nk.

• Hila r no de is N1
• N va lue s fo r lung a re 1, 2, a nd 3

32

Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 1a 1 IIA Path 99

QUE ST ION

• A pa tie nt with a c linic a l T

2a N0 M0 pro sta te c a nc e r o pts fo r pro sta te c to my. During the pro c e dure 2 lymph no de s a re re mo ve d a nd fo und to b e po sitive . T he pro sta te c to my wa s c a nc e lle d.

• Wha t is the pa tho lo g ic sta g e ?

33

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 12

ANSWE R

• Crite ria fo r pT

no t me t

• Hig he st pN va lue c o nfirme d pa tho lo g ic a lly
• Any T

, N1, M0 is Sta g e IV

34

Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 2a IIA Path 99

SUBCAT E GORIE S

• Sub c a te g o rie s ma y b e re q uire d to a ssig n a

sta g e g ro up.

• F
• r pro sta te T

2 is no t suffic ie nt to a ssig n a sta g e g ro up. Must ha ve t2a o r T 2b .

35

QUE ST ION

• A pa tie nt ha d DRE

due to a n e le va te d PSA (5.4). T he uro lo g ist fe lt a no dule in the le ft lo b e . T he uro lo g ist did no t indic a te if it wa s mo re o r le ss tha n ha lf a lo b e . Bx c o nfirme d a de no c a rc ino ma Gle a so n 3+3. No indic a tio n

• f a ny a dditio na l dise a se

36

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 13

ANSWE R

• I

f the re is no de sc riptio n tha t wo uld g uide se le c tio n o f the sub c a te g o ry it wo uld b e c o rre c tly a ssig ne d c T 2.

• T

his wo uld no t a llo w a c linic a l sta g e g ro up to b e a ssig ne d.

37

Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin 2 99 Path 99

QUE ST ION

• A pa tie nt ha d a b ro nc hia l wa shing po sitive fo r

sq ua mo us c e ll c a rc ino ma o f the lung .

• Ima g ing fa ile d to sho w a ma ss within the lung , b ut

did sho w me dia stina l a nd hila r lympha de no pa thy.

• Me dia stino sc o py wa s po sitive fo r two me ta sta tic

me dia stina l lymph no de s.

• Ho w is this sta g e d?

38

OCCUL T L UNG PRIMARIE S

• T

X de finitio n inc lude s a prima ry tha t ha s b e e n c o nfirme d b y sputum o r b ro nc hia l wa shing s, b ut no t visua lize d b y ima g ing .

• T

0 wo uld b e a tumo r no t c o nfirme d b y sputum, wa shing s, o r ima g ing

• Oc c ult is T

x N0 M0

39

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 14

ANSWE R

• Crite ria fo r c T

ha s b e e n e sta b lishe d

• T

umo r ha s b e e n c o nfirme d b y wa shing s, b ut no t visua lize d b y ima g ing

• Me dia stino sc o py is po sitive fo r lymph no de

me ts

40

Data Items as Coded in Current NAACCR Layout T N M Stage Group Clin X 2 IIIA Path 99

QUE ST ION

• Ca n yo u c la rify ho w to a ssig n c N a nd pN fo r a

pa tie nt tha t ha d a se ntine l lymph no de b io psy fo r a b re a st prima ry?

41

ANSWE R

• I

f the se ntine l lymph no de (SL N) b io psy is do ne

prio r to e sta b lishing the pT

, the n the SL N info rma tio n c a n b e use d to a ssig n the c N.

• At tha t po int the SL

N sta tus c a n b e use d to de te rmine tre a tme nt.

• SL

N c a n a lso b e use d to a ssig n pN.

• pN inc lude s c linic a l info rma tio n plus info rma tio n fro m

re mo va l o f lymph no de s

• I

f the SL N is re mo ve d during o r a fte r re mo va l o f the prima ry tumo r, it c a n o nly b e use d to a ssig n the pN.

42

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 15

QUE ST ION

• I

ha ve a pa tie nt with a lung prima ry tha t ha s c linic a l e vide nc e o f b ra in me ta sta sis(M1b ) a nd pa th e vide nc e o f ple ura l e ffusio n (M1a ).

• Bo th we re dia g no se d prio r to a ny tre a tme nt.
• Ho w sho uld I

e nte r this into my re g istry so ftwa re ?

43

ANSWE R

• AJCC rule s sta te tha t the pM re q uire s a b io psy

po sitive fo r c a nc e r a t the me ta sta tic site . Ho we ve r, the re a re no spe c ific a tio ns re g a rding the sub c a te g o rie s.

• I

t is pro b a b ly b e st to a ssig n the c linic a l sta g e a s c T 4 c N2 pM1b c linic a l sta g e I V.

44

http://cancerbulletin.facs.org/forums/showthread.php?9042‐Pericardial‐Effusion‐and‐Bone‐Mets‐p‐M1‐ M1a‐or‐M1b&highlight=subcategories.

