1

Common Errors in the Central Registry

TRAM Educational ConferenceSeptember 19, 2014

Meritus Medical Center

2

Common Errors in the Central Registry

Objectives:

- Discuss the Central Registry practice for reviews- Review common errors seen in the Central Registry- Focus on FORDS standards for palliative care and first course of treatment- Update from the MCR

3

Common Errors in the Central Registry

Audit Process MCR

5 year cycle CompletenessRe-abstraction

4

Common Errors in the Central Registry

Audit Process NPCR – Data Quality Evaluation

5 year cycle Visual Editing (Text to Code)Re-consolidation

Common Errors in the Central Registry

Top Primary Sites

BreastLungColonRectosigmoid ColonRectumUterusProstate

5

6

Common Errors in the Central Registry

Grade most frequent error

7

Common Errors in the Central Registry

Conversion issues

FIGO Grade

Coding Grade from a metastatic site

Following Rule G in the ICD-O-3 manual

Common Errors in the Central RegistryIf the information is not in FORDS refer to the SEER Coding and Staging Manual Appendix C

8

Nottingham Histologic Scores

BR Grade Nuclear Grade

Terminology

Histologic Grade

SEER Code

3-5 Low 1/3; 1/2 Well differentiated

I, I/III, 1/3 1

6, 7 Intermediate

2/3 Moderately differentiated

II, II/III; 2/3 2

8, 9 High 2/2; 3/3 Poorly differentiated

III, III/III, 3/3

3

--- --- 4/4 Undifferentiated/anaplastic

IV, IV/IV, 4/4 4

Grade Conversion Table for Invasive Carcinoma of the Breast

 

Common Errors in the Central RegistryFor Breast In-Situ

9

DCIS Grade Terminology SEER Code

Grade I Low 1

Grade II Intermediate 2

Grade III High 3

DCIS Grade Conversion Table

 

Common Errors in the Central Registry

The FIGO grading system for carcinomas of the uterine corpus is only officially designated for endometrioid carcinomas and is based on architectural features as follows: Grade 1 5% or less nonsquamous solid growth patternGrade 2 6% to 50% nonsquamous solid growth patternGrade 3 > 50% nonsquamous solid growth pattern

Ref: CAP Protocols for Cancer Reporting 2012

10

Common Errors in the Central Registry

Rule G. Grading or differentiation code: Assign the highest grade or differentiation code described in the diagnostic statement.

“Grade High/Stage Low”

DO NOT code grade from a metastatic site, use code 9.

Ref: ICD-O-3 Coding Manual page 21

11

Common Errors in the Central Registry

Date of First Surgical Procedure

Date of First Surgical Procedure is the date the first Surgical Procedure of Primary Site, Scope of Regional Lymph Node Surgery, or Surgical Procedure/Other Site is performed as part of first course of treatment.

Ref: FORDS 2013 page 21

12

Common Errors in the Central RegistryThe date in this item may be the same as that in Date of Most Definitive Surgical Resection of the Primary Site (NAACCR Item #3170), if the patient received only one surgical procedure and it was a resection of the primary site.

If surgery is the first or only treatment administered to the patient, then the date of surgery should be the same as the date entered into the item Date of First Course Treatment (NAACCR Item #1270).

13

Common Errors in the Central Registry

14

Examples:

A melanoma patient had an excisional biopsy on March 23, 2008, then a wide excision on March 28, 2008.

March 23, 2008

The patient had a small (0.5 cm) lump removed from her breast on November 16, 2009.

November 16, 2009

The patient’s primary tumor was treated with radiation beginning on April 16, 2007, after a distant metastasis was removed surgically on March 27, 2007.

March 27, 2007

Common Errors in the Central RegistryPalliative Care and Date First Course of Treatment

Surgical procedures, radiation therapy, or systemic therapy provided to prolong the patient's life by controlling symptoms, to alleviate pain, or to make the patient comfortable should be coded palliative care and as first course therapy if that procedure removes or modifies either primary or metastatic malignant tissue.

15

Common Errors in the Central Registry

Examples for Code 0: No Palliative Care is provided; diagnosed at

autopsy

Source: FORDS: Facility Oncology Registry Data Standards: Revised for 2012

16

Common Errors in the Central Registry

Examples for Code 1: Surgery (which may involve a bypass procedure) to alleviate symptoms, but no attempt to diagnose, stage, or treat the primary tumor is made.

