There is a Reason for Everything including Changes

Transcription

1 There is a Reason for Everything including Changes What & Why Who & When Overview A Closer look Introduction & Overview of Site-Specific Data Items A.K.A. SSDIs

2 Let me introduce myself Colleen M. Grosso, BS, MBA, RHIA, CTR Employee of the University of Pennsylvania (Philadelphia, PA) for the last 19 years. Currently the Assistant Director of the Cancer Registry Department 4 facilities Consultant on the side with MedPartners, HIM currently working for a Hospital in Brooklyn, NY Graduated from Saint Joseph s University (PA) with a Masters in Business Administration Graduated from Temple University (PA) with a Bachelor s of Science in Health Information Management Sat for my CTR exam when I was part of the Medical Record Department State Reporting Cancer cases only Co-President of the Delaware Cancer Registrar Association (DCRA) Married to my best friend for 11 years (together for 21 years) Mom to 2 very energetic, growing boys (ages 12 and 8) God-Mother (and very close with) to one of my Nephews (my late younger brothers son)

3 Important piece of Information to share. I feel as if it is necessary to share that I have NOT personally abstracted a 2018 case with SSDIs yet. Everything included in this presentation was extracted from the SSDI Manual and/or website. In addition, this presentation is NOT inclusive of ALL of the guidelines/instructions. I strongly encourage you all to still study and utilize your Manuals.

4 With that being said.

5 What are Site Specific Data Items? SSDIs: Site-Specific Data items based on Primary Site, the AJCC Chapter, Summary Stage Changer and the EOD Schema Have their own data item name and number Each SSDI applies only to selected schemas. SSDI fields should be BLANK where they do not apply. SSDIs are taking the place of CS SSFs for cases diagnosed 1/1/2018 or later

6 Site Specific Data Items (SSDIs) NAACCR (North American Association of Central Cancer Registries) is the custodian of the SSDIs and the SSDI Task Force is responsible for their development and updates.

7 Erase, yet Ease, Your Mind. Erase your mind - Partially. The type of data we will be collecting is similar; however, how you code it is DIFFERENT.

8 SSDIs vs. SSFs? CS SSFs: Collected on Cases diagnosed CS SSF data will NOT be mapped to the SSDIs Numeric only limited to 3 digits VS. SSDIs: Collected on Cases diagnosed 01/01/2018 or Later Majority of Data items were previously collected as SSFs; however, the format and allowable values have changed substantially, particularly for lab values Field length is no longer limited to 3 digits Decimals are now allowed Alpha and numeric codes Different Coding Conventions are used to record actual values, percentages and ranges.

9 SSDIs vs. SSFs? CS SSF Schemas in ICD-0-3 Topography Code Order OR Alpha Order SSDI Schemas in Alpha Order

10 Why the Change? Per the SSDI Manual on Page 15 (Version 1.2) More flexibility No longer will all site-specific data items be three characters in length. Some are shorter, others are longer Also, registrars can record lab values with the decimal point as part of the code Meaningful names Each new data item has been given a name that WILL BE displayed in registry software For example, the software displays ER instead of Breast, SSF1 It is easier for registrars and researchers to retrieve data For example, query the database for PSA instead of remembering that SSF is PSA for Prostate cases Reduced duplication CS SSFs which were collected for multiple sites/chapters/schema under different SSF numbers are now one data item when possible

11 Who will use SSDIs? Cancer Registrars will be required to complete all SSDIs on their cases. Any professional that requests data you can count on them wanting the SSDI data, i.e., Researchers Physicians Administrators

12 When will SSDIs be used? Any Reportable case with a DIAGNOSIS DATE of 01/01/2018 or later. Don t get confused if you have a 2018 case and the patient was diagnosed in 2017 or prior these cases will NOT have SSDIs coded (these will have the CS SSFs coded)

13 Overview/Introduction of SSDIs Number of SSDIs compared to CS SSFs Approximately 260 unique CS SSFs in CSv discontinued 12 obsolete 147 required Of these, 27 are no longer required for 1/1/ SSDIs added to the NAACCR v18 layout