QUE ST IONS?

45

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 16 AN AND N D NOW A A BRIEF BRIEF PAU PAUSE FO E FOR... R...

AN EPI AN EPI MOM MOMENT BY NT BY RECI CINDA S NDA SHERMAN MAN

(inse rt S wan L ake he re )

46

DIF F ICUL T VARIABL E S

• I

nc o mple te

• Sta g e
• T

re a tme nt

• Site Spe c ific
• SSF

1, SSF 2, SSF 15—b re a st E R/ PR/ HE R2

• I

nc o mple te & c o ding e rro rs

• Pr

ima ry Pa ye r

• Addre ss a t DX

PRIMARY PAYE R: DISPARIT IE S RE SE ARCH

• Re se a rc h q ue stio ns
• Pro xy fo r c la ss/ inc o me , a c c e ss to c a re , q ua lity o f c a re
• Co nde nse d g ro ups fo r a na lysis
• I

nsure d vs uninsure d; priva te insura nc e vs pub lic insura nc e

• Still impo rta nt e ve n if he a lthc a re unive rsa l
• No insura nc e : 01 ve rsus 02
• Do NOTwa it fo r mo st c urre nt info rma tio n
• Do NOT

inc lude insura nc e o b ta ine d a fte r dia g no sis

• E

g d ise a se spe c ific insura nc e o r pub lic insura nc e a pplie d fo r a fte r d ia g no sis

• 99 is a va lid c o de
• Co mb o c o de s
• Me dic a re 65+

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 17

POP QUIZ

A 55 yo Virg inia wo ma n is dia g no se d with sta g e I V b re a st c a nc e r. He r tre a tme nt is pa id fo r b y the sta te Bre a st a nd Ce rvic a l Ca nc e r Pre ve ntio n Pro g ra m. Ho w do yo u c o de prima ry pa ye r?

• A. 02, no t insure d, se lf-pa y
• B. 10, insura nc e , NOS
• C. 31, Me dic a id
• D. No ne o f the a b o ve

ADDRE SS AT DX: GE OSPAT IAL RE SE ARCH

• I

nc ide nc e , mo rta lity, tre a tme nt, a nd surviva l

• Va ry b y g e o g ra phy
• Ma p da ta , visua lize re la tio nships, g e ne ra te

hypo the se s

• Ge o spa tia l re se a rc h
• Re la tio nships a mo ng pla c e a nd he a lth
• Pro xy fo r c la ss/ inc o me , physic a l a c c e ss to c a re , re g io na l

syste ms

• E

nviro nme nta l, de mo g ra phic , pro ximity to c a re , g ro up-le ve l e ffe c ts, c a nc e r c luste rs

ADDRE SS AT DX

• Stre e t a ddre ss, supple me nta l a ddre ss, c ity, zip
• No PO Bo xe s
• Do no t pre fa c e a ddre ss with PO Bo x; pla c e PO Bo x in

Supple me nta l

• F

lo rida e dits

• Go o g le , DMV o r o the r e xte rna l so urc e s
• No t Curre nt a ddre ss
• Ho me le ss—a ddre ss o f ho spita l dia g no sis
• ho me le ss in supple me nta l a ddre ss fie ld

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 18

QUE ST ION

• Wha t do we do if a ll we ha ve is a PO Bo x

liste d?

52

ANSWE R

• Ve rify tha t the stre e t a ddre ss isn’ t sto re d

e lse whe re .

• If no t, turn to e xte rna l da ta so urc e s like DMV, Vo te r

Re g istra tio n Re c o rds, o r g o o g le pa tie nt.

• If no luc k, use PO Bo x fo r stre e t a ddre ss a nd use the

c ity, sta te a nd zip c o de fro m the PO Bo x a ddre ss.

• T

his pro vide s a pro xy fo r the c o unty a t dia g no sis.

• Ple ase make e ve ry e ffo rt to minimize the use o f the

PO Bo x as the stre e t addre ss.

53

“GIGO”

• Ge o g ra phy spe c ific ra te s
• Co unty, c e nsus tra c t, b lo c k g ro up
• Cluste r a na lysis
• Ge o c o ding (lo ng / la t)
• Are a -b a se d da ta
• po ve rty, urb a n/ rura l sta tus, urb a n/ rura l c o mmuting c o de s
• L

inka g e va ria b le s

• Co ho rt studie s, drug sa fe ty studie s

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 19

MISC…

• Q: Ho w do we c o de ra c e if the ra c e

do c ume nts the pa tie nt’ s ra c e a s “o the r”?

• A: Co de a s unkno wn if yo u do n’ t ha ve a ny

a dditio na l info rma tio n. Do no t c o de a s 98- Othe r!