Source: FORDS: Facility Oncology Registry Data Standards: Revised for 2012

17

1 A patient undergoes palliative surgical removal of brain metastasis.  [Surgery recorded in Surgical Procedure/Other Site (NAACCR Item #1294)]

1 A patient with unresectable pancreatic carcinoma (no surgical procedure of the primary site is performed) receives bypass surgery to alleviate jaundice and pain.

Common Errors in the Central Registry

Examples for Code 2: RT to alleviate symptoms, but no attempt to diagnose, stage, or treat the primary tumor is made.

18

2 A patient is diagnosed with Stage IV prostate cancer. His only symptoms are painful bony metastases in his right hip and lower spine. XRT is given to those areas. (Record all radiotherapy items also).

2 A patient with lung cancer with a primary tumor extending into the spine is treated with XRT to shrink tumor away from spine/nerves to provide pain relief.  (Record all radiotherapy items also).

Common Errors in the Central Registry

Examples for Code 3: Chemo, Hormonal or other systemic drugs to alleviate symptoms, but no attempt to diagnose, stage, or treat the primary tumor is made.

19

3 A patient is given palliative chemotherapy for Stage IIIB lung cancer. (Record all chemotherapy items also).

Common Errors in the Central Registry

Examples for Code 4: Patient received or was referred for pain management w/ no other palliative care.

20

4 A 93-year old patient is diagnosed with multiple myeloma and enters a pain management clinic to treat symptoms. No other therapy is planned due to other medical problems.

Common Errors in the Central Registry

Examples for Code 5, 6, and 7: Any combination of 1, 2, and/or 3 w/ or without 4 or no info available.

21

5 A patient is diagnosed with widely disseminated small cell lung cancer. A palliative resection of a solitary brain metastasis is performed followed by XRT to the lower spine for painful bony metastasis. There is no known pain management.  (Record all surgery and radiotherapy items also).

6 A patient diagnosed with colon cancer receives bypass surgery to alleviate symptoms and XRT to the liver for metastasis, and then enters a pain management clinic for treatment for unremitting abdominal pain.  (Record all radiotherapy items also).

7 A patient enters the facility with a clinical diagnosis of unresectable carcinoma of the pancreas. A stent was inserted into the bile duct to relieve obstruction and improve the bile duct flow.

Common Errors in the Central Registry

Regional Nodes Positive/Regional Nodes Examined

00/98 vs. 98/00

98 No nodes examined for RN Positive00 No nodes examined for RN Examined

22

Common Errors in the Central Registry

What are regional nodes???

23

Common Errors in the Central Registry

24

Common Errors in the Central Registry

Use of code 95.  Use code 95 when the only procedure for regional lymph nodes is a needle aspiration (cytology) or core biopsy (tissue).  

Example:  Patient with esophageal cancer.  Enlarged mid-esophageal node found on CT scan, which is aspirated and found to be positive.  Patient undergoes radiation therapy and no surgery.  Code Regional Nodes Positive as 95 and Regional Nodes Examined as 95.

25

Common Errors in the Central RegistryLymph node biopsy.  If a lymph node biopsy was performed, code the number of nodes removed, if known.  If the number of nodes removed by biopsy is not known, use code 96.

Definition of “sampling” (code 96).  A lymph node “sampling” is removal of a limited number of lymph nodes.  Other terms for removal of a limited number of nodes include lymph node biopsy, berry picking, sentinel lymph node procedure, sentinel node biopsy, selective dissection.  Use code 96 when a limited number of nodes are removed but the number is unknown. (Less than or equal to 4)

26

Common Errors in the Central Registry

27

Multiple lymph node procedures.  If both a lymph node sampling and a lymph node dissection are performed and the total number of lymph nodes examined is unknown, use code 97.

Common Errors in the Central Registry

Other issues:- Dates for treatment fields not in text- 00 vs. 99 when text indicates ‘none’ or the

treatment is not indicated for the diagnosis- 998 vs. 999 in the CS SSF fields- lack of adequate text to validate coding

28

Common Errors in the Central Registry

Questions?

29

30

MCR Updates

Death and Lab Only Follow-back

Disease Indices and Accession Registers

Submission Monitoring