14 Overview of SSDIs General Definitions General Definitions and Formats Not Applicable: this code is to be used ONLY when the data item is relevant for the case and the standard setter does not require the data item. N/A codes ALWAYS end in an 8, but will differ depending on the length of the data item N/A codes are NOT available for schema discriminators or data items that are required for Staging Unknown: Previous codes from CS for Test not done (998) and Unknown (999) have now been combined. Unknown codes ALWAYS end in a 9, but will differ depending on the length of the data item. The Unknown code now will include: Test/Evaluation/Assessment NOT done OR UNKNOWN if done

15 Overview of SSDIs General Rules General Definitions and Formats Cannot be Determined by Pathologist: For some data items, there is a selection box on the CAP checklist. This is primarily used when a tissue specimen is not adequate for testing. Not Identified: For some data items, there is a selection box on the CAP checklist. This means that the pathologist has looked for it and it is not present. This is NOT the same thing as looking for it in the Medical Record and not finding it (this would be not documented in the medical record )

16 Overview of SSDIs General Rules Examples for a 6- Character Lab Value Value in Record Data Item coded as General Rules for Entering Lab Values and Other Measurements Lab values and other measurements that are NOT whole numbers and are reported as continuous variables (not categories or ranges) will be recorded to a single decimal place with an explicit decimal point. There MUST always be a numeral or the letter X immediately before the decimal point and a numeral after the decimal point When a value in the Medical Record does not provide the expected decimal digit, i.e. it is expressed as a whole number, then enter the value followed by a decimal point and a zero (.0) Rounding always check coding instructions for Special Rules for rounding numbers. In the absence of a special rule, round 0-4 down and 5-9 up

17 Overview of SSDIs Timing of Recording Lab Tests Timing for Recording Laboratory Tests Unless instructions for a specific laboratory test state otherwise, record only test results obtained: Before any cancer-directed treatment is given, and No earlier than approximately 3 months before diagnosis If the only test or tests performed do NOT meet the above criteria, code test note done or unknown if test performed

18 Overview of SSDIs Histologic Examination Histologic Examination Histologic examination is the assessment of a tissue specimen. Aspiration of fluid (cells) is a cytologic examination. Some data items require analysis of tissue, whereas others can be performed on any specimen (tissue OR fluid). Pathologic examination can refer to either histological or cytological examination. Also referred to as microscopic confirmation

19 Overview of SSDIs Schema Discriminators Example: Nasopharynx and Pharyngeal tonsil have the same ICD-O Topography code (C11.1). However, for purposes of stage grouping AJCC 8 th Edition, Nasopharynx and Pharyngeal Tonsil are staged in different chapters. A Schema Discriminator is necessary to distinguish between these primary sites so that the appropriate chapter/schema is used. Schema Discriminators Introduced in Collaborative Stage version 2 (CSv2) Used when Primary Site and/or histology are not sufficient to identify the correct AJCC Staging Algorithm Due to the complexity of some of the 8 th Edition AJCC Chapters, more than one schema discriminator may be needed to define the correct schema Three SSDIs (Data Item # s 3926, 3927 and 3928) are available to collect the information needed to define schema, although most chapters that require a schema discriminator need only one. Schema discriminators do not have a not applicable code. If the schema discriminator is needed for some sites or histologies within the schema but not for all, it should be left blank where it is not necessary.

20 Overview of SSDIs Schema Discriminators Schema Discriminators Schema Discriminator 1 Schema Discriminator 2 Schema Discriminator 3 New Schema Discriminators Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck (Chapter 6) HPV-p16 (Chapters 10 and 11) Esophagus (Chapter 16) Urethra/Prostatic Urethra (Chapter 63) Thyroid/Thyroglossal Duct (Chapters 73 and 74)

21 Overview of SSDIs Schema Discriminators Schema Discriminator 1 Schema Discriminator 1: BileDuctsDistal/BileDuctsPerihilar/CysticDuct Schema Discriminator 1: EsophagusGEJunction (EGJ)/Stomach Schema Discriminator 1 (Histology Discriminator for 9591/3) Schema Discriminator 1: Lacrimal Gland/Sac Schema Discriminator 1: Melanoma Ciliary Body/Melanoma Iris Schema Discriminator 1: Nasopharynx/Pharyngeal Tonsil Schema Discriminator 1: Occult Head and Neck Lymph Nodes Schema Discriminator 1: Plasma Cell Myeloma Terminology Schema Discriminator 1: Primary Peritoneum Tumor Schema Discriminator 1: Thyroid Gland/Thyroglossal Duct Schema Discriminator 1: Urethra/Prostatic Urethra Schema Discriminator 2 Schema Discriminator 2: Histology Discriminator for 8020/3 Schema Discriminator 2: Oropharyngeal p16 Schema Discriminator 3 For 2018, there are no defined Schema Discriminators 3 s.