• Q: Ho w sho uld Alia s b e e nte re d?
• A: Alia s sho uld b e e nte re d la st na me the n first

na me witho ut punc tua tio n

55

QUE ST IONS?

Quiz 1

56

MP/ H

57

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 20

WHE N SHOUL D T HE MP/ H RUL E S BE USE D?

• DO use to de te rmine multiple prima rie s
• DO use to c o ding histo lo g y.
• DO NOT

use fo r c a se finding .

• DO NOT

use fo r c o ding tumo r g ra de .

• DO NOT

use the m fo r a ny da ta ite ms o the r

tha n histo lo g y o r fo r a ny use o the r tha n de te rmining multiple prima rie s

58

POP QUIZ

• 2/ 19/ 13 T

URBT : Pa pilla ry uro the lia l c a rc ino ma , hig h g ra de , no ninva sive o f rig ht la te ra l b la dde r wa ll

• 3/ 18/ 13 L

e ft re na l pe lvis b io psy: Hig h g ra de pa pilla ry tra nsitio na l c e ll c a rc ino ma o f c a lyx

• Wha t is the c o de fo r prima ry site
• C65.9 Re na l pe lvis
• C67.2 L

a te ra l wa ll o f b la dde r

• C68.9 Urina ry syste m NOS

59

CODING PRIMARY SIT E

• Rule 4
• Co de the site o f the inva sive tumo r whe n the re is a n

inva sive tumo r a nd insitu tumo r in diffe r

e nt sub site s o f

the sa me a na tomic site.

60

Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 21

CODING PRIMARY SIT E

• Rule 5
• Co de the la st dig it o f the prima ry site c o de to ‘ 9’ fo r

sing le prima rie s, whe n multiple tumor s a rise in diffe re nt subsite s o f the sa me a na to mic site a nd the

po int o r o rig in c a nno t b e de te rmine d.

61

CODING PRIMARY SIT E

• Rule 8
• Se e the site -spe c ific c o ding g uide line s in Appe ndix

C fo r prima ry site c o ding g uide line s fo r the fo llo wing site s:

• Bla dde r
• K

a po si sa rc o ma

• Bre a st
• L

ung

• Co lo n
• Re c to sig mo id, Re c tum
• E

so pha g us

62

CODING PRIMARY SIT E

• Rule 13
• Whe n the me dic a l re c o rd do e s no t c o nta in e no ug h

info rma tio n to a ssig n a prima ry site

• Co nsult a physic ia n a dviso r to a ssig n the site c o de
• Use the NOS c a te g o ry fo r the o rg a n syste m OR the I

ll- de fine d site s if the physic ia n a dviso r c a nno t ide ntify a prima ry site

• Co de Unkno wn Prima ry Site (C809) if the re is no t e no ug h

info rma tio n to a ssig n a n NOS o r I ll- De fine d Site Ca te g o ry

63

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CODING PRIMARY SIT E

64

QUE ST ION

• 01/ 27/ 15 Co lo no sc o py do ne . Bio psy o f Sig mo id

c o lo n.

• F

ina l Dia g no sis Ade no c a rc ino ma with muc ino us fe a ture s.

• Mic ro sc o pic de sc riptio n sta te s 45% o f c e lls a re

muc ino us

• Ho w do we c o de the histo lo g y?

65

COL ON HIST OL OGY RUL E S – H5

Co de 8480 o r 8490 whe n the fina l dia g no sis is:

• muc ino us o r c o llo id a de no c a rc io nma (8480)
• sig ne t ring c e ll a de no c a rc ino ma (8490)
• Ade no c a rc ino ma , NOS a nd mic ro sc o pic

de sc riptio n sa ys 50% o r mo re o f the tumo r is muc ino us o r c o llo id (8480)

• Ade no c a rc ino ma , NOS a nd the mic ro sc o pic

de sc riptio n sa ys 50% o r mo re o f the tumo r is sig ne t ring c e ll a de no c a rc ino ma (8490)

66

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COL ON HIST OL OGY RUL E S – H6

Co de 8140 (a de no c a rc ino ma , NOS) whe n the fina l dia g no sis is a de noc a rc inoma a nd:

• T

he mic ro sc o pic dia g no sis sta te s tha t le ss tha n

50% o f the tumo r is muc inous/ c olloid o r

• T

he mic ro sc o pic dia g no sis sta te s tha t le ss tha n

50% o f the tumo r is signe t r ing c e ll c a rc ino ma

• r
• T

he pe rc e nta g e o f muc ino us/ c o llo id o r sig ne t ring c e ll c a rc ino ma is unknown

67

COL ON HIST OL OGY RUL E S – H7

• Co de 8255 (a de no c a rc ino ma with mixe d

sub type s) whe n the re is a c ombina tion o f

muc inous/ c olloid a nd sig ne t r ing c e ll

c a rc ino ma

68

COL ON HIST OL OGY RUL E S – H13

Code the mo st spe c ific histo lo g ic te r m whe n the

dia g no sis is:

• Ca nc e r/ ma lig na nt ne o pla sm, NOS (8000) a nd a

mo re spe c ific histo lo g y o r

• Ca rc ino ma , NOS (8010) a nd a mo re spe c ific

c a rc ino ma o r

• Ade no c a rc ino ma , NOS (8140) a nd a mo re spe c ific

a de no c a rc ino ma o r

• Sa rc o ma , NOS (8800) a nd a mo re spe c ific sa rc o ma

(inva sive o nly)

69

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QUE ST ION

• Q: Ho w do we c o de a b re a st prima ry with

intra duc ta l c a rc ino ma with c o me do a nd so lid fe a ture s?

