MP/ H Rule 2014 12/ 4/ 2014 USING THE MULTIPLE PRIMARY AND - - PDF document

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MP/ H Rule 2014 12/ 4/ 2014 USING THE MULTIPLE PRIMARY AND - - PDF document

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MP/ H Rule 2014 12/ 4/ 2014 USING THE MULTIPLE PRIMARY AND HISTOLOGY (MP/H) CODING RULES 2014-2015 NAACCR We b inar Se rie s De c e mbe r 4, 2014 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

slide-1
SLIDE 1

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 1

USING THE MULTIPLE PRIMARY AND HISTOLOGY (MP/H) CODING RULES

2014-2015 NAACCR We b inar Se rie s De c e mbe r 4, 2014

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 inar.

2

F ABUL O US PRIZES!!!

3

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SLIDE 2

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 2

MP/ H CO DING RUL E S

  • Rule s re visio n te nta tive ly pla nne d fo r 2016
  • Site g ro ups rule s with big g e st c hang e s will be be ta

te ste d

  • So lid tumo r da ta b a se
  • F

re e standing to o l

  • Co mpre he nsive g lo ssarie s
  • T

ra ining

  • SE

E R*E duc ate

4

MP/ H CO DING RUL E S

  • Ne w histo lo g y te rms
  • http:/ / www.na a c c r.o rg / L

inkClic k.a spx? file tic ke t=u7d3sB 71t5w%3d&ta b id=126&mid=466

  • Using mixe d histo lo g y c o de s
  • Che c k I

CD-O-3 Ma nua l to ma ke sure the re is no t a spe c ific c o de

  • E

xample

  • Se ro us c ysta de no c a rc ino ma
  • Assig n c o de 8441/ 3
  • Do no t a ssig n c o de 8323/ 3 (mixe d c e ll a de no c a rc ino ma )
  • Othe r site s rule s H5, H16, H30

5

MP/ H CO DING RUL E S

  • Se nd q ue stio ns to :
  • Ask a SE

E R Re g istrar

  • http:/ / se e r.c anc e r.g o v/ re g istrars/ c o ntac t.html

6

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SLIDE 3

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 3

CO L O N MP/ H RUL ES

7

Co lo n

MUL T IPL E PRIMARY RUL ES

8

MUL T IPL E PRIMARY RUL E S

  • Rule M1
  • Whe n it is no t po ssible to de te rmine if the re is a

sing le tumo r o r multiple tumo rs, o pt fo r a sing le tumo r and abstrac t as a sing le primary.

  • Rule M2
  • A sing le tumo r is always a sing le primary.

9

SING L E T UMOR UNKNOWN IF SINGL E OR MUL T IPL E T UMORS

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SLIDE 4

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 4

MUL T IPL E PRIMARY RUL E S

  • Rule M3
  • Ade no c a rc ino ma in a de no ma to us po lypo sis c o li

(fa milia l po lypo sis) with o ne o r mo re ma lig na nt po lyps is a sing le prima ry.

  • Rule M4
  • T

umo rs in site s with I CD-O-3 to po g ra phy c o de s tha t a re diffe re nt a t the se c o nd (Cxxx), third, (Cxxx) o r fo urth (C18x) c ha ra c te r a re multiple prima rie s.

  • Rule M5
  • T

umo rs dia g no se d mo re tha n o ne (1) ye a r a pa rt a re multiple prima rie s.

10

MUL T IPL E T UMORS

PO P Q UIZ

  • Wo uld a c o lo n tumo r re po rte d a s "re c urre nt a t

the a na sto mo tic junc tio n" just o ve r o ne ye a r a fte r the dia g no sis o f a T 4 c o lo n tumo r to b e c o unte d a s a ne w prima ry?

11

ANSWER

  • T

his is two prima rie s.

  • Rule M4 applie s.
  • Whe n a c o lo n re se c tio n has take n plac e , the
  • rig inal primary site is no lo ng e r pre se nt.

12

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SLIDE 5

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 5

MUL T IPL E PRIMARY RUL E S

  • Rule M6
  • An invasive tumo r fo llo wing an in situ tumo r mo re

than 60 days afte r diag no sis are multiple primarie s.

  • Rule M7
  • A fra nk ma lig na nt o r in situ a de no c a rc ino ma a nd

an in situ o r malig nant tumo r in a po lyp are a sing le prima ry.

  • Rule M8
  • Abstrac t as a sing le primary whe n o ne tumo r is a

mo re spe c ific type o f histo lo g y than the first.

13

MUL T IPL E T UMORS

MUL T IPL E PRIMARY RUL E S

  • Rule M9
  • Multiple in situ a nd/ o r ma lig na nt po lyps a re a sing le

prima ry.

  • Rule M10
  • T

umo rs with I CD-O-3 histo lo g y c o de s tha t a re diffe re nt a t the first (xxxx), se c o nd (xxxx) o r third (xxxx) numbe r a re multiple prima rie s.

  • Rule M11
  • T

umo rs tha t do no t me e t a ny o f the a bo ve c rite ria a re a sing le prima ry

14

MUL T IPL E T UMORS

  • He mic o le c to my: 2 tumo rs o f le ft c o lo n

1.

I nvasive we ll diffe re ntia te d muc ino us a de no c a rc ino ma a rising in tub ulo villo us a de no ma with pe ric o lo nic sub se ro sa l fa t invasio n, 8.5c m

2.

I nfiltra tive mo de ra te ly diffe re ntiate d c o lo nic a de no c a rc ino ma with inva sio n o f musc ula ris pro pria, 4c m

  • Ho w ma ny prima ry tumo rs a re pre se nt?
  • 1 prima ry
  • Wha t M rule wa s use d to de te rmine the numbe r o f

prima ry tumo rs?

  • M7

PO P Q UIZ

15

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SLIDE 6

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 6

  • T
  • ta l c o le c to my:

1.

Dista l tumo r: U lc e ra ting mo de ra te ly diffe re ntiate d c o lo nic a de no c a rc ino ma , 3.2 c m in g re a te st dime nsio n. T umo r inva de s thro ug h the musc ula ris pro pria into the sub se ro sa (pt3).

2.

Pro xima l tumo r: E xo phytic mo de ra te ly diffe re ntiate d c o lo nic a de no c a rc ino ma , 2.9 c m in g re a te st dime nsio n. T umo r inva de s sub muc o sa (pt1). Multiple tub ula r a de no ma s pre se nt thro ug ho ut the c o lo n, a ppro xima te c o unt g re a te r tha n 200.

  • Ho w ma ny prima ry tumo rs a re pre se nt?
  • 1 prima ry
  • Wha t M rule wa s use d to de te rmine the numbe r o f

prima ry tumo rs?

  • M3

PO P Q UIZ

16

HIST O L O G Y RUL ES

Co lo n

17

HIST O L O G Y RUL ES

  • Rule H1
  • Co de the histo lo g y do c ume nte d b y the physic ia n whe n

the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ila b le .

  • Rule H2
  • Co de the histo lo g y fro m a me ta sta tic site whe n the re is

no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

  • Rule H3
  • Co de 8140 (a de no c a rc ino ma , NOS) whe n pa tho lo g y

de sc rib e s o nly inte stina l type a de no c a rc ino ma o r a de no c a rc ino ma , inte stina l type .

18

SING L E T UMOR

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SLIDE 7

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 7

HIST O L O G Y RUL ES

  • Rule H4
  • Co de 8210 (a de no c a rc ino ma in a de no ma to us po lyp), 8261

(a de no c a rc ino ma in villo us a de no ma ), o r 8263 (a de no c a rc ino ma in tub ulo villo us a de no ma ) whe n:

  • T

he fina l dia g no sis is a de no c a rc ino ma in a po lyp

  • T

he fina l dia g no sis is a de no c a rc ino ma a nd a re sidua l po lyp o r po lyp a rc hite c ture is re c o rde d in o the r pa rts o f the pa tho lo g y re po rt.

