Introduction to ICD-O-3 coding rules

Transcription

1 Introduction to ICD-O-3 coding rules Weena Laddachayaporn, MD National Cancer Institute, Bangkok, Thailand

2 ICD-O-3 The International Classification of Diseases for Oncology Is a coding system for primary site and cell type used by cancer registries throughout the world. It is currently in its third edition (ICD-O-3).

3 ICD-O-3 The topography section of this third edition remains the same as in the second edition. The morphology section has been revised, especially for lymphomas and leukemias. New terms have been added and the non- Hodgkin lymphoma and leukemia sections have been revised on the basis of the WHO Classification of Hematopoietic and Lymphoid Diseases.

4 Knowing how to code using ICD-O is important to cancer registry operations. Although the actual coding of primary site and morphology may be only 5% or less of the registrar s time, knowledge of the codes is critical to data retrieval and analysis.

5 No cancer registrar is expected to memorize all of the codes in ICD-O. What is important to learn is how to skillfully read a pathology report to determine the correct morphology code and how to apply the coding rules in ICD-O-3.

6 ICD-O-3 manual 1. Introduction, Structure and Format 2. Coding Guidelines 3. Topography Numerical Lists 4. Morphology Numerical Lists 5. Alphabetic Index 6. Appendices

7 ICD-O a dual classification with coding systems for : 1. Topography 2. Morphology

8 Topography Topography refers to the anatomic region or site within the body in which a tumor originates. Is the answer to the question where did the tumor start? Referred to as the primary site code Topography codes have four-character codes that run from C00.0 to C80.9.

9 Where did it start? (Topography) C. _ Primary site Subsite Example C34.1 Lung, upper lobe

10 Major Topography Code Groups C00-C14 C15-C26 C30 C31 C32 C33 C34 C38 C39 C40-C41 C42 C44 C47 C48 C49 C50 C51-C58 C60-C63 C64-C68 C69-C72 C73-C75 C76 C77 C80 Lip, Oral Cavity and Pharynx Digestive Organs Nasal Cavity and Middle Ear Accessory Sinuses Larynx Trachea Lung Heart, Mediastinum and Pleura Others and Ill-defined Sites within Respiratory System and Intrathoracic Organs Bones, Joints and Articular Cartilage Hematopoietic and Reticuloendothelial Systems Skin Peripheral Nerves and Autonomic Nervous System Retroperitoneum and Peritoneum Connective, Subcutaneous and Other Soft Tissues Breast Female Genital Organs Male Genital Organs Urinary Tract Eye, Brain and Other Parts of Central Nervous System Thyroid and Other Endocrine Glands Other and Ill-Defined Sites Lymph Nodes Unknown Primary Site

11 C50.0 Nipple Topography C50 Breast C50.1 Central portion of breast C50.2 Upper-inner quadrant of breast C50.3 Lower-inner quadrant of breast C50.4 Upper-outer quadrant of breast C50.5 Lower-outer quadrant of breast C50.6 Axillary tail of breast C50.8 Overlapping lesion of breast C50.9 Breast, NOS

12 Topography C18 Colon C18.0 Cecum C18.1 Appendix C18.2 Ascending colon C18.3 Hepatic flexure of colon C18.4 Transverse colon C18.5 Splenic flexure of colon C18.6 Descending colon C18.7 Sigmoid colon C18.8 Overlapping lesion of colon C18.9 Colon, NOS

13 Morphology Morphology refers to the cell type of the tumor (histology). Is the answer to the question what type is it? Morphology terms have five-digit code numbers ranging from 8000/0 to 9992/3.

14 Tumor Morphology Tumor Histology/Cell Type Tumor Behavior Tumor Differentiation/Grade

15 What type is it? (Morphology) M / _ Histology Behavior (Cell type) (4 digits) (1 digit) The first four digits indicate the specific histologic term (cell type). The fifth digit, after the slash, is a behavior code.

16 5 th Digit Behavior Code for Neoplasms ICD-O Behavior code Benign neoplasms 0 Neoplasms of uncertain or 1 unknown behavior In situ neoplasms 2 Malignant neoplasms 3 Malignant, metastatic 6

17 What type is it? (Morphology) M / Histology (Cell type) Grade Behavior

18 6 th Digit Code for Tumor Differentiation/Grade Well differentiated (Grade I, Low grade) Moderately differentiated (Grade II, Intermediate grade) Poorly differentiated (Grade III, High grade) Undifferentiated, Anaplastic (Grade IV)

19 Grade/Differentiation code Grade I/Well differentiated 1 Grade II/Moderately differentiated 2 Grade III/Poorly differentiated 3 Grade IV/Undifferentiated, Anaplastic 4 Grade or differentiation not determined, 9 not stated or not applicable

20 / histology behavior grade Example: Well-differentiated adenocarcioma 8140 / 3 1 Tumor cell type Behavior Differentiation (adeno-) (carcinoma) (well-differentiation)

21 6 th digit for the phenotype or T, B, Null, or NK cell origin for leukemias and lymphomas Phenotype (cell origin) Code T-cell 5 B-cell 6 Null cell 7 NK cell 8 Cell type not stated or not applicable 9

22 / histology behavior grade Example: Diffuse large B-cell lymphoma 9680 / 3 6 Tumor cell type Behavior Differentiation (malignant) (B-cell)

23 The Complete ICD-O-3 Code for a Neoplasm The complete code for a neoplasm contains ten characters, in two major sections. 1. Topography -site and subsite (primary site)-4 characters 2. Morphology -histologic type (cell type)-4 digits Behavior -1 digit Grade or differentiation (or cell phenotype for leukemia or lymphoma) -1 digit

24 Topography C. _ Morphology M / Grade

25 The Complete ICD-O-3 Code for a Neoplasm Example: Poorly differentiated small cell carcinoma arising in the upper lobe of the lung C34.1 M-8041/33 Topography = C34.1 Primary site = C34, lung Subsite =.1, upper lobe Morphology = 8041, small cell carcinoma Behavior = 3, malignant Grade = 3, poorly differentiated

26 The Complete ICD-O-3 Code for a Neoplasm Example: Diffuse large B-cell lymphoma in lymph node of neck C77.0 M-9680/36 Topography = C77.0 Primary site = C77, lymph node Subsite =.0, lymph node of neck Morphology = 9680 Behavior = 3, malignant B-cell origin = 6

27 Conditions not considered to be neoplasms (Tumor-like lesions) Could be confused with neoplasms For example, they may end in oma No ICD-O morphology code is given after the M-, only seven dashes (M ), because these conditions are not considered to be neoplasms.

28 Conditions not considered to be neoplasms (Tumor-like lesions) Pseudotumor Hamartoma Granuloma Metaplasia/Hyperplasia Acanthoma, Keratoacanthoma Keratosis (actinic keratosis, inverted follicular keratosis, seborrheic keratosis) Leucoplakia Acanthosis nigricans Juvenile polyp, Juvenile xanthogranuloma

29 Thank you

30 References April Fritz, et al. International Classification of Diseases for Oncology. 3 rd ed (1 st revision). Malta: World Health Organization; April Fritz, BA, RHIT, CTR. The Cancer Registry Casebook. 2 nd ed. Vol 1., Nevada: A. Fritz and Associates, LLC; 2011.