22 Overview of SSDIs SSDIs REQUIRED for Stage AJCC Chapter NAACCR Data Item Name 16: Esophagus (Squamous Cell only) Esophagus and EGJ Tumor Epicenter AJCC Chapter NAACCR Data Item Name 48: Breast Estrogen Receptor Summary 48: Breast Progesterone Receptor Summary AJCC Chapter NAACCR Data Item Name 48: Breast HER2 Overall Summary 56: Gestational Trophoblastic Tumors (Placenta) AJCC Chapter Gestational Trophoblastic Prognostic Scoring Index NAACCR Data Item Name 48: Breast Oncotype Dx Recurrence Score -Invasive AJCC Chapter NAACCR Data Item Name 79: Non-Hodgkin Lymphoma: CLL/SLL Adenopathy (Rai Classification: CLL/SLL) 58: Prostate PSA (Prostatic Specific Antigen) Lab Value AJCC Chapter NAACCR Data Item Name 59: Testis S Category Clinical 59: Testis S Category Pathological 79: Non-Hodgkin Lymphoma: CLL/SLL Anemia (Rai Classification: CLL/SLL) 79: Non-Hodgkin Lymphoma: CLL/SLL Lymphocytosis (Rai Classification: CLL/SLL) 79: Non-Hodgkin Lymphoma: CLL/SLL Organomegaly (Rai Classification: CLL/SLL) 79: Non-Hodgkin Lymphoma: CLL/SLL Thrombocytopenia (Rai Classification: CLL/SLL) AJCC Chapter NAACCR Data Item Name AJCC Chapter NAACCR Data Item Name 82: Plasma Cell Myeloma and Plasma Cell Disorders High Risk Cytogenetics 68: Retinoblastoma Heritable Trait 82: Plasma Cell Myeloma and Plasma Cell Disorders LDH Pretreatment Level AJCC Chapter NAACCR Data Item Name 82: Plasma Cell Myeloma and Plasma Cell Disorders Serum Albumin Pretreatment Level 81: Primary Cutaneous Lymphomas: Mycosis Fungoides Peripheral Blood Involvement 82: Plasma Cell Myeloma and Plasma Cell Disorders Serum Beta-2 Microglobulin Pretreatment Level

23 Overview of SSDIs Manual Set-up NAACCR Data Item Name Item Length NAACCR Item # NAACCR Alternative Name AJCC 8 th Edition Chapter(s) Description The description is a brief summary used to define the data item in the NAACCR data dictionary Rationale The rationale describes the reason why the data item is collected, such as required for staging or recommended for registry data collection by AJCC. If the data item was collected in CSv2, the primary site and SSF# is included in the rationale Definition The definition provides additional background on the data item and its clinical importance. This information was previously included in the CSv2 Manual, Part I, Section II Additional Information This section may include source documents, other names, normal reference ranges and any other information deemed relevant for a particular SSDI. The information was previously included in the CSv2 Manual, Part I, Section II Coding Instructions and Codes Coding instructions are provided as numbered notes. Codes are provided in a table. Codes and Coding instructions are usually provided in registry software

24 Overview of SSDIs Web-Site Set-up

25 Overview of SSDIs Manual vs. Website The Manual definitely has more information for each SSDI. The order in which each SSDI is listed for each Site/Schema differs. When looking at Colon & Rectum on the Website the order is: CEA PreTX Lab Value CEA PreTX Interpretation Tumor Deposits Perineural Invasion Circumferential Resection Margin (CRM) KRAS Microsatellite Instability (MSI) When looking at Colon & Rectum in the Manual, you will find the following order: CEA PreTX Lab Value CEA PreTX Interpretation Circumferential Resection Margin (CRM) KRAS Microsatellite Instability (MSI) Perineural Invasion Tumor Deposits

26 A Closer Look Sites/Histologies with NO SSDIs Sites/Histologies with NO SSDIs Pharynx Other Middle Ear Sinus Other Small Intestine Anus Ampulla of Vater Biliary Other Pancreas Digestive Other NET Stomach NET Duodenum / NED Ampulla of Vater NED Jejunum and Ileum NET Appendix NET Colon and Rectum NET Pancreas Thymus Trachea Respiratory Other Soft Tissue Other Skin (except Eyelid) (excludes Melanoma)

