Coding Pitfalls 9/11/14

Transcription

1 Coding Pitfalls NAACCR Webinar Series September 11, 2014 Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching this webinar at your site, please collect their names and s. We will be distributing a Q&A document in about one week. This document will fully answer questions asked during the webinar and will contain any corrections that we may discover after the webinar. Fabulous Prizes 3 NAACCR Webinar Series 1

2 Resources and Requirements Collaborative Stage Data Collection System (CS) V02.05 effective for cases diagnosed 1/1/2014 thru 12/31/2015 Required by CoC, CDC NPCR, and NCI SEER for cases diagnosed in 2014 and Resources and Requirements AJCC TNM Stage AJCC Cancer Staging Manual 7 th Edition CoC continues to require TNM stage CDC NPCR 1/1/2014 Requires directly coded TNM as available from CoC providers 1/1/2015 Requires directly coded TNM from CoC providers and may be as available from small providers 1/1/2016 Requires directly coded TNM NCI SEER 1/1/2015 Requests directly coded TNM as available 1/1/2016 Requires directly coded TNM 5 Resources and Requirements AJCC TNM Stage AJCC Cancer Staging Manual 8th Edition 10/1/2016 Scheduled publication 1/1/2017 Scheduled implementation 6 NAACCR Webinar Series 2

3 Resources and Requirements Summary Stage 2000 CDC NPCR 1/1/2015 Requires directly coded Summary Stage 2000 NCI SEER 1/1/2016 Requires directly coded Summary Stage Resources and Requirements Multiple Primary and Histology (MP/H) Coding Rules Revised 8/24/2012 Revision tentatively planned for 1/1/2016 implementation Hematopoietic and Lymphoid Neoplasm Database and Coding Manual Revised 1/17/2014 Provides data collection rules for 2010 forward Resources and Requirements SEER*Rx Interactive Antineoplastic Drugs Database (SEER*Rx) Updated 8/6/ SEER Program Coding & Staging Manual 2014 Released 7/2/2014 Effective for cased diagnosed 1/1/2014 and forward NAACCR Webinar Series 3

4 Resources and Requirements FORDS manual 2013.pdf Release of FORDS major revision tentatively scheduled for 1/1/2017 CoC Cancer Program Standards 2012: Ensuring Patient Centered Care oc/programstandards2012.ashx 10 Resources and Requirements Standards for Cancer Registries Volume II: Data Standards & Data Dictionary # Version 14: Implemented 1/1/2014 Version 15: Scheduled for implementation 1/1/2015 Version 16: Scheduled for implementation 1/1/2016 Version 17: Scheduled for implementation 1/1/2017 Version 18: Scheduled for implementation 1/1/ Resources and Requirements ICD O and 2015 Guidelines for ICD O 3 Update Implementation 6&mid=466 1/1/2016 ICD O 3.1 tentatively scheduled for North American implementation Online version ICD O 3 (2000) ICD O 3.1 (2011) NAACCR Webinar Series 4

5 Where to Send Questions CAnswer Forum AJCC TNM Staging Collaborative Stage FORDS/NCDB 2012 CoC Cancer Program Standards content.php Ask a SEER Registrar Multiple Primary & Histology Coding Rules Hematopoietic & Lymphoid Neoplasm Database and Coding Manual SEER*Rx Interactive Antineoplastic Drugs Database ICD O 3, ICD 10 CM, ICD 9 CM SEER Coding & Staging Manuals act.html 13 Grade 14 Grade Revised instructions Are applicable for cases diagnosed 1/1/2014 and forward 15 NAACCR Webinar Series 5

6 Grade Q: Is there going to be a change to Gleason 7, which is now = grade 3? I've heard it will change to grade 2, MOD DIFF. A: Gleason 7 will be coded as grade 2 beginning with 2014 cases. 16 Special Grade System Rules: Prostate Gleason Score CS Code Grade Code AJCC 7 th SEER G1 G G1 G G1 G G1 G G1 G G2 G G3 G G3 G G3 G3 Grade Q: If there were multiple invasive tumors, would we code grade based on the higher grade even if it's the smaller tumor of the two? A:Yes. Per grade coding instruction #5 for solid tumors, code the highest grade if there is more than 1 grade. 18 NAACCR Webinar Series 6