  • T

he fina l dia g no sis is a de no c a rc ino ma a nd the re is re fe re nc e to a re sidua l

  • r pre -e xisting po lyp o r
  • T

he fina l dia g no sis is muc ino us/ c o llo id o r sig ne t ring c e ll a de no c a rc ino ma in a po lyp o r

  • T

he re is do c ume nta tio n tha t the pa tie nt ha d a po lype c to my

19

SING L E T UMOR

PO P Q UIZ

  • Co lo n: T

he fina l dia g no sis o n a pa th re po rt fo r a c o lo n spe c ime n sa ys: c a rc ino ma in situ in a se rra te d a de no ma . Sho uld I c o de it to :

  • 8010/ 2
  • 8210/ 2
  • 8213/ 2

SI NQ I D 20120089

20

HIST O L O G Y RUL ES- SING L E T UMO R

  • Rule H5
  • Co de 8480 (muc ino us/ c o llo id ade no c arc ino ma) o r

8490 (sig ne t ring c e ll c arc ino ma) whe n the final diag no sis is:

  • Muc ino us/ c o llo id (8480) o r sig ne t ring c e ll c a rc ino ma (8490)
  • r
  • Ade no c a rc ino ma , NOS a nd the mic ro sc o pic de sc riptio n

do c ume nts tha t 50% o r mo re o f the tumo r is muc ino us/ c o llo id o r

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

do c ume nts tha t 50% o r mo re o f the tumo r is sig ne t ring c e ll c a rc ino ma

21

SING L E T UMOR

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SLIDE 8

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 8

HIST O L O G Y RUL ES- SING L E T UMO R

  • Rule H6
  • Co de 8140 (ade no c arc ino ma , NOS) whe n the final

diag no sis is ade no c arc ino ma and:

  • 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 ino us/ c o llo id 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 sig ne t ring c e ll c a rc ino ma o 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 unkno wn

22

SING L E T UMOR

PO P Q UIZ

  • I

a m a little c o nfuse d a b o ut whe n yo u sho uld use c o de 8480 (muc ino us) ve rsus 8140 (a de no c a rc ino ma ).

  • Do e s the pa tho lo g y ha ve to sta te a pe rc e ntag e o f

muc in/ c o llo id in o rde r to use the c o de 8480? I f it is sta te d to be muc ino us c a rc ino ma o r muc ino us ade no c arc ino ma sho uld it b e c o de d to 8480?

  • I

have re vie we d rule H5 and H6 in the MPH manual and am still c o nfuse d.

23

ANSWER

  • I

f the fina l dia g no sis is muc ino us a de no c a rc ino ma , use c o de 8480 e ve n if the pe rc e nta g e o f muc ino us tumo r is no t do c ume nte d.

24

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SLIDE 9

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 9

PO P Q UIZ

  • Ho w do yo u use Rule H5 o r H6 to c o de

"mo de ra te ly diffe re ntia te d a de no c a rc ino ma with muc ino us c o mpo ne nt"?

25

ANSWER

  • Co de the histo lo g y 8140 (Ade no c a rc ino ma ,

NOS)

  • Rule H6 applie s be c ause the final diag no sis is no t

"muc ino us a de no c a rc ino ma " a nd the pe rc e ntag e

  • f muc ino us a de no c a rc ino ma is no t sta te d.
  • Rule H13 do e s no t a pply b e c a use "c o mpo ne nt" is

no t a te rm tha t indic ate s a spe c ific histo lo g y.

SI NQ I D 20081098

26

HIST O L O G Y RUL ES

  • Rule 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 o mb ina tio n o f muc ino us/ c o llo id a nd sig ne t ring c e ll c a rc ino ma.

  • Rule H8
  • Co de 8240 (c a rc ino id tumo r, NOS) whe n the dia g no sis is

ne uro e ndo c rine c a rc ino ma (8246) a nd c a rc ino id tumo r (8240).

  • Rule H9
  • Co de 8244 (c o mpo site c a rc ino id) whe n the dia g no sis is

a de no c a rc ino ma a nd c a rc ino id tumo r.

  • Rule H10
  • Co de 8245 (a de no c a rc ino id) whe n the dia g no sis is e xa c tly

“a de no c a rc ino id.”

27

SING L E T UMOR

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SLIDE 10

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 10

PO P Q UIZ

  • Wha t rule a pplie s a nd ho w is histo lo g y c o de d if

a c o lo n tumo r is c o mpo se d o f mo de ra te ly diffe re ntia te d a de no c a rc ino ma a nd ne uro e ndo c rine tumo r, g ra de 1 (G1)?

28

ANSWER

  • Ne uro e ndo c rine tumo r, g ra de 1 (G1) is

syno nymo us with c a rc ino id tumo r (8240/ 3) fo r the purpo se o f rule H9.

  • F

inal histo lo g y wo uld b e 8244

SI NQ I D 20130007

29

HIST O L O G Y RUL ES

  • Rule H11
  • Co de the histo lo g y whe n o nly o ne histo lo g ic type is

ide ntifie d.

  • Rule H12
  • Co de the inva sive histo lo g y whe n b o th inva sive a nd in situ

histo lo g ie s a re pre se nt.

  • Rule H13
  • Co de the mo re spe c ific histo lo g ic te rm whe n the dia g no sis is

a mo re spe c ific histo lo g ic te rm a nd a re la te d b ut le ss spe c ific histo lo g ic te rm.

  • Rule H14
  • Co de the histo lo g y with the nume ric ally hig he r I

CD-O-3 c o de .

30

SING L E T UMOR

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SLIDE 11

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 11

HIST O L O G Y RUL ES

  • Rule H15
  • Co de the histo lo g y do c ume nte d by the physic ian

whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the patho lo g y/ c yto lo g y re po rt is no t available .

  • Rule H16
  • Co de the histo lo g y fro m a me tasta tic site whe n

the re is no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

31

MUL T IPL E T UMORS

HIST O L O G Y RUL ES

  • Rule H17
  • Co de 8220 (ade no c arc ino ma in ade no mato us

po lypo sis c o li) whe n:

  • Clinic al histo ry sa ys fa milial po lypo sis a nd fina l dia g no sis o n

the pa tho lo g y re po rt fro m re se c tio n is a de no c a rc ino ma in a de no ma to us po lyps o r

  • T

he re a re >100 po lyps ide ntifie d in the re se c te d spe c ime n

  • r
  • T

he numb e r o f po lyps is no t g ive n b ut the dia g no sis is fa milia l po lypo sis

32

MUL T IPL E T UMORS

HIST O L O G Y RUL ES

  • Rule H18
  • Co de 8263 (ade no c arc ino ma in a tubulo villo us

ade no ma) whe n multiple in situ o r malig nant po lyps are pre se nt, at le ast o ne o f whic h is tubulo villo us

33

MUL T IPL E T UMORS

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SLIDE 12

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 12

HIST O L O G Y RUL ES

  • Rule H19
  • Co de 8221 (ade no c arc ino ma in multiple

ade no mato us po lyps) whe n:

  • T

he re a re >1 a nd <=100 po lyps ide ntifie d in the re se c te d spe c ime n o r

  • T

he re a re multiple po lyps (a de no ma s) a nd the numb e r is no t g ive n a nd fa milial po lypo sis is no t me ntio ne d.

34

MUL T IPL E T UMORS

HIST O L O G Y RUL ES

  • Rule H20
  • Co de the histo lo g y o f the mo st invasive tumo r whe n:
  • T

he re is a fra nk a de no c a rc ino ma a nd a c a rc ino ma in a po lyp o r

  • T

he re a re in situ a nd inva sive tumo rs o r

  • T

he re a re multiple inva sive tumo rs

35

MUL T IPL E T UMORS

HIST O L O G Y RUL ES

  • Rule H21
  • Co de 8210 (a de no c a rc ino ma in a de no ma to us po lyp),

8261 (a de no c a rc ino ma in villo us a de no ma ), o r 8263 (a de no c a rc ino ma in tub ulo villo us a de no ma ) whe n:

  • T

he fina l dia g no sis is a de no c a rc ino ma a nd the mic ro sc o pic de sc riptio n o r surg ic a l g ro ss de sc ribe s po lyps o r

  • T

he fina l dia g no sis is a de no c a rc ino ma a nd the re is re fe re nc e to re sidua l o r pre -e xisting po lyps o r

  • T

he fina l dia g no sis is muc ino us/ c o llo id o r sig ne t ring c e ll a de no c a rc ino ma in po lyps o r

  • T

he re is do c ume nta tio n tha t the pa tie nt ha d a po lype c to my

36

MUL T IPL E T UMORS

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SLIDE 13

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 13

  • T
  • tal c o le c to my:

1.