27 Pre-Quiz Question for the Audience???? Which Site/Schema do you think has the MOST SSDIs? A. Colon & Rectum B. Liver C. Breast D. Testis

28 Pre-Quiz Answer Correct Answer:

29 A Closer Look Breast CS SSFs vs. Breast SSDIs

30 A Closer Look Breast SSDIs

31 A Closer Look Breast SSDIs Coding Instructions (not inclusive): Note 1: Physician statement of ER (Estrogen Receptor) Summary status can be used to code this data item when no other information is available. Physician statement of ER or PR Total Allred Score and/or ER/PR Percent Positive or Range can be used to code these data items. Note 2: The result of the ER test performed on the primary breast tissue is to be recorded in this data item. The ER and PR results reported should be coded using the same report. Note 3: Results from nodal or metastatic tissue may be used ONLY when there is no evidence of primary tumor.

32 A Closer Look Breast SSDIs Changes from Collaborative Stage v2: In CSv2, there were multiple SSFs that collected information on FISH, CISH, or other. In addition, the lab value and the interpretation were collected. For 2018 cases forward, only the interpretation will be recorded. Also, interpretation of all types of ISH test (FISH, CISH, SISH, single probe, double probe) are to be recorded in the overall ISH data item. If there are multiple tests, record the highest. NOTE: HER2 results are to be recorded from IHC or ISH tests. Do not use results from the following tests to record HER2 results: Oncotype Dx MammaPrint EndoPredict PAM 50 (Prosigna) Any other test that records HER2

33 A Closer Look Breast SSDIs NOTE: Oncotype is no longer captured under Multigene Signature Results and Multigene Signature Method.

34 A Closer Look Female Reproductive Organs SSDIs The Federation Internationale de Gynecologie et d Obstetrique (FIGO) is a staging system for female reproductive cancers. In English, the organization is the International Federation of Gynecology and Obstetrics. FIGO uses Roman numerals and subscripts to define a stage. There is no T, N or M descriptor with FIGO Stage, only a Stage Group. For example, FIGO Stage IA is equivalent to T1a, FIGO Stage III can be either T3_ or N1 and FIGO Stage IV is M1. The FIGO Stage will be required for the following Sites/Chapters. Do not attempt to code FIGO Stage based on T, N and M alone. Chapter 50: Vulva Chapter 51: Vagina Chapter 52: Cervix Uteri Chapter 53: Corpus Uteri Carcinoma and Carcinosarcoma Chapter 54: Corpus Sarcoma Chapter 55: Ovary, Fallopian Tube, and Primary Peritoneal Carcinoma Chapter 56: Gestational Trophoblastic Neoplasms (Placenta) NOTE: Do not confuse FIGO Stage with FIGO Grade.

35 A Closer Look Prostate SSDIs PSA (Prostatic Specific Antigen) is a protein produced by cells of the prostate gland and is elevated in patients with Prostate Cancer. NOTE: Serum PSA is not the same as free PSA or precursor PSA do not record values from either of these tests. Coding Guidelines: Record the last pre-diagnosis PSA lab value PRIOR to Diagnostic Biopsy of Prostate and initiation of treatment in nanograms per milliliter (ng/ml) in the range 0.1 (.1 ng/ml) to (999.9 ng/ml) NOTE: This is a change from CSv2, where you were directed to code the highest PSA value within 3 months prior to diagnosis.

36 A Closer Look Prostate SSDIs Pathologic Gleason fields: Note 1: Physician statement of Gleason Score and Patterns Pathological can be used to code this data item when there is no other information available. Note 2: Code the Gleason primary and secondary patterns from Prostatectomy or Autopsy. Note 3: If neo-adjuvant therapy was given, code Gleason Pathologic Patterns, Gleason Pathologic Scores and Gleason Tertiary Pattern as X9.

37 A Closer Look Colon & Rectum SSDIs CEA (Carcinoembryonic Antigen) is a non-specific Tumor marker that has prognostic significance for colon and rectum cancers. Coding Instructions (not inclusive): Physician statement of CEA Pretreatment Lab Value and Interpretation can be used to code these data items when no other information is available. Record the lab value (and interpretation of the highest CEA test result) documented in the Medical Record PRIOR to treatment or Polypectomy.