7 Grade Q: What about grade for noninvasive papillary urothelial carcinoma? Is there not a special grade system for bladder? A: The WHO/ISUP grade for bladder is not defined as a special grade system in grade coding instruction #6 for solid tumors and should not be used to code the grade data item. 19 Grade Q: Should brain be on the list for a special grade system rule? We code the WHO grade as a SSF but don't code it in the grade field. A:No. Brain is not a special grade system in reference to coding the grade data item. Under the table of special grade systems in instruction #6, it is documented that the tables are not used to code grade for WHO CNS tumors, WHO/ISUP for bladder & renal pelvis, or FIGO for female gynecologic sites. 20 Grade Q: What is the grade code if you have a path report for a GE Junction, mucinous adenocarcinoma, histologic differentiation, poorly differentiated, grade 3/4, high grade? A: There is no special grade system for GE junction. That takes you to instruction 7, use 2, 3, or 4 grade system. The statement of grade 3/4 indicates a 4 grade system. 3/4 in 4 grade system is grade code NAACCR Webinar Series 7

8 Grade Q: If you have a well differentiated bronchiolar adenocarcinoma of the lung, would you follow the terminology grade guidance? A: Yes. 22 Grade Q: Does the instruction regarding assigning grade prior to neoadjuvant treatment only apply to the grade data item? I was wondering if there was any kind of similar instruction for the data item, lymph vascular invasion. A: The grade coding instructions apply specifically to coding the grade data item. Coding instructions for the data item, lymph vascular invasion, are found in Part I of the CS Coding Instructions. Part I in v02.05 does include information on how to code lymph vascular invasion when it is identified in a path specimen after neoadjuvant treatment. 23 Grade Q: For solid tumor grade rule 5 (highest grade even if focus and priority order), which takes precedence highest grade or priority order? That is, if terminology gives the highest grade and nuclear grade gives a lower grade, what do we use? A: The priority order takes precedence. Code the highest grade from the applicable system. The applicable system is identified in the priority order. In the example you give, nuclear grade would be coded. 24 NAACCR Webinar Series 8

9 Grade Q: If all we see is FIGO grade 1, 2, 3, do we assign grade code 1, 2, 3, or 9? A: If the only description of grade for a gynecologic primary is FIGO grade 1, 2, or 3, assign code 9 in the grade data item. The FIGO grade system is different in that it describes the amount of non squamous or non modular solid growth pattern. 25 Grade Q: Does the two grade system for breast apply to both invasive and in situ tumors? A:Instruction #4 says to code the grade for in situ tumor if it is documented. So if a grade was documented for an in situ tumor and it was documented using a 2 grade system, not BR score or grade, then it should be coded. Remember that for breast BR score/grade as coded in CS SSF7 is the first priority for coding the grade data item. 26 Grade Q: It is my understanding that these new grade coding rules are somewhat "hierarchical". You stop at the first rule that applies. Is this true? Please clarify. A: For solid tumors, rules 1 5 apply across the board. Rules 6 9 are a hierarchy; you stop at the 1 st rule that applies. 27 NAACCR Webinar Series 9

10 Lip & Oral Cavity 28 Collaborative Stage Pathology Report Right subtotal partial inferior maxillectomy with dermal skin graft reconstruction: Right maxillectomy specimen with 1 x 1 x 0.7 cm tumor of upper alveolar ridge, poorly differentiated squamous cell carcinoma, which infiltrates bone and mucoperiosteum of maxillary sinus. All margins of resection are negative for tumor, the closest being the posterior margin at 8 mm. Right selective neck dissection: Metastatic squamous cell carcinoma in 2 of 3 lymph nodes, largest metastasis less than 2 cm. There is extracapsular extension in one of the two metastatic nodes. 29 Collaborative Stage What is the code for SSF3 (Levels I III Lymph Nodes)? a. 000: No involvement in Levels I, II, or III lymph nodes b. 100: Level I lymph node(s) involved c. 111: Levels I, II & III lymph nodes involved d. 999: Unknown What is the code for SSF4 (Levels IV V & Retropharyngeal Lymph Nodes)? a. 000: No involvement in Levels IV or IV or retropharyngeal lymph nodes b. 100: Level IV lymph node(s) involved c. 111: Levels IV & V &retropharyngeal lymph nodes involved d. 999: Unknown 30 NAACCR Webinar Series 10

