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

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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 OUS PRIZE S!!!

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 CODING 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 CODING 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 CODING 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

COL ON MP/ H RUL E S

7

Co lo n

MUL T IPL E PRIMARY RUL E S

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

SINGL 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

POP QUIZ

  • 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

ANSWE R

  • 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 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

  • Ho w many primary tumo rs are pre se nt?
  • Wha t M rule was use d to de te rmine the numb e r o f

prima ry tumo rs?

POP QUIZ

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?
  • Wha t M rule wa s use d to de te rmine the numbe r o f

prima ry tumo rs?

POP QUIZ

16

HIST O L O G Y RUL E S

Co lo n

17

HIST OL OGY RUL E S

  • 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

SINGL 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 OL OGY RUL E S

  • 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

SINGL E T UMOR

POP QUIZ

  • 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 OL OGY RUL E S- SINGL E T UMOR

  • 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

SINGL 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 OL OGY RUL E S- SINGL E T UMOR

  • 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

SINGL E T UMOR

POP QUIZ

  • 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 (Ade 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 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

ANSWE R

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

POP QUIZ

  • 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

ANSWE R

SI NQ I D 20081098

26

HIST OL OGY RUL E S

  • 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

SINGL 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

POP QUIZ

  • 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

ANSWE R

SI NQ I D 20130007

29

HIST OL OGY RUL E S

  • 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

SINGL 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 OL OGY RUL E S

  • 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 OL OGY RUL E S

  • 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 OL OGY RUL E S

  • 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 OL OGY RUL E S

  • 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 OL OGY RUL E S

  • 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 OL OGY RUL E S

  • 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
  • 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 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 (a re ) the histo lo g y c o de (s)?
  • Wha t H rule wa s use d to c o de the histo lo g y?

POP QUIZ

37

HIST OL OGY RUL E S

  • 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)?
  • What H rule was use d to c o de the histo lo g y?

POP QUIZ

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

CASE SCE NARIO

Que stio ns?

40

RE NAL PE L VIS, URE T E R, BL ADDE R, AND OT HE R URINARY

Using the MP/ H Co ding Rule s

41

URINARY T E RMS & DE F INIT IONS

  • 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

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SLIDE 15

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

T ABL E 1: UROT HE L IAL T UMORS

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: UROT HE L IAL T UMORS (CONT .)

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

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SLIDE 16

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

MP RUL E S: URINARY MUL T IPL E T UMORS

  • 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

POP QUIZ

  • 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?

47

POP QUIZ

  • 12/ 12/ 13 Cysto sc o py with b io psy: No ninva sive

pa pilla ry tra nsitio na l c e ll c a rc ino ma o f la te ra l b la dde r wa ll

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

ra nsitio na l c e ll c a rc ino ma o f b la dde r ne c k inva de 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?

48

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SLIDE 17

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

MP RUL E S: URINARY MUL T IPL E T UMORS

  • 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

POP QUIZ

  • 1/ 8/ 08: T

URB: Small 5 mm transitio nal c e ll c arc ino ma late ral bladde r wall invade s sub muc o sa .

  • 1/ 26/ 11: T

URB: Uro the lial c arc ino ma with sq ua mo us diffe re ntia tio n o f b la dde r trig o ne , 8 mm; T 1.

  • 2/ 3/ 14 T

URB: F

  • c us o f papillary transitio nal c e ll

c a rc ino ma in b la dde r ne c k invo lve 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?

50

POP QUIZ

  • 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?

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 E S: URINARY MUL T IPL E T UMORS

  • 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

POP QUIZ

  • 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

MP RUL E S: URINARY MUL T IPL E T UMORS

  • 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

POP QUIZ

  • 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?

55

POP QUIZ

  • 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?

56

HIST OL OGY CODING RUL E S: URINARY SINGL E T UMOR

  • 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 OL OGY CODING RUL E S: URINARY SINGL E T UMOR

  • 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 OL OGY CODING RUL E S: URINARY SINGL E T UMOR

  • 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

POP QUIZ

  • 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?