Dista l tumo r: U lc e ra ting mo de ra te ly diffe re ntiate d c o lo nic a de no c a rc ino ma , 3.2 c m in g re a te st dime nsio n. T umo r inva de s thro ug h the musc ula ris pro pria into the sub se ro sa (pt3).

2.

Pro xima l tumo r: E xo phytic mo de ra te ly diffe re ntiate d c o lo nic a de no c a rc ino ma a rising in a tub ular a de no ma me a suring 2.9 c m in g re a te st dime nsio n. T umo r invade s sub muc o sa (pt1).

3.

Multiple tub ular a de no ma s pre se nt thro ug ho ut the c o lo n, a ppro xima te c o unt g re a te r tha n 200.

  • Wha t is (are ) the histo lo g y c o de (s)?
  • 8220/ 3 Ade no c a rc ino ma in a de no ma to us po lypo sis c o li
  • Wha t H rule was use d to c o de the histo lo g y?
  • H17

PO P Q UIZ

37

HIST O L O G Y RUL ES

  • Rule H22
  • Co de the histo lo g y whe n o nly o ne histo lo g ic type is

ide ntifie d.

  • Rule H23
  • Co de the mo re spe c ific histo lo g ic te rm whe n the

dia g no sis is a mo re spe c ific histo lo g ic te rm a nd a re la te d b ut le ss spe c ific histo lo g ic te rm.

  • Rule H24
  • Co de the histo lo g y with the nume ric a lly hig he r I

CD-O-3 c o de .

38

MUL T IPL E T UMORS

  • He mic o le c to my: 2 tumo rs o f le ft c o lo n

1.

I nva sive we ll diffe re ntia te d muc ino us a de no c a rc ino ma a rising in tub ulo villo us a de no ma with pe ric o lo nic sub se ro sa l fa t inva sio n, 8.5c m

2.

I nfiltra tive mo de ra te ly diffe re ntia te d c o lo nic a de no c a rc ino ma with inva sio n o f musc ula ris pro pria , 4c m

  • What is (are ) the histo lo g y c o de (s)?
  • 8263/ 3 Ade no c a rc ino ma in tub ulo villo us a de no ma
  • What H rule was use d to c o de the histo lo g y?
  • H20

PO P Q UIZ

39

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SLIDE 14

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 14

CO L O N CASE SCENARIO

Que stio ns?

40

RENAL PEL VIS, URET ER, BL ADDER, AND O T HER URINARY

Using the MP/ H Co ding Rule s

41

URINARY T ERMS & DEF INIT IO NS

  • F

lat tumo r/ No n-invasive flat transitio nal c e ll c a rc ino ma

  • L

ie s fla t a g a inst b la dde r tissue

  • I

n situ tumo r

  • Co nfine d to e pithe lium

with no pe ne tra tio n o f b a se me nt me mb ra ne

  • I

ntra muc o sa l tumo r

  • Within muc o sa l surfa c e
  • I

nvasive tumo r

  • Pe ne tra te s b e yo nd

b a se me nt me mb ra ne

  • No n-invasive tumo r
  • Co nfine d to e pithe lium

with no pe ne tra tio n o f b a se me nt me mb ra ne

  • Papillary tumo r
  • Wa rty g ro wth tha t is

a tta c he d to the wa ll b y a sta lk

42

slide-15
SLIDE 15

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 15

T ABL E 1: URO T HEL IAL T UMO RS

Urothe lia l/ T ra nsitiona l Ce ll T umors Code

With sq ua mo us diffe re ntiatio n 8120 With g la ndular diffe re ntiatio n With tro pho b lastic diffe re ntiatio n Ne ste d Mic ro c ystic T ra nsitio nal c e ll, NOS Pa pilla ry c a rc ino ma 8130 Pa pilla ry tra nsitio nal c e ll

43

T ABL E 1: URO T HEL IAL T UMO RS (CO NT .)

Urothe lia l/ T ra nsitiona l Ce ll T umors

Code

Mic ro papillary 8131 L ympho e pithe lio ma -like 8082 Pla sma c yto id Sa rc o ma to id 8122 Gia nt c e ll 8031 U ndiffe re ntia te d 8020

44

MUL T IPL E PRIMARY (MP) RUL E S: URINARY

  • Unkno wn if Sing le o r Multiple T

umo rs

  • M1: Whe n it is no t po ssible to de te rmine if the re is a

sing le tumo r o r multiple tumo rs, o pt fo r a sing le tumo r and abstrac t as a sing le primary.

  • Sing le T

umo r

  • M2: A sing le tumo r is always a sing le primary.

45

slide-16
SLIDE 16

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 16

MP RUL ES: URINARY MUL T IPL E T UMO RS

  • M3: Whe n no o the r urina ry site s a re invo lve d,

tumo r(s) in the rig ht re na l pe lvis AND tumo r(s) in the le ft re na l pe lvis a re multiple prima rie s.

  • M4: Whe n no o the r urina ry site s a re invo lve d,

tumo r(s) in b o th the rig ht ure te r AND tumo r(s) in the le ft ure te r a re multiple prima rie s.

  • M5: An inva sive tumo r fo llo wing a no n-inva sive
  • r in situ tumo r mo re tha n 60 da ys a fte r

dia g no sis is a multiple prima ry.

46

PO P Q UIZ

  • 9/ 20/ 13 L

e ft ure te r & kidne y re se c tio n: I nva sive tra nsitio na l c e ll c a rc ino ma , 1 c m, le ft ure te r

  • 2/ 5/ 14 E

xc isio n o f le sio n rig ht ure te r: No ninva sive pa pilla ry tra nsitio na l c e ll c a rc ino ma , 6 mm.

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt

ha ve , a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 prima ry tumo rs pe r M4

47

PO P Q UIZ

  • 12/ 12/ 13 Cysto sc o py with bio psy: No ninvasive

papillary transitio nal c e ll c arc ino ma o f late ral b ladde r wall

  • 2/ 26/ 14 Cysto sc o py with bio psy: T

ra nsitio na l c e ll c arc ino ma o f b ladde r ne c k invade s lamina pro pria

  • Ho w many primary tumo rs do e s the pa tie nt ha ve ,

a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 prima ry tumo rs pe r M5

48

slide-17
SLIDE 17

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 17

MP RUL ES: URINARY MUL T IPL E T UMO RS

  • M6: Bla dde r tumo rs with a ny c o mb ina tio n o f

the fo llo wing histo lo g ie s:

  • Papillary c arc ino ma (8050)
  • T

ransitio nal c e ll c arc ino ma (8120-8124)

  • Papillary transitio nal c e ll c arc ino ma (8130-8131)

a re a sing le prima ry.

  • M7: T

umo rs dia g no se d mo re tha n thre e (3) ye a rs a pa rt a re multiple prima rie s.

49

PO P Q UIZ

  • 1/ 8/ 08: T

U RB: Sma ll 5 mm tra nsitio na l c e ll c a rc ino ma la te ra l bla dde r wa ll invade s submuc o sa .

  • 1/ 26/ 11: T

U RB: U ro the lia l c a rc ino ma with squa mo us diffe re ntiatio n o f bla dde r trig o ne , 8 mm; T 1.

  • 2/ 3/ 14 T

U RB: F

  • c us o f pa pillary tra nsitio na l c e ll

c a rc ino ma in bla dde r ne c k invo lve s la mina pro pria .

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt ha ve , a nd

wha t M rule wa s use d to de te rmine tha t?

  • 1 prima ry tumo r pe r M6

50

PO P Q UIZ

  • 1/ 19/ 11: T

URB: Uro the lia l c a rc ino ma o f b la dde r trig o ne , 8 mm; T 1.

  • 2/ 6/ 14 E

xc isio n o f le sio n rig ht ure te r: Pa pilla ry uro the lia l c a rc ino ma , rig ht ure te r, invo lve s la mina pro pria .