11 Collaborative Stage What is the code for SSF5 (Levels VI VII & Facial Lymph Nodes)? a. 000: No involvement in Levels VI or VII or facial lymph nodes b. 100: Level VI lymph node(s) involved c. 111: Levels VI & VII & facial lymph nodes involved d. 999: Unknown What is the code for SSF6 (Parapharyngeal, Parotid, & Suboccipital Lymph Nodes)? a. 000: No involvement of any group b. 100: Parapharyngeal lymph node(s) involved c. 111: Involvement of 3 groups d. 999: Unknown 31 Primary Site Q: Code C14.8 assigned for squamous cell carcinoma diagnosed from lymph node and deemed to be a head and neck primary, but a specific site could not be identified. I assigned code C14.8 based on a note in ICD O 3 indicating it should be used when a code between C00.0 and C14.2 cannot be assigned. However, an old I & R (46158) indicated it should be coded to C76.0. A: Assign C148 based on the note in ICD O 3. C148 is a more specific site code than C760. The I & R answer has been revised. ata collection.html 32 Breast 33 NAACCR Webinar Series 11

12 Coding Breast Biopsies Q: How do I code a core biopsy when there is no residual tumor on the subsequent lumpectomy? p?2427-breast-surgery A: In most cases, the core biopsy would be coded as a diagnostic/staging procedure (02). If the margins from the core biopsy were documented as negative on the pathology report, it could be coded as a surgical procedure. The results of the lumpectomy are not a factor in how this procedure is coded. 34 FORDS and SEER FORDS Facility Oncology Registry Data Standards (FORDS) manual, Section One If surgery of the respective type was performed, the code that best describes the surgical procedure is recorded whether or not any cancer was found in the resected portion." oc/issues/ /4.html SEER The Surveillance Epidemiology and End Results (SEER) program instructions for Surgery of the Primary Site are consistent: Code the most invasive, extensive, or definitive surgery if the patient has multiple surgical procedures of the primary site, even if there is no residual tumor found in the pathologic specimen from the more extensive surgery. SEER does not require Surgical Diagnostic and Staging Procedure to be coded. 35 National Cancer Data Base News Both FORDS and the SEER Coding Manual instructions say to code an incisional biopsy as excisional when the margins are microscopically or macroscopically free of tumor. Neither SEER nor FORDS instructs registrars to use the pathologic examination from the subsequent surgery (for example, a lumpectomy) to determine whether a preceding biopsy was incisional or excisional. That coding decision depends only on marginal evaluation of the tissue removed in the biopsy. Needle biopsies are not amenable to margin evaluation. ues/ /4.html 36 NAACCR Webinar Series 12

13 Diagnostic Staging Procedure Only record positive procedures Do not code excisional biopsies with clear or microscopic margins 37 Surgical Treatment Lumpectomy followed by radiation Mastectomy 38 Big Picture Standard Treatment 1. Diagnostic staging procedure (02) 2. Definitive surgical treatment 3. Adjuvant treatment (if necessary) 20 Partial mastectomy, NOS; less than total mastectomy, NOS 21 Partial mastectomy WITH nipple resection 22 Lumpectomy or excisional biopsy 23 Re-excision of the biopsy site for gross or microscopic residual disease 24 Segmental mastectomy (including wedge resection, quadrantectomy, tylectomy Re excision Re excisions are performed when the patient has a lumpectomy and the entire tumor was not removed. Coding a core needle biopsy as an excisional biopsy would artificially inflate the number of re excisions being done. 39 NAACCR Webinar Series 13