• A: Pe r rule H4 we c o de 8501/ 2 c o me do c a rc ino ma
• Q: Ho w do we c o de a b re a st prima ry with a

histo lo g y de sc rib e d a s c a rc ino ma with c o me do ne c ro sis.

• A: Ca rc ino ma NOS
• No t c o me do c a rc ino ma !

70

QUE ST ION

• Q: Ho w do I

c o de c le a r c e ll re na l c e ll c a rc ino ma o f the kidne y?

• A: Re na l c e ll is a n NOS c o de . Cle a r c e ll is the

mo re spe c ific c o de 8310/ 3.

71

HE MAT OPOIE T IC AND L YMPHOID NE OPL ASMS

72

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QUE ST ION

• I

f a pa tie nt is dia g no se d with a c ute le uke mia , mo st like ly a c ute mye lo id le uke mia (AML ), a nd the c linic no te s a lwa ys re fe r to the pa tie nt b e ing tre a te d a s AML , is this c a se c o de d a s a c ute le uke mia , NOS o r a c ute mye lo id le uke mia ?

73

ANSWE R

• T

his c a se wo uld b e c o de d a s AML .

• Pe r the prima ry site a nd histo lo g y c o ding instruc tio ns

a nd rule s, if yo u ha ve a mb ig uo us te rmino lo g y use d with a spe c ific histo lo g y a nd the n the physic ia n sta te s tha t the y a re tre a ting fo r the spe c ific dise a se , the n yo u c a n a ssig n the spe c ific histo lo g y.

74

QUE ST ION

• Ca n yo u re vie w the diffe re nc e b e twe e n

Chro nic a nd Ac ute he ma to po ie tic ma lig na nc ie s?

75

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CHRONIC VS ACUT E

• HE

MAT OPOIE T IC

• I

f a c hro nic ne o pla sm c a n tra nsfo rm to a n a c ute / mo re se ve re ne o pla sm, the He me DB will sho w the a c ute ne o pla sm in the “T ra nsfo rma tio ns to ” se c tio n.

• I

f a n a c ute ne o pla sm c a n tra nsfo rm to a c hro nic fo rm o f the ne o pla sm, the He me DB will sho w the a c ute ne o pla sm in the “T ra nsfo rma tio n fro m” se c tio n.

76

HE MAT OPOIE T IC MANUAL

• Rule s M8-13 de a l with tra nsfo rma tio n to a nd

fro m

• Yo u must use the ma nua l b e fo re yo u use the

multiple prima ry c a lc ula to r!!!

77

QUE ST ION

• 66 ye a r o ld white ma le wa s dia g no se d o n

7/ 17/ 2013 a t Ho spita l A with Sta g e I fo llic ula r lympho ma invo lving o nly re tro pe rito ne a l a nd pe ria o rtic lymph no de s.

• I

n Oc to b e r, 2014, the sa me pa tie nt de ve lo pe d disc o mfo rt in his rig ht ha rd pa la te .

• A b io psy o f the rig ht ma xilla ry pa ra sinus wa s pe rfo rme d o n

10/ 2/ 2014 a t Ho spita l B, a nd pa tho lo g y re ve a le d diffuse la rg e B-c e ll lympho ma .

• T

he pa tie nt is se e n b y a no the r o nc o lo g ist a t Ho spita l B, who c a lls this dise a se pro c e ss a tra nsfo rma tio n fro m the pa tie nt’ s pre vio usly dia g no se d fo llic ula r c e nte r c e ll lympho ma -up.

• Sho uld Ho spita l B re po rt this a s a ne w prima ry?

78

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RE ASONING

• Diffuse la rg e B-c e ll lympho ma is the a c ute

pha se o f fo llic ula r lympho ma

• E

a c h histo lo g y wa s dia g no se d mo re tha n 21 da ys a pa rt

• Rule M10
• Ab stra c t a s multiple prima rie s** whe n a ne o pla sm is
• rig ina lly dia g no se d a s a c hro nic ne o pla sm AND

the re is a se c o nd dia g no sis o f a n a c ute ne o pla sm mo re tha n 21 da ys a fte r the c hro nic dia g no sis.