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt

ha ve , a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 prima ry tumo rs pe r M7

51

slide-18
SLIDE 18

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 18

MP RUL ES: URINARY MUL T IPL E T UMO RS

  • M8: Uro the lia l tumo rs in two o r mo re o f the

fo llo wing site s a re a sing le prima ry. (Se e T a b le 1.)

  • Re nal pe lvis (C659)
  • Ure te r(C669)
  • Bladde r (C670-C679)
  • Ure thra / pro sta tic ure thra (C680)

52

PO P Q UIZ

  • 1/ 19/ 13 T

U RBT : Pa pillary uro the lial c a rc ino ma , hig h g ra de , no ninva sive o f rig ht la te ra l bla dde r wa ll

  • 3/ 18/ 13 L

e ft re na l pe lvis bio 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

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt ha ve , a nd

wha t M rule wa s use d to de te rmine tha t?

  • 1 prima ry tumo r pe r M8
  • Wha t is the c o de fo r prima ry site

a.

C65.9 Re na l pe lvis

b.

C67.2 L a te ra l wa ll o f b la dde r

c .

C68.9 U rina ry syste m NOS

53

SI NQ 20120048; SI NQ 20140047

MP RUL ES: URINARY MUL T IPL E T UMO RS

  • M9: T

umo rs with I CD-O-3 histo lo g y c o de s tha t a re diffe re nt a t the first (xxxx), se c o nd (xxxx) o r third (xxxx) numb e r a re multiple prima rie s.

  • M10: T

umo rs in site s with I CD-O-3 to po g ra phy c o de s with diffe re nt se c o nd (Cxxx) a nd/ o r third c ha ra c te rs (Cxxx) a re multiple prima rie s.

  • M11: T

umo rs tha t do no t me e t a ny o f the a b o ve c rite ria a re a sing le prima ry.

54

slide-19
SLIDE 19

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 19

PO P Q UIZ

  • 1/ 18/ 13: T

URB: Uro the lia l c a rc ino ma o f b la dde r trig o ne , 8 mm; T 1.

  • 2/ 6/ 14 T

URB: F

  • c us o f sq ua mo us c e ll

c a rc ino ma in b la dde r ne c k invo lve s la mina pro pria .

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt

ha ve , a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 prima ry tumo rs pe r M9

55

PO P Q UIZ

  • 7/ 18/ 13: T

URB: Sq ua mo us c e ll c a rc ino ma in b la dde r ne c k invo lve s la mina pro pria .

  • 2/ 6/ 14 L

e ft uppe r lo b e lung b io psy: Sq ua mo us c e ll c a rc ino ma

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt

ha ve , a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 prima ry tumo rs pe r M10

56

HIST O L O G Y CO DING RUL ES: URINARY SING L E T UMO R

  • H1: Co de the histo lo g y do c ume nte d by the

physic ia n whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ila b le .

  • H2: Co de the histo lo g y fro m the me ta sta tic site

whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

57

slide-20
SLIDE 20

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 20

HIST O L O G Y CO DING RUL ES: URINARY SING L E T UMO R

  • H3: Co de 8120 (transitio nal c e ll/ uro the lial

c arc ino ma) (T able 1 - Co de 8120) whe n the re is:

  • Pure tra nsitio na l c e ll c a rc ino ma
  • F

la t (no n-pa pilla ry) tra nsitio na l c e ll c a rc ino ma

  • T

ra nsitio na l c e ll c a rc ino ma with sq ua mo us diffe re ntia tio n

  • T

ra nsitio na l c e ll c a rc ino ma with g la ndula r diffe re ntia tio n

  • T

ra nsitio na l c e ll c a rc ino ma with tro pho b la stic diffe re ntia tio n

  • Ne ste d tra nsitio na l c e ll c a rc ino ma
  • Mic ro c ystic tra nsitio na l c e ll c a rc ino ma

58

HIST O L O G Y CO DING RUL ES: URINARY SING L E T UMO R

  • H4: Co de 8130 (pa pilla ry tra nsitio na l c e ll

c a rc ino ma ) (T a b le 1 - Co de 8130) whe n the re is:

  • Papillary c arc ino ma
  • Papillary transitio nal c e ll c arc ino ma
  • Papillary c arc ino ma and transitio nal c e ll c arc ino ma

59

PO P Q UIZ

  • T

URBT : 1 c m pa pilla ry c a rc ino ma o f b la dde r ne c k.

  • Wha t is the histo lo g y c o de ?
  • 8050/ 3 Papillary c arc ino ma NOS
  • 8130/ 3 Papillary transitio nal c e ll c arc ino ma
  • Wha t is the histo lo g y c o ding rule tha t a pplie s?
  • H4

60

slide-21
SLIDE 21

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 21

HIST O L O G Y CO DING RUL ES: URINARY SING L E T UMO R

  • H5: Co de the histo lo g y whe n o nly o ne

histo lo g ic type is ide ntifie d

  • H6: Co de the inva sive histo lo g ic type whe n a

sing le tumo r ha s inva sive a nd in situ c o mpo ne nts.

61

HIST O L O G Y CO DING RUL ES: URINARY SING L E T UMO R

  • H7: Co de the mo st spe c ific histo lo g ic te rm:
  • 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

  • Ca rc ino ma, NOS (8010) a nd a mo re spe c ific c a rc ino ma
  • Sa rc o ma , NOS (8800) a nd a mo re spe c ific sa rc o ma (inva sive
  • nly)
  • No te 1: T

he spe c ific histo lo g y fo r in situ tumo rs may be ide ntifie d as patte rn, arc hite c ture , type , subtype , pre do minantly, with fe ature s o f, majo r, o r with ____diffe re ntiatio n

  • No te 2: T

he spe c ific histo lo g y fo r invasive tumo rs may be ide ntifie d as type , subtype , pre do minantly, with fe ature s o f, majo r, o r with ____diffe re ntiatio n.

  • H8: Co de the histo lo g y with the nume ric a lly hig he r I

CD- O-3 c o de .

62

PO P Q UIZ

  • Bla dde r bio psy: I

nvasive hig h g ra de uro the lia l c arc ino ma with c o mpo ne nt o f small c e ll c a rc ino ma (30%) with invasio n into musc ula ris pro pria pre se nt.

  • What is the histo lo g y c o de ?
  • 8041/ 3 Sma ll c e ll c a rc ino ma NOS
  • 8045/ 3 Co mb ine d sma ll c e ll c a rc ino ma
  • 8120/ 3 Uro the lia l c a rc ino ma NOS
  • Wha t is the histo lo g y c o ding rule tha t a pplie s?
  • H7

63

slide-22
SLIDE 22

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 22

PO P Q UIZ

  • SI

NQ que stio n 20140023

  • Rule H7 is a pplic a b le fo r this c a se b a se d o n the

info rma tio n pro vide d. T his tumo r ha s a mixe d histo lo g y, uro the lia l c a rc ino ma with c o mpo ne nt o f sma ll c e lls. I n g e ne ra l, b la dde r c a nc e rs o f sma ll c e ll type sho w a mo re a g g re ssive c linic a l c o urse tha n uro the lia l c e ll type , the mo re spe c ific histo lo g y c o de 8045/ 3, c o mb ine d sma ll c e ll c a rc ino ma , is pre fe ra b le fo r this c a se , c o mpa re d to the c o de 8120/ 3, uro the lia l c a rc ino ma , NOS, b e c a use the small c e ll c o mpo ne nt drive s the tre atme nt and surviva l. T his is a n e xc e ptio n to the c urre nt rule s. T he ne xt ve rsio n o f the rule s will c la rify this po int.

64

HIST O L O G Y CO DING RUL ES: URINARY MUL T IPL E T UMO RS SING L E PRIMARY

  • H9: Co de the histo lo g y do c ume nte d by the

physic ia n whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ila b le .