60

slide-21
SLIDE 21

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

HIST OL OGY CODING RUL E S: URINARY SINGL E T UMOR

  • 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 OL OGY CODING RUL E S: URINARY SINGL E T UMOR

  • 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

POP QUIZ

  • Bla dde r b io psy: I

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

  • Wha t is the histo lo g y c o de ?
  • 8041/ 3 Small c e ll c arc ino ma NOS
  • 8045/ 3 Co mbine d small c e ll c arc ino ma
  • 8120/ 3 Uro the lial c arc ino ma NOS
  • Wha t is the histo lo g y c o ding rule tha t a pplie s?

63

slide-22
SLIDE 22

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

POP QUIZ

  • 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 OL OGY CODING RUL E S: 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 OL OGY CODING RUL E S: 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 OL OGY CODING RUL E S: 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

POP QUIZ

  • 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?

68

HIST OL OGY CODING RUL E S: 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

POP QUIZ

  • 1/ 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 tra nsitio na l c e ll c a rc ino ma o f c a lyx

  • 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?

70

CASE SCE NARIO

Bladde r

71

MUL IT PL E PRIMARY RUL E S

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 OL OGY RUL E S

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

SINGL 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

Lung Terms and Definitions

Lung Equivalent Terms, Definitions, Charts, Tables and Illustrations C340-C349 (Excludes lymphoma and leukemia M9590-9989 and Kaposi sarcoma M9140) Chart 1 – Lung Histology Groups and Specific Types

Note: This chart is based on the WHO Classification of Tumors for tumors of the lung. The chart is not a complete listing of histologies that may occur in the lung.

Acinar cell CA (8550) Adenocarcinoma, mixed subtypes (8255) Alveolar adenocarcinoma (8251) Bronchioloalveolar CA, NOS (8250) Bronchioloalveolar CA, non mucinous (8252) Bronchioloalveolar CA, mucinous (8253) Bronchioloalveolar CA, mixed mucinous & non mucinous (8254) Clear cell adenoCA (8310) Mucinous cystadenoCA (8470) Mucinous/colloid adenoCA (8480) Mucin-producing adenocarcinoma (8481) Papillary adenoCA (8260) Signet rIng adenoCA (8490) Solid AdenoCA (8230) Well dIfferentiated fetal AdenoCA (8333) Large cell neuroendocrine CA (8013) Large cell CA with rhabdoid phenotype (8014) Lymphoepithelioma like CA (8082) Basaloid CA (8123) Clear cell CA (8310) Basaloid squamous cell CA (8083) Papillary squamous cell CA (8052) Squamous cell CA, clear cell type (8084) Squamous cell CA, keratinizing, NOS (8071) Squamous cell CA, large cell, nonkeratinizing, NOS (8072) Squamous cell CA, small cell, nonkeratinizing, (8073) Malignant neoplasm, NOS and Malignant tumor cells (8000 and 8001) Fusiform cell CA (8043) Atypical carcinoid (8249) Large Cell CA, NOS (8012) Carcinoma, NOS, Carcinoma, undifferentiated, NOS and Carcinoma, anaplastic, NOS (8010, 8020 and 8021) Non-Small Cell CA (8046) Giant cell CA (8031) Carcinosarcoma (8980) Sarcomatoid CA (8033) Pleomorphic CA (8022) Pulmonary Blastoma (8972) Spindle cell CA (8032) Neuroendocrine CA, NOS (8246) Combined Small Cell CA (8045) Carcinoid, NOS (8240) Small Cell CA, NOS (8041) Adenoid cystic CA (8200) and Mucoepidermoid CA (8430) AdenoCA, NOS (8140) Adenosquamous (8560) Squamous Cell CA, NOS (8070)

Cha hart rt Instru nstruct ction

  • ns: Use this chart with multiple

primary rule M10 to identify types of non-small cell

  • carcinoma. Use this chart with the histology rules

to code the most specific histologic term. The tree is arranged in descending order. Each branch is a histology group, starting with the NOS or group terms and descending into the specific types for that group. As you follow the branch down, the terms become more specific.