79

ANSWE R

• Ho spita l B will a b stra c t a s a se c o nd prima ry
• Da te o f Dia g no sis: 10/ 2/ 2014
• Histo lo g y: 9680/ 3

80

QUE ST ION

• I
• fte n se e the a b stra c to r c o de the lymph

no de re g io ns whe re the b io psy wa s ta ke n b ut the CT re ve a ls lympha de no pa thy a b o ve a nd b e lo w the dia phra g m.

• Co uld yo u stre ss tha t this sho uld b e c o de d to

C77.8?

81

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ANSWE R

• Se e Mo dule 7 o f the he ma to po ie tic ma nua l
• Rule PH21
• Co de the prima ry site to multiple lymph no de

re g io ns, NOS (C77.8) whe n multiple lymph no de re g io ns, a s de fine d b y ICD-O-3, a re invo lve d a nd it is no t po ssib le to ide ntify the lymph no de re g io n whe re the lympho ma o rig ina te d.

82

T E ST IS

83

MAT URE T E RAT OMA

• Whe n is ma ture te ra to ma o f the te stis

re po rta b le ?

84

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MAT URE T E RAT OMA

• Re po rta b le vs No n-Re po rta b le
• Pre -pub e rty vs po st–pub e rty
• Physic ia n Sta te me nt

http:/ / se e r.c a nc e r.g o v/ ma nua ls/ 2015/ SPCSM_2015_ma indo c .p d f

85

SE RUM T UMOR MARKE R L E VE L

• Se rum tumo r ma rke r le ve ls sho uld b e me a sure d prio r to
• rc hie c to my, but le ve ls a fte r orc hie c tomy a re use d for

a ssig nme nt of S c a te g ory, ta king into a c c o unt the ha lf

life o f AF P a nd hCG. Sta g e g ro uping c la ssific a tio n o f Sta g e I S re q uire s pe rsiste nt e le va tio n o f se rum tumo r ma rke rs fo llo wing o rc hie c to my.

• T

he Se rum T umo r Ma rke rs (S) c a te g o ry c o mprise s the fo llo wing :

• Alpha fe to pro te in (AF

P) – ha lf life 5-7 da ys

• Huma n c ho rio nic g o na do tro pin (hCG) – ha lf life 1-3 da ys
• L

a c ta te de hydro g e na se (L DH)

86

S DE F INIT IONS

SX Marke r studie s not available or not pe rforme d S0 Marke r study le ve ls within normal limits S1 L DH < 1.5 x N* and hCG (mIu/ ml) < 5,000 and AF P (ng / ml) <1,000 S2 L DH 1.5- 10 x N o r hCG (mIu/ ml) 5,000- 50,000 o r AF P (ng / ml) 1,000- 10,000 S3 L DH >10xN o r hCG (mIu/ ml) >50,000 o r AF P (ng / ml)>10,000

87

*N indic a te s the uppe r limit o f no rma l fo r the L DH a ssa y

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SSF T HAT DE T E RMINE S CAT E GORY

SSF 13 – Po st Orc hie c to my AF P Ra ng e SSF 15 – Po st Orc hie c to my hCG Ra ng e SSF 16 – Po st Orc hie c to my L DH Ra ng e

88

CODE S F OR SSF 13,15,16

000 Within normal limits 010 Ra ng e 1 (S1) 020 Ra ng e 2 (S2) 030 Ra ng e 3 (S3)

89

CODE S F OR SSF 13,15,16

990 Post- orc hie c tomy te st unknown but pre - orc hie c tomy te st norma l 991 Post –orc hie c tomy te st still e le vate d 992 Post- or c hie c tomy te st unknown but post orc hie c tomy se rum tumor make rs, NOS normal 993 Post- orc hie c tomy te st unknown but post –orc hie c tomy se rum tumor make rs, NOS still e le vate d; State d as Stage IS

90

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CODE S F OR SSF 13,15,16

988 Not applic able : Information not c olle c te d for this c ase 997 T e st orde re d re sults not in c hart 998 T e st not done (te st not orde re d and not pe rforme d) 999 Unknown or no information; Not doc ume nte d in patie nt re c ord

91

S CAT E GORY

• Q: Pa tie nt ha s AF

P te st do ne po st o rc hie c to my with a re sult o f 3,365 ng / ml. hCG a nd L DH we re within no rma l limits. Wha t wo uld the S c a te g o ry b e ?

• A: T

he S c a te g o ry wo uld b e S2. S2 L DH 1.5-10 x N o r hCG (mI u/ ml) 5,000-50,000 o r AF P (ng / ml) 1,000-10,000

92

UT E RUS

93

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UT E RUS

Wha t is the diffe re nc e b e twe e n AJCC Sta g e a nd F I GO Sta g e ? F I GO g ra de a nd histo lo g ic g ra d?