  • H10: Co de the histo lo g y fro m the me ta sta tic

site whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

65

HIST O L O G Y CO DING RUL ES: URINARY MUL T IPL E T UMO RS SING L E PRIMARY

  • H11: Co de 8120 (transitio nal c e ll/ uro the lial

c arc ino ma) (T able 1 - Co de 8120) whe n the re is:

  • Pure tra nsitio na l c e ll c a rc ino ma
  • F

la t (no n-pa pilla ry) tra nsitio na l c e ll c a rc ino ma

  • T

ra nsitio na l c e ll c a rc ino ma with sq ua mo us diffe re ntia tio n

  • T

ra nsitio na l c e ll c a rc ino ma with g la ndula r diffe re ntia tio n

  • T

ra nsitio na l c e ll c a rc ino ma with tro pho b la stic diffe re ntia tio n

  • Ne ste d tra nsitio na l c e ll c a rc ino ma
  • Mic ro c ystic tra nsitio na l c e ll c a rc ino ma

66

slide-23
SLIDE 23

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 23

HIST O L O G Y CO DING RUL ES: URINARY MUL T IPL E T UMO RS SING L E PRIMARY

  • H12: Co de 8130 (pa pilla ry tra nsitio na l c e ll

c a rc ino ma ) (T a b le 1 - Co de 8130) whe n the re is:

  • Papillary c arc ino ma
  • Papillary transitio nal c e ll c arc ino ma
  • Papillary c arc ino ma and transitio nal c e ll c arc ino ma

67

PO P Q UIZ

  • T

URBT : 1 c m tra nsitio na l c e ll c a rc ino ma b la dde r wa ll invo lve s la mina pro pria ; 0.8 c m pa pilla ry tra nsitio na l c e ll c a rc ino ma invo lve s the la mina pro pria .

  • Wha t is the histo lo g y c o de ?
  • 8120/ 3 T

ransitio nal c e ll c arc ino ma NOS

  • 8130/ 3 Papillary transitio nal c e ll c arc ino ma
  • Wha t is the histo lo g y c o ding rule tha t a pplie s?
  • H12

68

SI NQ 20140016

HIST O L O G Y CO DING RUL ES: URINARY MUL T IPL E T UMO RS SING L E PRIMARY

  • H13: Co de the histo lo g y whe n o nly o ne

histo lo g ic type is ide ntifie d.

  • H14: Co de the histo lo g y o f the mo st inva sive

tumo r.

  • H15: Co de the histo lo g y with the nume ric a lly

hig he r I CD-O-3 c o de .

69

slide-24
SLIDE 24

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 24

PO P Q UIZ

  • 1/ 19/ 13 T

URBT : Papillary uro the lial c arc ino ma, hig h g ra de , no ninva sive o f rig ht late ra l bla dde r wall

  • 3/ 18/ 13 L

e ft re nal pe lvis bio psy: Hig h g rade transitio nal c e ll c arc ino ma o f c alyx

  • What is the histo lo g y c o de ?
  • 8120/ 3 T

ra nsitio na l c e ll c a rc ino ma NOS

  • 8130/ 3 Pa pilla ry tra nsitio na l c e ll c a rc ino ma
  • Wha t is the histo lo g y c o ding rule tha t a pplie s?
  • H14

70

URINARY CASE SCENARIO

Que stio ns?

71

MUL IT PL E PRIMARY RUL ES

L ung

72

slide-25
SLIDE 25

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 25

  • Rule M1
  • Whe n it is no t po ssible to de te rmine if the re is a sing le tumo r
  • r multiple tumo rs, o pt fo r a sing le tumo r a nd a bstrac t a s a

sing le primary.

73

HIST O L O G Y RUL ES

UNKNOWN IF SINGL E OR MUL T IPL E T UMORS

  • Rule M2
  • A sing le tumo r is always a sing le primary.

74

MUL T IPL E PRIMARY RUL E S

SING L E T UMOR

  • Rule M3
  • T

umo rs in site s with I CD-O-3 to po g raphy c o de s tha t are diffe re nt at the se c o nd (Cxxx) and/ o r third c harac te r (Cxxx) are multiple primarie s.

  • Rule M4
  • At le ast o ne tumo r tha t is no n-small c e ll c arc ino ma (8046)

and ano the r tumo r tha t is small c e ll c arc ino ma (8041-8045) are multiple primarie s.

75

MUL T IPL E PRIMARY RUL E S

MUL T IPL E T UMORS

slide-26
SLIDE 26

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 26

76

  • Rule M5
  • A tumo r tha t is ade no c arc ino ma with mixe d subtype s

(8255) and ano the r tha t is b ro nc hio lo alve o lar (8250-8254) are multiple primarie s.

  • Rule M6
  • A sing le tumo r in e ac h lung is multiple primarie s.

77

MUL T IPL E PRIMARY RUL E S

MUL T IPL E T UMORS

Q UEST IO N

  • Sing le tumo r in le ft lung , sing le tumo r in rig ht lung . T

he rule s ta ke yo u to M6.

  • Suppo se the tumo r in le ft lung is b io psie d (sq ua mo us

c e ll c a rc ino ma )a nd the re is a physic ia n sta te me nt tha t rig ht lung ma ss is me ta sta tic fro m le ft lung tumo r.

  • I

n this c ase , is it a sing le primary o r multiple primarie s?

78

slide-27
SLIDE 27

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 27

ANSWER

  • Whe n the re is a sing le tumo r in o ne lung a nd a sing le

tumo r in the o the r lung , a pply rule M6 a nd a b stra c t a s multiple prima rie s. Use this rule whe ne ve r the re is a sing le tumo r in e a c h lung , e ve n whe n ne ithe r tumo r is b io psie d o r re se c te d.

  • T

he rig ht uppe r lo b e ma ss wo uld b e a ssig ne d a histo lo g y o f 8070/ 3 (sq ua mo us c e ll c a rc ino ma ) a nd the “ma ss” wo uld b e a ssig ne d a histo lo g y o f 8000 (ma lig na nc y, no s)

79

L ung SE E R SI NQ 20071051

MUL T IPL E PRIMARY RUL E S

  • Rule M7
  • Multiple tumo rs in bo th lung s with I

CD-O-3 histo lo g y c o de s tha t are diffe re nt at the first (xxxx), se c o nd (xxxx) o r third (xxxx) numbe r are multiple primarie s.

  • Rule M8
  • T

umo rs diag no se d mo re than thre e (3) ye ars apart are multiple primarie s.

80

MUL T IPL E T UMORS

  • Rule M9
  • An invasive tumo r fo llo wing an in situ tumo r mo re than 60

days afte r diag no sis is a multiple primary.

  • Rule M10
  • T

umo rs with no n-small c e ll c arc ino ma, NOS (8046) and a mo re spe c ific no n-small c e ll c arc ino ma type (Chart 1) are a sing le primary.

81

MUL T IPL E PRIMARY RUL E S

MUL T IPL E T UMORS

slide-28
SLIDE 28

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 28

  • Rule M11
  • T

umo rs with I CD-O-3 histo lo g y c o de s tha t a re diffe re nt a t the first (xxxx), se c o nd (xxxx) o r third (xxxx) numbe r are multiple primarie s.

  • Rule M12
  • T

umo rs tha t do no t me e t a ny o f the a bo ve c rite ria a re a sing le primary.

82

MUL T IPL E PRIMARY RUL E S

MUL T IPL E T UMORS

PO P Q UIZ

  • L

ung , rig ht lo we r lo be , we dg e e xc isio n (A): I nva sive mo de ra te ly diffe re ntiate d a de no c a rc ino ma with fo c a l le pidic pa tte rn (pT 1a , pN0).

  • L

ung rig ht lo we r lo be , c o mple tio n lo be c to my (F ): Se pa ra te fo c us o f we ll diffe re ntia te d a de no c a rc ino ma with le pidic pa tte rn (4mm) (se e c o mme nt).

  • COMME

NT : T he b lo c k F 7 sho ws a mic ro sc o pic fo c us o f a de no c a rc ino ma with le pidic g ro wth pa tte rn. T his mo st like ly re pre se nts a se pa ra te prima ry tumo r sinc e the sta ple d ma rg ins we re a ll ne g a tive fo r invo lve me nt. T his fo c us me a sure s le ss tha n 0.4 c m.

  • T

umo r fo c a lity: Mo st like ly two se pa ra te prima ry tumo r no dule s. Histo lo g ic type : a de no c a rc ino ma , mixe d type (NOS a nd le pidic type ).

83

ANSWER

  • Ac c e ssio n a sing le prima ry, a de no c a rc ino ma

[8140/ 3] o f the rig ht lo we r lo b e lung .