14 Prostate 40 Collaborative Stage Patient has elevated PSA. Per physician note, DRE is benign. Needle biopsy of prostate: Adenocarcinoma right and left lobes. Per managing physician ct1c. MRI report states the result as ct2c prostate carcinoma. What is the code for CS Extension Clinical Extension? a. 150: Tumor identified by needle biopsy (clinically inapparent); Stated as ct1c with no other information on clinical extension b. 230: Clinically apparent tumor involves both lobes/sides; Stated as ct2c with no other info on clinical extension c. 300: Localized NOS; Confined to prostate NOS; Intracapsular involvement only; Not stated if T1 or T2, clinically apparent or inapparent d. 999: Unknown 41 Collaborative Stage Patient has elevated PSA. Tumor involving about a third of the lobe palpated in left prostate lobe on DRE. Needle biopsy of prostate: Adenocarcinoma left lobe. What is the code for CS Tumor Size/Ext Eval? a. 0: Evaluation based on physical examination including DRE, imaging examination, or other non invasive clinical evidence b. 1: Evaluation based on endoscopy, diagnostic biopsy (needle core biopsy or fine needle aspiration biopsy), TURP or other invasive techniques 42 NAACCR Webinar Series 14

15 Ovary 43 AJCC TNM Stage Debulking path report: High grade serous carcinoma, bilateral ovaries, with peritoneal metastasis beyond the pelvis, largest 2.5 cm; 2/2 mesenteric lymph nodes positive for metastasis. How is the mesenteric lymph node involvement coded? a. N1 b. M1 44 Collaborative Stage Final diagnosis: Bilateral ovarian serous carcinoma with liver metastasis. How is the liver metastasis coded in CS? A: Code liver parenchyma metastasis in CS Mets at DX. Code metastasis on liver surface in CS Extension. 45 NAACCR Webinar Series 15

16 GIST 46 Histology Q: Please repeat the difference between GIST NOS and malignant GIST. A:GIST NOS has an ICD O 3 behavior code of /1 (borderline). Malignant GIST has a behavior code of /3 (malignant). You should not code as /3 unless you have a statement of malignancy 47 NAACCR Webinar Series 16

17 Reportability Are there criteria other than a pathologist or clinician s statement that a registrar can use to determine reportability of gastrointestinal stromal tumors (GIST)? Per SINQ and , GIST cases are not reportable unless they are stated to be malignant. A pathologist or clinician must confirm the diagnosis of cancer. There are cases that are not stated to be malignant in the pathology report or confirmed as such by a clinician; however, these cases do have information that for other primary sites would typically be taken into consideration when determining reportability. (SEER SINQ ) Question Pathologists have used tumor size and mitotic activity to determine whether GISTS were benign or malignant. The 7th Edition AJCC Manual uses criteria for Stage I GIST which would otherwise be considered benign. Could you clarify if we are to go by staging criteria to determine if a GIST is reportable? Answer The CoC requires to report all sites malignancies with behavior 2 and 3, except skin cancers , CIS, intraepithelial neoplasia grade III (8077/2) of the cervix (CIN III), prostate (PIN III), vulva (VIN III), vagina (VAIN III), and anus (AIN III). Benign GIST is not reportable since the behavior is 0. However, if your facility or your state requires to collect benign GIST, you should follow their requirements. When you submit the data, make sure you do not include benign GIST in your data file submitted to NCDB (CoC), otherwise it will be rejected. Staging forms can be used to stage all GIST tumors /0/1 or /3. however, this does not mean that the GIST tumors with a /0 or /1 are reportable. Reportabitity is determined by the CoC, SEER, state and your cancer committee. You could however pick these up as a reportable by agreement case. CoC&highlight=GIST NAACCR Webinar Series 17