94

UT E RUS

• I

nte rna tio na l F e de ra tio n o f Gyne c o lo g y a nd Ob ste tric s

• No Sta g e O in the F

I GO Sta g ing Syste m

95

UT E RUS

F IGO GRADE

GX T he grade c annot be e valuate d G1 We ll Diffe re ntiate d G2 Mode rate ly Diffe re ntiate d G3 Poorly Diffe re ntiate d G4 Undiffe re ntiate d

HIST OL OGIC GRADE

1 We ll diffe re ntiate d 2 Mode rate ly diffe re ntiate d 3 Poorly diffe re ntiate d 4 Undiffe re ntiate d 9 Not de te rmine d, not state d or not applic able

96

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ST OMACH AND E SOPHAGUS

97

RE GIONAL L YMPH NODE S

Q: Whe n CS g o e s a wa y, whic h list o f re g io na l lymph no de s will we use b e twe e n AJCC & SE E R Summa ry Sta g e fo r the c o ding the fie lds Re g io na l No de s Po sitive a nd Re g io na l No de s E xa mine d? A: Use the re g io na l lymph no de s liste d in the AJCC ma nua l. All o f the sta nda rd se tte rs ha ve a g re e d to this.

98

L ARYNX AND T HYROID

99

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PAPIL L ARY CARCINOMA OF T HE T HYROID

• Q: Ho w sho uld I

c o de pa pilla ry c a rc ino ma o f the thyro id?

• A: Co de to 8260/ 3
• Do no t c o de to pa pilla ry mic ro c a rino ma (8341/ 3)

100

QUE ST ION

• I

n the rule s fo r c linic a l sta g ing fo r thyro id it is sta te d tha t the dia g no sis o f thyro id c a nc e r must b e c o nfirme d b y ne e dle b io psy o r o pe n b io psy o f the tumo r.

• If a pa tie nt pre se nts with a me a sura b le ma ss in the

thyro id b ut no b io psy is do ne , c a n a c linic a l sta g e b e a ssig ne d?

• In o ur e xa mple the pa tie nt we nt o n to ha ve surg e ry

tha t c o nfirme d ma lig na nc y.

101

ANSWE R

• Witho ut a b io psy c o nfirming c a nc e r, the

pa tie nt c a nno t b e a ssig ne d a c linic a l sta g e . E spe c ia lly sinc e the sta g ing is so de pe nde nt o n the histo lo g y, witho ut kno wing the type o f c a nc e r yo u c a nno t a ssig n sta g e .

• T

his wa s ve rifie d with a n AJCC e xpe rt pa ne l me mb e r.

102

http://cancerbulletin.facs.org/forums/forum/ajcc‐tnm‐staging/education‐developed‐by‐ partner‐organizations/naaccr‐webinars/56673‐clinical‐stage‐thryroid‐no‐bx

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QUE ST ION

• I

f a pa tie nt with thyro id c a nc e r is g ive n synthro id prio r to surg e ry, is it c o de d a s ne o a djuva nt tre a tme nt?

103

ANSWE R

• Synthro id is NOT

ne o a djuva nt the ra py

• So me physic ia ns (no t ma ny e ndo c rino lo g ists) try to

shrink thyro id no dule s with Synthro id.

• No t o nly do e s this ra re ly wo rk, b ut it is a lso no t dia g no stic -

b o th b e nig n a nd ma lig na nt no dule s c a n g ro w, shrink, o r sta y the sa me .

• T

his sho uld no t b e c o nside re d a ne o a djuva nt tre a tme nt o f c a nc e r.

• NCCN g uide line s a lso sho w tha t the re is NOT

ne o a djuva nt the ra py fo r this dise a se .

104

http://cancerbulletin.facs.org/forums/forum/collaborative‐stage/larynx‐and‐trachea/thyroid/6108‐ synthroid‐after‐diagnosis‐but‐before‐treatment

QUE ST ION

• A pa tie nt with a sma ll la ryng e a l prima ry ha d

surg e ry o f the prima ry site , b ut no lymph no de s we re re mo ve d. Ac c o rding to the NCCN g uide line s re mo ving lymph no de s is no t re c o mme nde d .

• Ho w do we c o de pN?

105

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ANSWE R

• I

f re se c tio n o f the prima ry site me e ts the pa tho lo g ic sta g e c rite ria a nd is pe rfo rme d, if lymph no de s we re no t re mo ve d, N c a te g o ry wo uld b e pNX, no t b la nk.

106

http://cancerbulletin.facs.org/forums/forum/ajcc‐tnm‐staging/education‐developed‐by‐partner‐

• rganizations/naaccr‐webinars/56581‐x‐and‐blank

CNS

107

L OW GRADE GL IOMA

• Q: I

f a ll we ha ve is a ra dio lo g y re po rt with a lo w g ra de g lio ma is this c o nsiste nt with ma lig na nt b e ha vio r (/ 3)?