L ung SE E R SI NQ 20130072

84

slide-29
SLIDE 29

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 29

L E PIDIC

  • "L

e pidic " is a g ro wth pa tte rn me a ning tha t tumo r c e lls a re g ro wing a lo ng the a lve o la r se pta .

  • I

t is c ha ra c te ristic o f b ro nc hio lo a lve o la r c a rc ino ma (BAC), b ut no t dia g no stic o f it.

  • I

t is no t c o nside re d a type / sub type o f a de no c a rc ino ma .

  • F
  • r le pidic lung ne o pla sms, c o de the histo lo g y

indic a te d, fo r e xa mple BAC.

85

PO P Q UIZ

  • Ho w ma ny prima rie s sho uld b e re po rte d whe n

a pa tie nt ha s a histo ry o f RL L a de no c a rc ino ma dia g no se d o n 10/ 8/ 2009 fo llo we d b y dia g no se s o f L UL a de no c a rc ino ma o n 10/ 5/ 2012 a nd a RUL a de no c a rc ino ma o n 3/ 26/ 2014?

86

ANSWER

  • Assuming e a c h o f the thre e dia g no se s is a

sing le tumo r a nd the re a re no o the r tumo rs in e ithe r lung , a b stra c t two prima rie s: 1 in the RL L dia g no se d o n 10/ 8/ 2009 a nd 1 in the L UL dia g no se d o n 10/ 5/ 2012. Do no t a b stra c t the 3/ 26/ 2014 dia g no sis a s a ne w prima ry.

L ung SE E R SI NQ 20140062

87

slide-30
SLIDE 30

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 30

HIST O L O G Y RUL ES

L ung

88

  • Rule H1
  • Co de the histo lo g y do c ume nte d b y the physic ia n whe n the re is no

pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ilable .

  • Rule H2
  • Co de the histo lo g y fro m a me ta sta tic site whe n the re is no

pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

  • Rule H3
  • Co de the histo lo g y whe n o nly o ne histo lo g ic type is ide ntifie d.

89

HIST O L O G Y RUL ES

SING L E T UMOR

PO P Q UIZ

  • Ho w is histo lo g y c o de d whe n the re is a lung

b io psy c o mpa tib le with no n-sma ll c e ll c a rc ino ma a nd re g io na l lymph no de b io psie s c o mpa tib le with a de no c a rc ino ma ?

90

slide-31
SLIDE 31

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 31

ANSWER

  • Co de histo lo g y b a se d o n a pa tho lo g y re po rt

fro m the prima ry site whe ne ve r po ssib le . Co de histo lo g y to 8046/ 3 [no n-sma ll c e ll c a rc ino ma ] fo r the c a se e xa mple pro vide d.

L ung SE E R SI NQ 20100062

91

  • Rule H4
  • Co de the invasive histo lo g ic type whe n a sing le tumo r ha s

invasive and in situ c o mpo ne nts.

  • Rule H5
  • Co de the mo st spe c ific te rm using Cha rt 1 whe n the re a re

multiple histo lo g ie s within the same branc h.

92

HIST O L O G Y RUL ES

SING L E T UMOR

PO P Q UIZ

  • F

I NAL PAT HOL OGI C DI AGNOSI S: CT

  • g uide d

ne e dle b io psie s: Po sitive fo r ma lig na nc y, c o nsiste nt with a de no c a rc ino ma .

  • Co mme nt: the a de no c a rc ino ma pre se nt a lso sho ws

rare CD56 staining whic h indic ate s a ne uro e ndo c rine c o mpo ne nt.

  • Wha t is the c o rre c t histo lo g y c o de fo r this lung

tumo r?

93

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 32

ANSWER

  • Assig n histo lo g y c o de 8140/ 3,

a de no c a rc ino ma , b a se d o n the fina l dia g no sis. T he ne uro e ndo c rine c o mpo ne nt in this c a se is no t a no the r histo lo g y, no r is it a mo re spe c ific a de no c a rc ino ma . “Co mpo ne nt” is no t o ne o f the wo rds tha t we use to indic a te a mo re spe c ific histo lo g y.

L ung SE E R SI NQ 20140060

94

  • Rule H6
  • Co de the a ppro pria te c o mbina tio n/ mixe d c o de (T

a ble 1) whe n the re a re multiple spe c ific histo lo g ie s o r whe n the re is a no n-spe c ific with multiple spe c ific histo lo g ie s.

  • Rule H7
  • Co de the histo lo g y with the nume ric a lly hig he r I

CD-O-3 c o de .

95

HIST O L O G Y RUL ES

SING L E T UMOR

96

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 33

PO P Q UIZ

  • Ho w is histo lo g y c o de d fo r a sing le tumo r with

a dia g no sis o f sq ua mo us c a rc ino ma a nd la rg e c e ll undiffe re ntia te d ne uro e ndo c rine c a rc ino ma ?

97

ANSWER

  • Apply rule H7 a nd c o de the nume ric a lly hig he r

I CD-O-3 c o de , 8070/ 3 (Sq ua mo us c e ll c a rc ino ma ).

  • Se e Cha rt 1, the histo lo g y tre e in lung

e quiva le nt te rms.

  • L

a rg e c e ll ne uro e ndo c rine c a rc ino ma is histo lo g y c o de 8013/ 3.

  • T

he o the r histo lo g y is squamo us c arc ino ma, 8070/ 3. 8070/ 3 is hig he r nume ric ally than 8013/ 3.

98

L ung SE E R SI NQ 20100078

  • Rule H8
  • Co de the histo lo g y do c ume nte d b y the physic ia n whe n the re is no

pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ilable .

  • Rule H9
  • Co de the histo lo g y fro m a me ta sta tic site whe n the re is no

pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

  • Rule H10
  • Co de the histo lo g y whe n o nly o ne histo lo g ic type is ide ntifie d.

99

HIST O L O G Y RUL ES

MUL T IPL E T UMORS

slide-34
SLIDE 34

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 34

  • Rule H11
  • Co de the histo lo g y o f the mo st invasive tumo r.
  • Rule H12
  • Co de the mo st spe c ific te rm using Cha rt 1 whe n the re a re

multiple histo lo g ie s within the same branc h.

100

HIST O L O G Y RUL ES

MUL T IPL E T UMORS

PO P Q UIZ

  • T

he fina l dia g no sis is "a de no c a rc ino ma in situ/ BAC" a nd the c o mme nt sta te s, “T he finding s in the c urre nt b io psy a re mo st c o mpa tib le with lo w g ra de ma lig na nt le sio ns whic h, in this sa mple , sho ws fe a ture s o f a de no c a rc ino ma in situ (fo rme r b ro nc hio lo a lve o la r a de no c a rc ino ma )

  • Wha t histo lo g y c o de sho uld I

use ?

101

ANSWER

  • Co de the histo lo g y to 8140/ 2

[a de no c a rc ino ma in situ, NOS].

L ung SE E R SI NQ 20130093

102

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SLIDE 35

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 35

L UNG CASE SCENARIO

Que stio ns?

103

BREAST

Using the MP/ H Co ding Rule s

104

EQ UIVAL E NT O R EQ UAL T ERMS: BREAST

  • And, with (use d in

histo lo g y rule s, i.e . duc t a nd lo b ula r is e q uiva le nt to duc t with lo b ula r)

  • Duc t, duc ta l
  • Ma mma ry, b re a st
  • Muc ino us, c o llo id
  • NOS, NST
  • T

umo r, ma ss, le sio n, ne o pla sm

  • Syno nyms fo r “in situ”
  • Be ha vio r c o de ‘ 2’
  • DCI

S

  • I

ntra c ystic

  • I

ntra duc ta l

  • No ninfiltrating
  • No ninva sive

105

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SLIDE 36

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 36

T ABL E 1: INT RADUCT AL CARCINO MA

ICD- O - 3 Code T ype

8201 Crib rifo rm 8230 So lid 8401 Apo c rine 8500 I ntra duc ta l, NOS 8501 Co me do 8503 Pa pilla ry 8504 I ntra c ystic c a rc ino ma 8507 Mic ro papillary/ Cling ing

106

T ABL E 2: DUCT AL CARCINO MA

ICD- O - 3 Code T ype

8022 Ple o mo rphic c a rc ino ma 8035 Ca rc ino ma with o ste o c la st-like c e lls 8500 Duc t, NOS 8501 Co me do c a rc ino ma 8502 Se c re to ry c a rc ino ma o f b re a st 8503 I ntra duc ta l pa pillary a de no c a rc ino ma with inva sio n 8508 Cystic hype rse c re to ry c a rc ino ma

107

T ABL E 3: CO MBINAT IO N CO DES F O R BREAST CANCER

108

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SLIDE 37

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 37

T ABL E 3: CO MBINAT IO N CO DES F O R BREAST CANCER

109

MP RUL ES: BREAST

  • Unkno wn if Sing le o r Multiple T

umo rs

  • M1: Whe n it is no t po ssible to de te rmine if the re is a

sing le tumo r o r multiple tumo rs, o pt fo r a sing le tumo r and abstrac t as a sing le primary.