18 Reportability Q: If GIST is benign, why do pathologist stage them? This is confusing since we always assume if cancer is staged, it is malignant A:The AJCC Cancer Staging Manual isn't based on the reportability rules that registrars use. I assume the authors felt there was sufficient clinical benefit to collect staging information on low and intermediate risk GISTs to provide staging criteria for clinicians that choose to collect these cases. 52 Question Q: Our cancer committee has decided that we should collect ALL GIST tumors. In the event that a GIST that we have abstracted becomes malignant and thus is now reportable to NCDB, how should be handle this case? A:Yes, to your last three questions. 1. Would we create a new abstract with the date of diagnosis being the date the physician states the case is malignant and thus the patient would have two abstracts? 2. The first would have a sequence code of 60 and a behavior code of 1? 3. The second would have a sequence code of 00 (if it was the first malignancy) and behavior code of 3 and a different date of diagnosis? Reportability Q: What if the patient is being treated as malignant even though there is no statement of malignancy (reportability)? A:Treatment cannot be used as a determination of malignancy because borderline GIST and malignant GIST receive the same types of treatments (surgery and imatinib). 54 NAACCR Webinar Series 18

19 Bladder 55 Stage TURB pathology: Bladder cancer in lateral wall; 1 cm urothelial carcinoma that invades the superficial muscularis propria. Cystectomy: In situ urothelial carcinoma of bladder. 56 Collaborative Stage What is the code for CS Extension? a. 060: Nonpapillary Sessile CA in situ, CA in situ NOS, transitional cell CA in situ b. 210: Muscle of bladder only; superficial muscle inner half c. 220: Muscle of bladder only deep muscle outer half d. 240: Muscle invaded NOS of bladder only What is the code for CS Tumor Size/Ext Eval? a. 0 b. 1 c. 3 d NAACCR Webinar Series 19

20 AJCC TNM Stage What is the directly coded AJCC clinical T category? a. X: Primary tumor cannot be assessed b. Tis: CA in situ flat tumor c. T2: Tumor invades muscularis propria d. pt2a: Tumor invades superficial muscularis propria What is the directly coded AJCC pathologic T category? a. X: Primary tumor cannot be assessed b. Tis: CA in situ flat tumor c. T2: Tumor invades muscularis propria d. pt2a: Tumor invades superficial muscularis propria 58 Melanoma 59 Collaborative Stage/Surgery Data Items Q: If patient has 1 lymph node positive for melanoma and primary skin site cannot be identified, how should the following fields be coded? CS Lymph Nodes: 100 (Regional nodes NOS) Regional Nodes Positive: 01 Regional Nodes Examined: 01 Scope of Regional Lymph Node Surgery: Code surgery performed Surgical Procedure/Other Site: 0 (None) 60 NAACCR Webinar Series 20

21 Collaborative Stage LDH Q1: What is the code for SSF4 [Serum Lactate Dehydrogenase (LDH)] if the 1 st LDH test is negative and 2 nd test was unknown? A1: 000 (Within normal limits) Q2: What is the code for SSF5 (LDH Lab Value) if 1 st test is positive and 2 nd test is negative? A2: Code lab value from negative test (2 nd ) 61 Question It came to our attention while reviewing the changes to the SEER Program Manual for 2014, that a new coding instruction was added to the Surgery of Primary Site section. I was hoping you could help clarify how this effects coding. The new statement added says, "Shave or punch biopsies are most often diagnostic. Code as a surgical procedure only when the entire tumor is removed and margins are clear." This was statement was not included in the SPCM Shave Biopsy 63 NAACCR Webinar Series 21

22 Surgical Diagnostic Staging Procedure If the tumor is very large or in a site that is difficult to biopsy, the physician may choose to take a small sample of the tumor rather than remove the entire tumor. If this is done, the margins on the specimen sent to pathology will be grossly positive. This would be coded as a Surgical Diagnostic Staging Procedure code Excisional Biopsy If a physician suspects melanoma, they will probably try to remove the entire lesion. This may be done as a standard excisional biopsy, punch biopsy, or a shave biopsy. Regardless of the approach, this procedure should be coded using the surgery code 27. If the margins of the biopsy are microscopically positive or there is no information about the margins, assume it was an excisional biopsy. The surgeon will attempt to take 3 5mm of healthy tissue and will try to minimize damage to the lymphatics. 65 Wide Excision Following the excisional biopsy the patient will probably have a wide excision. A wide excision removes a margin of healthy tissue from around the melanoma site. If a sentinel lymph node biopsy is recommended, it will be done prior to the wide excision. 66 NAACCR Webinar Series 22