• A: We se nt this o ff to SE

E R a nd the y sa id we sho uld c o de lo w g ra de g lio ma to g lio ma , no s (9380/ 3).

108

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ME DUL L OBL AST OMA

• Q: I

wa s ta ug ht tha t Me dullo b la sto ma wa s a lwa ys c o de d to the c e re b e llum.

• I b e lie ve the Ame ric a n Bra in T

umo r Asso c ha s this do c ume nte d.

• A: Me dullo b la sto ma sho uld b e a ssig ne d to the

site fro m whe re the y a ro se . Mo st o c c ur e ithe r within the c e re b e llum o r the fo urth ve ntric le .

109

http:/ / se e r.c anc e r.go v/ se e rinq uiry/ inde x.php? pag e =vie w&id=20140013&type =q

WHO GRADE AND SSF 1

• I

s tissue dia g no sis re q uire d to c o de the WHO g ra de , o r c a n we c o de b a se d o n ima g ing (i.e . me ning io ma ) a nd use ta b le 56.3 in the AJCC Ma nua l?

110

WHO GRADE AND SSF 1

• What I

’ ve to ld o ur re gistrars he re is to c o de the WHO g rade as do c ume nte d o n the patho lo g y re po rt in S S F 1.

• I

f the re is a patho lo g y re po rt but the WHO g rade is no t do c ume nte d, the n the y sho uld re fe r to T able 56.3 and use the WHO g rade indic ate d fo r the histo lo g y if it is liste d o n the table ; o the rwise , assig n 999.

• I

f, ho we ve r, the c ase is o nly c linic al, the y sho uld assig n c o de 998.

111

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T RE AT ME NT

• SURGE

RY

Wha t surg e ry c o de sho uld I use whe n the tumo r wa s g ro ssly re se c te d b ut a lo b e c to my wa s no t do ne ?

112

T RE AT ME NT – SURGE RY

CNS Code s Proc e dure

20 L

• c a l e xc isio n o f tumo r, le sio n o r ma ss; e xc isio na l b io psy

21 Sub to ta l re se c tio n o f tumo r, le sio n o r ma ss in b ra in 22 Re se c tio n o f tumo r o r spina l c o rd ne rve 30 Ra dic a l, to ta l, g ro ss re se c tio n o f tumo r, le sio n o r ma ss in b ra in 40 Pa rtia l re se c tio n o f lo b e o f b ra in, whe n the surg e ry c a nno t b e c o de d a s 20-30 55 Gro ss to ta l re se c tio n

113

T RE AT ME NT – SURGICAL APPROACH

Whe n c o ding surg ic a l a ppro a c h, if the pa tie nt ha d a ro b o tic a ssiste d-la pa ro sc o pic pro c e dure , whic h ta ke s pre c e de nc e ? T he ro b o tic a ssiste d a ppro a c h o r the la pa ro sc o pic a ppro a c h?

114

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T RE AT ME NT – SURGICAL APPROACH

115

Code De finition

No surg ic a l pro c e dure o f prima ry site a t this fa c ility, Dia g no se d a t a uto psy 1 Ro b o tic Assiste d 2 Ro b o tic c o nve rte d to o pe n 3 Minima lly inva sive (suc h a s e ndo sc o pic o r la pa ro sc o pic ) 4 Minima lly inva sive (e ndo sc o pic o r la pa ro sc o pic ) c o nve rte d to o pe n 5 Ope n o r a ppro a c h unspe c ifie d 9 Unkno wn whe the rsurg e ry wa s pe rfo rme d a t this fa c ility

ST E RE OT ACT IC BIOPSY

• Q: F
• r surg e ry do e s c o de 20 inc lude a

ste re o ta c tic b io psy?

• 20 L
• c a l e xc isio n o f tumo r, le sio n, o r ma ss, e xc isio na l

b io psy 21 Sub to ta l re se c tio n o f tumo r, le sio n o r ma ss in b ra in 22 Re se c tio n o f tumo r in spina l c o rd o r ne rve

• [SE

E R No te : Assig n c o de 20 fo r ste re o ta c tic b io psy o f b ra in tumo r]

116

ST E RE OT ACT IC BIOPSY

• A: We c he c ke d with b o th SE

E R a nd Co C a nd the y b o th a g re e a b io psy b e ing do ne fo r dia g no stic purpo se s o nly (i.e . a n inc isio na l b io psy), wo uld no t b e c o de d a s surg e ry, b ut a n e xc isio na l b io psy wo uld.

• In c o ding a c a se suc h a s this it is impo rta nt to re me mb e r

the sig nific a nc e o f re a ding the surg e ry/ o p re po rt to se e wha t a mo unt o f tissue wa s re mo ve d.

• Ofte n time s, the surg e o n will sta te the inte nde d

pro c e dure , b ut the a c tua l re po rt ma y sho w tha t a mo re de finitive pro c e dure o r e xc isio n wa s do ne .