  • Sing le T

umo r

  • M2: I

nfla mma to ry c a rc ino ma in o ne o r b o th b re a sts is a sing le primary.

  • M3: A sing le tumo r is always a sing le primary.

110

MP RUL ES: BREAST MUL T IPL E T UMO RS

  • M4: T

umo rs in site s with I CD-O-3 to po g ra phy c o de s (Cxxx) with diffe re nt se c o nd (Cxxx) a nd/ o r third c ha ra c te rs (Cxxx) a re multiple prima rie s.

  • M5: T

umo rs dia g no se d mo re tha n five (5) ye a rs a pa rt a re multiple prima rie s.

  • M6: I

nfla mma to ry c a rc ino ma in o ne o r b o th b re a sts is a sing le prima ry.

111

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 38

PO P Q UIZ

  • 6/ 2008 Ne e dle bio psy rig ht bre ast c anc e r: Invasive

c arc ino ma

  • 7/ 2008 L

umpe c to my: Infiltrating duc tal c arc ino ma

  • 7/ 2008 Che mo the rapy
  • 1/ 2009 Bilate ral maste c to my and re c o nstruc tio n: No re sidual

bre a st tumo r; 1 po sitive rig ht a xillary lymph no de .

  • 12/ 2013 Ne e dle bio psy at 2:00 rig ht re c o nstruc te d bre ast:

Invasive c arc ino ma

  • 1/ 2014 L

umpe c to my rig ht bre ast: Po o rly diffe re ntiate d infiltrating duc tal c anc e r, b re ast tissue

112

PO P Q UIZ

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt

ha ve , a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 pe r M5

113

SI NQ 20120062

MP RUL ES: BREAST MUL T IPL E T UMO RS

  • M7: T

umo rs o n b o th side s (rig ht a nd le ft b re a st) a re multiple prima rie s.

  • M8: An inva sive tumo r fo llo wing a n in situ tumo r

mo re tha n 60 da ys a fte r dia g no sis is a multiple prima ry.

  • M9: T

umo rs tha t a re intra duc ta l o r duc t a nd Pa g e t Dise a se a re a sing le prima ry.

  • M10: T

umo rs tha t a re lo b ula r (8520) a nd intra duc ta l o r duc t a re a sing le prima ry.

114

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 39

PO P Q UIZ

  • A 1.2 c m lo bular c arc ino ma was inc ide ntally

disc o ve re d during the wo rk-up o f the pa tie nt’ s le ft bre a st tha t wa s infla mma to ry c a rc ino ma with c o re b io psy diag no sing duc tal c arc ino ma with a po c rine fe a ture s. T he lo bular c a rc ino ma o n the rig ht wa s lo c a lize d witho ut a ny skin invo lve me nt.

  • Ho w many primary tumo rs do e s the pa tie nt ha ve ,

a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 tumo rs pe r M7

115

SI NQ 20120095

MP RUL ES: BREAST MUL T IPL E T UMO RS

  • M11: Multiple intra duc ta l a nd/ o r duc t

c a rc ino ma s a re a sing le prima ry.

  • M12: T

umo rs with I CD-O-3 histo lo g y c o de s tha t a re diffe re nt a t the first (xxxx), se c o nd (xxxx) o r third (xxxx) numb e r a re multiple prima rie s.

  • M13: T

umo rs tha t do no t me e t a ny o f the a b o ve c rite ria a re a b stra c te d a s a sing le prima ry.

116

PO P Q UIZ

  • Rig ht b re a st ma ste c to my: 2.3 c m tumo r with

infiltra ting duc t a nd lo b ula r c a rc ino ma ; Pa g e t dise a se o f the nipple .

  • Ho w ma ny prima ry tumo rs do e s the pa tie nt

ha ve , a nd wha t M rule wa s use d to de te rmine tha t?

  • 2 pe r M12

117

SI NQ 20130205

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 40

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: IN SIT U O NL Y

  • H1: Co de the histo lo g y do c ume nte d by the

physic ia n whe n the pa tho lo g y/ c yto lo g y re po rt is no t a va ila b le .

  • H2: Co de the histo lo g y whe n o nly o ne

histo lo g ic type is ide ntifie d.

118

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: IN SIT U O NL Y

  • H3: Co de the mo re spe c ific histo lo g ic te rm whe n

the dia g no sis is:

  • Ca rc ino ma in situ, NOS (8010) a nd a spe c ific c a rc ino ma

in situ o r

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

a de no c a rc ino ma in situ o r

  • I

ntra duc ta l c a rc ino ma , NOS (8500) a nd a spe c ific intra duc ta l c a rc ino ma (T a b le 1)

  • H4: Co de 8501/ 2 (c o me do c arc ino ma, no n-

infiltra ting ) whe n the re is no n-infiltra ting c o me do c arc ino ma and any o the r intraduc tal c arc ino ma (T able 1).

119

PO P Q UIZ

  • Rig ht b re a st lumpe c to my: I

ntra duc ta l c a rc ino ma with so lid fe a ture s.

  • Wha t is the histo lo g y c o de ?

a . 8230/ 2 Duc tal c arc ino ma in situ, so lid type b . 8500/ 2 I

ntraduc tal c arc ino ma, no ninfiltrating , NOS

c . 8523/ 2 intraduc tal mixe d with o the r type s o f

c a rc ino ma

  • Wha t is histo lo g y c o ding rule a pplie s?
  • H3

120

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SLIDE 41

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 41

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: IN SIT U O NL Y

  • H5: Co de 8522/ 2 (intra duc ta l c a rc ino ma a nd

lo b ula r c a rc ino ma in situ) (T a b le 3) whe n the re is a c o mb ina tio n o f in situ lo b ula r (8520) a nd intra duc ta l c a rc ino ma (T a b le 1).

  • H6: Co de 8523/ 2 (intra duc ta l c a rc ino ma

mixe d with o the r type s o f in situ c a rc ino ma ) (T a b le 3) whe n the re is a c o mb ina tio n o f intra duc ta l c a rc ino ma a nd two o r mo re spe c ific intra duc ta l type s OR the re a re two o r mo re spe c ific intra duc ta l c a rc ino ma s.

121

PO P Q UIZ

  • Rig ht bre a st lumpe c to my: 1 c m tumo r with lo bular

c a rc ino ma in situ a nd intraduc tal papillary c arc ino ma.

  • What is the histo lo g y c o de ?

a .

8503/ 2 No ninfiltra ting intra duc ta l pa pilla ry a de no c a rc ino ma

b .

8520/ 2 L

  • b ula r c a rc ino ma in situ NOS

c .

8522/ 2 I ntra duc ta l c a rc ino ma a nd lo b ula r c a rc ino ma in situ

  • Wha t is the histo lo g y c o ding rule tha t a pplie s?
  • H5

122

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: IN SIT U O NL Y

  • H7: Co de 8524/ 2 (in situ lo b ula r mixe d with
  • the r type s o f in situ c a rc ino ma ) (T

a b le 3) whe n the re is in situ lo b ula r (8520) a nd a ny in situ c a rc ino ma o the r tha n intra duc ta l c a rc ino ma (T a b le 1).