23 Wide Excision If the margin of healthy tissue is 1cm or less, code this procedure using codes Codes would also be used if the margin of healthy tissue is not stated. Even though these codes reflect two procedures, the date of surgery when assigning codes is the date of the wide excision. 67 Wide Excision Code 30 is used if the original excisional biopsy was a standard excisional technique or if the technique was not indicated. Code 31 is used if the original excisional biopsy was a shave biopsy. Code 33 is used if the original biopsy was incisional and then a wide excision was done (the incisional biopsy was coded as a diagnostic staging procedure). If your facility only codes one surgery for each abstract (i.e. hospital only reporting to the state cancer registry), use the code for the most definitive procedure. 68 Wide Excision Code 45 is used if the patient has a wide excision and the margins are more than 1cm, but it is not documented if they are more or less than 2cm s. Code 46 is used if the patient has a wide excision and the margins are more than 1cm and it is documented that the margins are equal to or less than 2cm s. Code 47 is used if the patient has a wide excision and the margins are more than 2cm s. 69 NAACCR Webinar Series 23

24 Wide Excision When a wide excision with 1 2cm margins is performed (code 46), followed by re excision for wider margins: If the total combined resection margins are >2cm, use code 47 If no information is available of the path report does not describe the distance from the margins to the previous spot, code the reexcision as 46 (two entries with surgical code 46) 70 Answer If the margins are grossly positive code as dx staging procedure. If they are negative or only microscopically positive, code as surgery. The big question is what to do if the margins are unknown. 71 Hematopoietics 72 NAACCR Webinar Series 24

25 Hematopoietics Transformations Transformations to Acute or more severe neoplasm Transformations from Chronic neoplasm Examples Essential thrombocythemia (9962/3) Transformations to: Acute myeloid leukemia (9861/3) Plasma cell myeloma (9732/3) Transformations from: Solitary plasmacytoma of bone (9731/3) 73 Colon & Rectum 74 Treatment Q: Please address staging polypectomies. Is polypectomy, then chemotherapy, lastly hemicolectomy considered neoadjuvant treatment? A:Yes, the chemotherapy given prior to hemicolectomy would be considered neoadjuvant treatment. 75 NAACCR Webinar Series 25

26 Anatomy Q: When a tumor extends into the subserosa, isn't that considered pericolonic fat? 76 Anatomy A: Subserosal fat indicates a portion of the colon covered by serosa. If the colon is not covered by serosa, all of the fat outside of the colon is referred to as pericolic fat. Pericolic Fat Subserosal Fat Muscularis Propria Lamina Propria Lumen Histology Q: If you had an adenocarcinoma with mucinous features how would you code the histology? A:For cases diagnosed , code 8480 (mucinous adenocarcinoma). When the final diagnosis states "mucinous," code When mucinous is stated in the final diagnosis, the percent does search_results&records=n&search_results_show=first& search_within_results=0&search_type=quick_search& not need to be specified. See rule topic1=&topic2=&topic3=&start_year=2000&end_ye H5. ar=2014&quicksearch= &question_id=&cat_ andor=and&cat0=+&cat1=+&cat2=+&last_update= &date_finalized=&free_andor=and&free0=&free1=& free2=&free3=&asc_yr_text=&question_1=1&questio n_3=1&search_display_format=1 78 NAACCR Webinar Series 26