38 A Closer Look Colon & Rectum SSDIs Tumor Deposits: A.K.A. discontinuous extramural extension, malignant tumor foci, malignant peritumoral deposits, satellite nodule Change from CSv2 In CSv2, if pathology report was available and there was no mention of tumor deposits, the registrar could assume there were no tumor deposits and code none. Per SSDI, this assumption CANNOT be made. There must be a statement that there are no tumor deposits to code 00. Record the number of Tumor Deposits whether or not there are positive lymph nodes. Perineural Invasion: Change from CSv2 In CSv2, if pathology report was available and there was no mention of perineural invasion, the registrar could assume that it was negative and code appropriately. Per SSDI, this assumption CANNOT be made. There must be a statement that perineural invasion is not present/negative to assign negative (Code 0)

39 A Closer Look Colon & Rectum SSDIs Circumferential Resection Margin (CRM): Also referred to as the Radial Margin, Mesenteric Margin or Surgical Clearance The CRM is NOT the same as the distance to the proximal and distal margins of the colon specimen. Recorded in Millimeters (mm) If the value on the Pathology report is in Centimeters (cm), multiply by 10 to get the value in Millimeters (mm), i.e. CRM recorded as 0.2cm 0.2 x 10 = 2.0. Record as 2.0 KRAS: KRAS analysis is commonly done for patients with metastatic disease If KRAS is positive and there is no mention of the mutated codon, or the mutated codon is not specified, code 4 Abnormal (mutated), NOS, codon(s) not specified Microsatellite Instability (MSI): If testing was done via immunology, code 9. ONLY genetic testing results will specify whether the MSI is low or high

40 Schema Discriminator 1: Occult Head & Neck Lymph Nodes In AJCC 8 th Edition, a new chapter was introduced for situations when there are positive cervical nodes (head & neck nodes), however, the primary tumor is not known (occult tumor) and the primary tumor is presumed to be from the head and neck region (primarily C00-C14, C30-C32). This chapter does NOT apply to those cases where the primary site is known or suspected. In situations as mentioned above, Cancer Registrars will assign C760 (Head and Neck, NOS) when there is a suspected head and neck tumor yet the primary site is not known. Change from previous instructions: Previous instructions led Registrars to code these type of cases to C14.8.

41 Schema Discriminator 1: Occult Head & Neck Lymph Nodes To get to this schema discriminator, the registrar will code C760 (head and neck, NOS) when there is a suspected head and neck tumor, yet the primary site is not known, and/or the primary tumor was not identified. The schema discriminator will then be brought up. Note: If the physician suspects or assigns a specific head and neck subsite, the registrar is still to assign C760 so that the correct staging information can be abstracted. Example: FNA of cervical lymph node metastases shows squamous cell carcinoma, p16 negative. Workup shows no evidence of primary tumor, although physician states this may be a laryngeal primary based on best guess. Even though the primary site is suspected to be larynx, primary site would still be coded to C760. For all head and neck sites, except for oropharynx p16+ and nasopharynx EBV positive, no evidence of primary tumor (T0) does not exist in the individual AJCC chapters or EOD schemas. These cases are collected as unknown head and neck primary (C760), which will have no evidence of primary tumor. This Schema ID was designed specifically to group together these cases of an occult primary, a tumor that is not identified on physical exam or imaging techniques.