January 1, 2007 35

slide-27
SLIDE 27

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

QUE ST ION

  • 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-28
SLIDE 28

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

ANSWE R

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-29
SLIDE 29

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

POP QUIZ

  • 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

ANSWE R

L ung SE E R SI NQ 20130072

84

slide-30
SLIDE 30

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

POP QUIZ

  • 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

ANSWE R

L ung SE E R SI NQ 20140062

87

slide-31
SLIDE 31

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 E S

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 OL OGY RUL E S

SINGL E T UMOR

POP QUIZ

  • 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-32
SLIDE 32

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

ANSWE R

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 OL OGY RUL E S

SINGL E T UMOR

POP QUIZ

  • 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

slide-33
SLIDE 33

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

ANSWE R

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 OL OGY RUL E S

SINGL E T UMOR

96

slide-34
SLIDE 34

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

POP QUIZ

  • 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

ANSWE R

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 OL OGY RUL E S

MUL T IPL E T UMORS

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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 OL OGY RUL E S

MUL T IPL E T UMORS

POP QUIZ

  • 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

ANSWE R

L ung SE E R SI NQ 20130093

102

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

L UNG CASE SCE NARIO & QUIZ

Que stio ns?

103

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

BRE AST

Using the MP/ H Co ding Rule s

105

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

E QUIVAL E NT OR E QUAL T E RMS: BRE AST

  • 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

106

T ABL E 1: INT RADUCT AL CARCINOMA

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

107

T ABL E 2: DUCT AL CARCINOMA

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

108

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

T ABL E 3: COMBINAT ION CODE S F OR BRE AST CANCE R

109

T ABL E 3: COMBINAT ION CODE S F OR BRE AST CANCE R

110

MP RUL E S: BRE AST

  • 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.

111

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

MP RUL E S: BRE AST MUL T IPL E T UMORS

  • 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.

112

POP QUIZ

  • 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

113

POP QUIZ

  • 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?

114

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

MP RUL E S: BRE AST MUL T IPL E T UMORS

  • 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.

115

POP QUIZ

  • A 1.2 c m lo b ula r c a rc ino ma wa s inc ide nta lly

disc o ve re d during the wo rk-up o f the pa tie nt’ s le ft b re a st tha t wa s infla mma to ry c a rc ino ma with c o re b io psy dia g no sing duc ta l c a rc ino ma with a po c rine fe a ture s. T he lo b ula r c a rc ino ma

  • n the rig ht wa s lo c a lize d witho ut a ny skin

invo lve me nt.

  • 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?

116

MP RUL E S: BRE AST MUL T IPL E T UMORS

  • 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.

117

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

POP QUIZ

  • 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?

118

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: IN SIT U ONL 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.

119

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: IN SIT U ONL 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).

120

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

POP QUIZ

  • 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?

121

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: IN SIT U ONL 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.

122

POP QUIZ

  • 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?

123

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

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: IN SIT U ONL 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).

124

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: 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.

125

POP QUIZ

  • 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

126

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

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: 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 .

127

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: 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 .

128

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: 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).

129

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

POP QUIZ

  • 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

SINQ que stion 20130170

130

POP QUIZ

  • 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

SINQ que stion 20130174

131

POP QUIZ

  • Rig ht b re a st q ua 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 a rc ino ma .

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

a . 8022/ 3 Ple o mo rphic c arc ino ma b . 8501/ 3 Co me do c arc ino ma NOS c . 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?

132

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

POP QUIZ

  • 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?

133

HIST OL OGY CODING RUL E S: BRE AST SINGL E T UMOR: 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).

134

POP QUIZ

  • 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 a po c rine a de no c a rc ino ma .

  • What is the histo lo g y c o de ?

a .

8410/ 3 Apo c rine 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?

135

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

HIST OL OGY CODING RUL E S: BRE AST 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 .

136

HIST OL OGY CODING RUL E S: BRE AST 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).

137

HIST OL OGY CODING RUL E S: BRE AST 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 .

138

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

CASE SCE NARIO

Bre a st

139

COMING 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

140

AND T HE WINNE RS ARE … …

141

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MP/ H Rule 2014 12/ 4/ 2014 NAACCR 2014-2015 We b ina r Se rie s 48

CE CE RT IF ICAT E QUIZ/ SURVE Y

  • Phra se
  • L

ink

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

142