117

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ME NINGIOMA

• Q: Whe n do e s o ne use me ning e s, no s (C70.9)?
• A: Only if o ne do e sn’ t kno w if it sta rte d in

c e re b ra l me ning e s (C70.0) o r the spina l me ning e s (C70.1).

• Wo uld b e unusua l to use C70.9
• C70.9 is no t c o nside re d a pa ire d site so la te ra lity

wo uld b e 0. T his c o uld impa c t the multiple prima ry rule s.

118

MIDL INE SHIF T

• Q: Do e s a “midline shift” indic a te a tumo r ha s

me ta sta size d fro m o ne he misphe re to a no the r?

• A: No . I

t just me a ns tha t the tumo r is pushing a g a inst the c o ntra la te ra l he misphe re .

119

OT HE R QUE ST IONS

120

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ADM WIT HIN 30 DAYS AFT ER SURG DISC HARG E

• I

s a se c o nd surg e ry, fo r a b re a st prima ry fo r insta nc e -to g e t c le a n ma rg ins, c o nside re d pla nne d re a dmissio n a nd c o de d 2.

• I

unde rsto o d unpla nne d re a dmissio ns we re fo r c o mplic a tio ns.

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ADM WIT HIN 30 DAYS AFT ER SURG DISC HARG E

• No , the se c o nd surg e ry c a nno t b e c o nside re d

pla nne d re a dmissio n, b e c a use the ite m "Re a dm to the sa me ho sp within 30 da ys o f surg disc ha rg e " e va lua te s the pre se nc e o r a b se nc e o f c o mplic a tio ns (sig ns a nd sympto ms) re la te d to surg ic a l tre a tme nt.

• T

he pla nne d re a dmissio n within 30 da ys to the sa me ho spita l is c o unte d o nly if the pa tie nt wa s a dmitte d fo r dise a se -re la te d purpo se s.

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L UPRON

• A pa tie nt with me ta sta tic b re a st c a nc e r is

g ive n L upro n. Ho w sho uld yo u c o de this?

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Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 42

SE E R*RX

• Do e s no t list a ll site s o r histo lo g ie s tha t a drug is

a ppro ve d fo r

• Re a d the re ma rks to se e if a ny site s/ histo lo g ie s

a re e xc lude d.

• Othe rwise the y a re o k to c o de fo r a ll site s.

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SE E R RX NOT E S

T he use o f L upro n ha s no t re c e ive d F DA a ppro va l fo r tre a tme nt o f b re a st c a nc e r. While it ma y no t ha ve re c e ive d F DA a ppro va l, it c a n b e use d "o ff la b e l" fo r o the r c o nditio ns. L upro n sho uld b e c o de d a s “Othe r T he ra py” until suc h time tha t it re c e ive s F DA a ppro va l.

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L UPRON

• Pa tie nt re c e ive d L

upro n o ne we e k prio r to pro sta te c to my. Whe n a ssig ning AJCC pa tho lo g ic a l sta g e , sho uld I use the y de sc ripto r?

• No .

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Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 43

ME L ANOMA SURGE RY

• Ple a se c la rify the re visio n a dditio n in F

ORDs 2015 re g a rding Me la no ma Surg e ry c o de s 45-47- "I f the e xc isio n do e s no t ha ve c linic a lly ne g a tive ma rg ins during surg e ry g re a te r tha n 1c m, use the a ppro pria te c o de , 20-36"

127

ANSWE R

• T

his wa s a typo . I t sho uld sta te "I f the e xc isio n do e s no t ha ve mic r

• sc opic a lly ne g a tive

ma rg ins during surg e ry g re a te r tha n 1c m, use the a ppro pria te c o de , 20-36" Ma rg ins a re b a se d o n pa th re po rt no t o n info rma tio n fro m the o pe ra tive re po rt.

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F INAL PIT F AL L

• T

e xt(o r la c k o f it)!

• T

e xt is pa rt o f yo ur a b stra c t! Be sure to g ive it the sa me a tte ntio n yo u wo uld g ive to a ssig ning prima ry site o r sta g ing !!!

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Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 44

QUE ST IONS?

Quiz 2

130

COMING UP…

• Co lle c ting Ca nc e r Da ta : Unusua l Site s a nd

Histo lo g ie s

• 10/ 1/ 15
• Co lle c ting Ca nc e r Da ta : Pha rynx
• 11/ 5/ 15

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AND T HE WINNE RS ARE … ..

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Co ding Pitfa lls 9/ 3/ 15 NAACCR 2015-2016 We b ina r Se rie s 45

CE CE RT IF ICAT E QUIZ/ SURVE Y

• Phra se
• ST

a g ing

• L

ink

• http:/ / www.surve yg izmo .c o m/ s3/ 2309936/ Co ding -Pitfa lls-2015

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