42 Schema Discriminator 1: Occult Head & Neck Lymph Nodes Some Exceptions to the Rule: Note 1: This schema discriminator is used to discriminate between head and neck tumors with unknown primary site coded as C760. Some situations require that a more specific primary site be assigned. AJCC 8th Chapter 6: Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck (Schema ID 00060: Cervical Lymph Nodes and Unknown Primary) Occult head and neck tumor with cervical metastasis in Levels I-VII, and other group lymph nodes without a p16 immunostain or with negative results and without an Epstein-Barr virus (EBV) encoded small RNAs (EBER) by in situ hybridization performed or with negative results are staged using Chapter 6. Assign primary site C760; code the schema discriminator accordingly. AJCC 8th edition Chapter 9: Nasopharynx (Schema ID 00090: Nasopharynx) Occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes that is positive for Epstein Barr virus (EBV+) (regardless of p16 status) encoded small RNAs (EBER) identified by in situ hybridization are staged using Chapter 9. Assign primary site C119; do NOT code this discriminator. AJCC 8th edition Chapter 10: HPV-Mediated (p16+) Oropharyngeal Cancer (Schema ID 00100: Oropharynx HPV-Mediated (p16+)) Occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes, p16 positive with histology consistent with HPV-mediated oropharyngeal carcinoma (OPC), should be staged using Chapter 10. Assign primary site C109; do NOT code this discriminator Ill-Defined Other (Summary Stage only) (Schema ID 99999: Ill-Defined Other) If the tumor is not occult or does not have cervical metastasis in Levels I-VII, and other group lymph nodes, it is not included in Chapter 6 and will be classified as Ill-Defined Other for Summary Staging Note 2: If there is no evidence of the primary tumor, yet the physician suspects a specific head and neck subsite, do not assign that primary site, but code C760 (see exceptions for EBV positive or p16 positive cancers.)

43 Head & Neck SSDI helpful tips. In CSv2, Facial Lymph Nodes were collected with Levels VI-VII. They have now been moved to the other group. Extranodal Extension (ENE) is defined as the extension of a nodal metastasis through the lymph node capsule into adjacent tissue and is a prognostic factor for most H&N tumors. Clinical ENE must be based on evidence acquired PRIOR to definitive surgery of primary site, chemotherapy, radiation or other type of treatment. The assessment for Clinical ENE in addition to physical exam may include imaging, biopsy of regional lymph node and/or biopsy of tissues surrounding the regional lymph node. Imaging alone is NOT enough to determine or exclude Clinical ENE. Pathologic ENE Code the status of pathologic ENE on histopathological examination of surgically resected involved regional lymph node(s). Do NOT code pathologic ENE from a lymph node biopsy (FNA, core, incisional, excisional, sentinel). Do NOT code pathologic ENE for any distant lymph nodes.

44 A few more changes to remember (from CSv2). Intrahepatic Bile Ducts SSDI Primary Sclerosing Cholangitis Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of primary sclerosing cholangitis, the registrar could assume that it was not present and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that primary sclerosing cholangitis is not present to code 0. Lung: SSDI Visceral Pleural Invasion Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of visceral pleural invasion, the registrar could assume that it was negative and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that visceral pleural invasion is not present to code 0 Melanoma Skin: SSDI Ulceration Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of ulceration, the registrar could assume that it was negative and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that ulceration is not present to code 0

45 A few more changes to remember (from CSv2). Kidney SSDI Invasion Beyond Capsule Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there is no mention of invasion beyond capsule, the registrar could assume that it was negative and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that invasion beyond capsule is not present to code 0. SSDI Ipsilateral Adrenal Gland Involvement Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of ipsilateral gland involvement, the registrar could assume that it was negative and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that ipsilateral gland involvement is not present to code 0. SSDI Major Vein Involvement Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of major vein involvement, the registrar could assume that it was negative and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that major vein involvement is not present to code 0. SSDI Sarcomatoid Features Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of sarcomatoid features, the registrar could assume that they were not present and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that sarcomatoid features are not present to code 000.

46 A few more changes to remember (from CSv2). Eyelid Carcinoma SSDI Perineural Invasion Change from Collaborative Stage v2 (CSv2): In CSv2, if pathology report was available and there was no mention of perineural invasion, the registrar could assume that it was negative and code appropriately. Per the SSDI as of 2018, this assumption cannot be made. There must be a statement that perineural invasion is not present/negative to assign negative. (Code 0) Lymphomas (Adult & Pediatric Hodgkin and Non-Hodgkin): SSDI B Symptoms This was previously required for staging under the Ann Arbor Staging Classification for Lymphomas. The new Lugano Staging System does not require this for staging. If your physicians no longer record the B symptoms because of this change, code 9. Change from Collaborative Stage v2 (CSv2): In CSv2, if there was no mention of B symptoms, the registrar could assume that they were not present and code appropriately. For the SSDI, this assumption cannot be made. There must be a statement that B symptoms are not present to assign code 0.

47 One Last Reminder if you printed the SSDI Manual or saved it to your PC, check the website again. I had saved/printed it (version 1.2) and while working on this presentation realized a more current version is now available (version 1.4)

48

49 THE END!! Any Questions?