  • H8: Co de 8255/ 2 (a de no c a rc ino ma in situ with

mixe d sub type s) (T a b le 3) whe n the re is a c o mb ina tio n o f in situ/ no n-inva sive histo lo g ie s tha t do e s no t inc lude e ithe r intra duc ta l c a rc ino ma (T a b le 1) o r in situ lo b ula r (8520).

123

slide-42
SLIDE 42

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 42

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: INVASIVE & IN SIT U

  • H9: Co de the inva sive histo lo g y whe n b o th

inva sive a nd in situ c o mpo ne nts a re pre se nt.

124

PO P Q UIZ

  • L

e ft b re a st lumpe c to my: 1 c m tumo r, infiltra ting lo bular c arc ino ma with are as o f intraduc tal c arc ino ma.

  • What is the histo lo g y c o de ?

a .

8500/ 2 I ntra duc ta l c a rc ino ma , no ninfiltra ting NOS

b .

8500/ 3 I nfiltra ting duc t c a rc ino ma NOS

c .

8520/ 3 L

  • b ula r c a rc ino ma NOS

d.

8522/ 3 I nfiltra ting duc t a nd lo b ula r c a rc ino ma

  • What histo lo g y c o ding rule applie s?
  • H9

125

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: INVASIVE

  • H10: Co de the histo lo g y do c ume nte d by the

physic ia n whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t a va ila b le .

  • H11: Co de the histo lo g y fro m a me ta sta tic site

whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

126

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 43

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: INVASIVE

  • H12: Co de the mo st spe c ific histo lo g ic te rm whe n

the dia g no sis is:

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

  • Duc t c a rc ino ma , NOS (8500) a nd a mo re spe c ific duc t

c a rc ino ma (8022, 8035, 8501-8508) o r

  • Sa rc o ma , NOS (8800) a nd a mo re spe c ific sa rc o ma
  • H13: Co de 8530 (inflammato ry c arc ino ma) o nly

whe n the fina l dia g no sis o f the pa tho lo g y re po rt spe c ific a lly sta te s infla mma to ry c a rc ino ma .

127

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: INVASIVE

  • H14: Co de the histo lo g y whe n o nly o ne

histo lo g ic type is ide ntifie d.

  • H15: Co de the histo lo g y with the nume ric a lly

hig he r I CD-O-3 c o de whe n the re a re two o r mo re spe c ific duc t c a rc ino ma s.

  • H16: Co de 8522 (duc t a nd lo b ula r) whe n the re

is a c o mb ina tio n o f lo b ula r (8520) a nd duc t c a rc ino ma (T a b le 3).

128

PO P Q UIZ

  • Wha t is the histo lo g y c o de fo r inva sive

c a rc ino ma o f the b re a st, no spe c ia l type ?

a . 8010/ 3 Carc ino ma NOS b . 8500/ 3 I

nfiltrating duc tal c arc ino ma NOS

SI NQ 20130170

129

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SLIDE 44

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 44

PO P Q UIZ

  • Wha t is the histo lo g y c o de fo r ple o mo rphic

lo b ula r c a rc ino ma ?

a . 8022/ 3 Ple o mo rphic c arc ino ma b . 8520/ 3 L

  • b ular c arc ino ma NOS

SI NQ 20130174

130

PO P Q UIZ

  • Rig ht bre a st qua dra nte c to my: 1.5 c m tumo r,

c o me do c a rc ino ma mixe d with ple o mo rphic c arc ino ma.

  • What is the histo lo g y c o de ?

a .

8022/ 3 Ple o mo rphic c a rc ino ma

b .

8501/ 3 Co me do c a rc ino ma NOS

c .

8523/ 3 I nfiltra ting duc t mixe d with o the r type s o f c a rc ino ma

  • What histo lo g y c o ding rule applie s?
  • H15

131

PO P Q UIZ

  • Wha t is the histo lo g y c o de fo r ple o mo rphic

lo b ula r c a rc ino ma a nd duc t c a rc ino ma in a sing le b re a st tumo r?

  • 8522/ 3 I

nfiltrating duc t and lo b ular c arc ino ma

  • 8523/ 3 I

nfiltrating duc t mixe d with o the r type s o f c a rc ino ma

  • Wha t histo lo g y c o ding rule a pplie s?
  • H16

132

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SLIDE 45

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 45

HIST O L O G Y CO DING RUL ES: BREAST SING L E T UMO R: INVASIVE

  • H17: Co de 8523 (duc t mixe d with o the r type s
  • f c a rc ino ma ) whe n the re is a c o mb ina tio n o f

duc t a nd a ny o the r c a rc ino ma (T a b le 3).

  • H18: Co de 8524 (lo b ula r mixe d with o the r type s
  • f c a rc ino ma ) whe n the tumo r is lo b ula r (8520)

a nd a ny o the r c a rc ino ma (T a b le 3).

  • H19: Co de 8255 (a de no c a rc ino ma with mixe d

sub type s) (T a b le 3) fo r multiple histo lo g ie s tha t do no t inc lude duc t o r lo b ula r (8520).

133

PO P Q UIZ

  • H&P: I

nfla mma to ry c a rc ino ma o f le ft bre a st.

  • Bio psy le ft bre ast at 2 o ’ c lo c k: Duc tal c arc ino ma

mixe d with muc ino us a de no c a rc ino ma .

  • What is the histo lo g y c o de ?

a .

8480/ 3 Muc ino us a de no c a rc ino ma

b .

8523/ 3 I nfiltra ting duc t mixe d with o the r type s o f c a rc ino ma

c .

8530/ 3 I nfla mma to ry c a rc ino ma

  • What histo lo g y c o ding rule applie s?
  • H17

134

HIST O L O G Y CO DING RUL ES: BREAST MUL T IPL E T UMO RS SING L E PRIMARY

  • H20: Co de the histo lo g y do c ume nte d b y the

physic ia n whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n o r the pa tho lo g y/ c yto lo g y re po rt is no t available .

  • H21: Co de the histo lo g y fro m a me tastatic site

whe n the re is no pa tho lo g y/ c yto lo g y spe c ime n fro m the prima ry site .

  • H22: Co de 8530 (inflammato ry c arc ino ma) o nly

whe n the fina l dia g no sis o f the pa tho lo g y re po rt spe c ific a lly sta te s infla mma to ry c a rc ino ma .

135

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SLIDE 46

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 46

HIST O L O G Y CO DING RUL ES: BREAST MUL T IPL E T UMO RS SING L E PRIMARY

  • H23: Co de the histo lo g y whe n o nly o ne histo lo g ic

type is ide ntifie d.

  • H24: Co de 8543/ 2 (in situ Pag e t dise ase and

intraduc tal c arc ino ma) (T able 3) whe n the pa tho lo g y re po rt spe c ific a lly sta te s tha t the Pag e t dise ase is in situ and the unde rlying tumo r is intraduc tal c arc ino ma (T able 1).

  • H25: Co de 8543/ 3 (Pag e t dise ase and intraduc tal

c arc ino ma) fo r Pag e t dise ase and intraduc tal c arc ino ma (T able 3).

136

HIST O L O G Y CO DING RUL ES: BREAST MUL T IPL E T UMO RS SING L E PRIMARY

  • H26: Co de 8541/ 3 (Pag e t dise ase and infiltrating

duc t c arc ino ma ) fo r Pag e t dise a se a nd invasive duc t c arc ino ma.(T able 3).

  • H27: Co de the invasive histo lo g y whe n bo th

invasive a nd in situ tumo rs a re pre se nt.

  • H28: Co de 8522 (duc t and lo bular) whe n the re is

any c o mbinatio n o f lo bular (8520) and duc t c arc ino ma. (T able 3).

  • H29: Co de the histo lo g y with the nume ric a lly

hig he r I CD-O-3 c o de .

137

BREAST CASE SCENARIO

Que stio ns?

138

slide-47
SLIDE 47

MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 47

CO MING UP…

  • Co lle c ting Ca nc e r Da ta : T

e stis

  • 1/ 8/ 15
  • Co lle c ting Ca nc e r Da ta : Ute rus
  • 2/ 5/ 15

139

AND T HE WINNERS ARE… …

140

CE CERT IF ICAT E Q UIZ/ SURVEY

  • Phra se
  • L

ink

  • http:/ / www.surve yg izmo .c o m/ s3/ 1911795/ MP-H-2014

141