27 Histology Q: What is the histology code of a mucinous adenocarcinoma in a polyp? A: When going through the histology coding rules assuming this is a single tumor, the first rule that applies in this situation is rule H4. Rule H4 says to use one of the polyp codes. With no more info, I would use code 8210/3 for a diagnosis of mucinous adenocarcinoma in a polyp of the colon 79 Anatomy Q: Would you say the basement membrane is before the lamina propria, and once a tumor invades the lamina propria it is local stage? A:: Yes; the lamina propria is beyond the basement membrane. Invasion into the lamina propria, (Intramucosal) is localized summary stage for colon and rectum. at risk for metastasis. 80 Collaborative Stage Patient had routine colonoscopy with polypectomy which diagnosed adenocarcinoma. Hemicolectomy was performed a month later, and there was no residual malignancy. CEA was drawn after the polypectomy but before the resection. The results were 7 ng/ml with normal being <5. 81 NAACCR Webinar Series 27

28 Collaborative Stage What is the code for SSF1 [Carcinoembryonic Antigen (CEA)]? a. 010: Positive/elevated b. 020: Negative/normal c. 998: Test not done d. 999: unknown What is the code for SSF3 (CEA Lab Value)? a. 050 b. 070 c. 998: Test not done d. 999: Unknown 82 AJCC TNM Q: Patient has polypectomy. Path shows that the polyp is purely in situ, and there is no residual tumor. Can we pathologically stage this cancer? A: Yes 83 Liver 84 NAACCR Webinar Series 28

29 AJCC TNM Stage MRI: Hepatomegaly; 7 cm right liver lobe mass with intrahepatic metastases in both lobes and vascular invasion; small hepatic nodes; no other organomegaly. Liver is cirrhotic. Hepatic biopsy: Hepatocellular carcinoma, grade AJCC TNM Stage What is the clinical T? a. TX: Primary tumor cannot be assessed b. T2: Solitary tumor with vascular invasion or multiple tumors none more than 5 cm c. T3a: Multiple tumors more than 5 cm d. T3b: Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein What is the pathologic T? a. TX: Primary tumor cannot be assessed b. T2: Solitary tumor with vascular invasion or multiple tumors none more than 5 cm c. T3a: Multiple tumors more than 5 cm d. T3b: Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein 86 Lung 87 NAACCR Webinar Series 29

30 Histology & Behavior Q: Is bronchioalveolar carcinoma considered in situ? A:Not according to the coding rules we currently use. This may change in the future, but for now consider it a /3 unless instructed otherwise by a physician or pathologist. The new edition of the lung WHO classification (blue books) is not expected until Topography Q: What is the ICD O site code for "infrahilar tumor"? A: Per Ask a SEER Registrar Assign code C349 when infrahilar refers to the infrahilar area of the lung and no further information is available. See #12 on page 67 in the SEER manual, als/2014/spcsm_2014_maindoc.p df 89 Collaborative Stage Q1: Please define pleural based mass. A1: Lesion within lung that abuts visceral pleura on imaging Q2: Is the CS Extension code for a pleural based mass with no other statement of invasion 410? A2: No 90 NAACCR Webinar Series 30

31 Collaborative Stage Right lung cancer with right pleural effusion; single negative cytology of pleural effusion but fluid is exudative and bloody. What is the code for CS Mets at DX? a. 00: No distant metastasis b. 15: Malignant pleural effusion, ipsilateral or same lung What is the code for CS Mets Eval? a. 0: Evaluation of distant metastasis based on non invasive clinical evidence b. 3: Specimen from metastatic site microscopically positive 91 AJCC TNM Stage How would you code the T category for invasion of primary lung tumor into rib? a. T3: Tumor more than 7cm or one that directly invades: parietal pleura chest wall, diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in main bronchus; or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodules in same lobe b. T4: Tumor of any size that invades: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, separate tumor nodules in different ipsilateral lobe 92 Questions? 93 NAACCR Webinar Series 31

32 Coming Up Registration is open for Cancer Registry & Surveillance Webinar Series And the winners are 95 CE Certificate Quiz/Survey Phrase Stand up Link Pitfalls 2014 NAACCR Webinar Series 32

33 Thank You!!!! Please send any questions to: Jim Hofferkamp Shannon Vann NAACCR Webinar Series 33