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CODING pitfalls

CODING pitfalls. 2012 Kentucky Cancer Registry Fall workshop. Avoiding the pit…. Do you feel like the fella on the tightrope when it comes to choosing abstracting codes? Let’s review a few coding examples and get off the coding tightrope!. Example # 1 - race.

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CODING pitfalls

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  1. CODING pitfalls 2012 Kentucky Cancer Registry Fall workshop Rhonda Paul, CTR Kentucky Cancer Registry September 6, 2012

  2. Avoiding the pit… • Do you feel like the fella on the tightrope when it comes to choosing abstracting codes? • Let’s review a few coding examples and get off the coding tightrope!

  3. Example # 1 - race • Medical record states patient’s mother was Japanese and patient’s father was Caucasian. How would you code the following race codes? • Race 1 ___ ___ • Race 2 ___ ___ • Race 1 = code 05 (Japanese) • Race 2 = code 01 (White) March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  4. Example # 2 - Spanish origin • A Brazilian male is diagnosed with cancer and treated at your facility. How would you code the Spanish origin? • 0 – Non-Spanish; non-Hispanic • 4 – South or Central American (except Brazil) • 5 – Other specified Spanish/Hispanic origin (includes European; excludes Dominican Republic) • 9 – Unknown • Answer = Code 0 – non-Spanish/non-Hispanic March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  5. Example #3 - Topography • Final pathologic diagnosis: Poorly differentiated infiltrating ductal carcinoma originating in the uncinate process of the pancreas extending into the duodenum. What topography code would you assign? • C25.0 – Head of pancreas • C25.9 – Pancreas NOS • C50.9 – Breast NOS • C80.9 – Unknown primary • Answer = C25.0 – Head of pancreas March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  6. Example #3 (continued) - Histology • What histology code would you assign? • 8000/3 – Malignant neoplasm • 8010/3 – Carcinoma NOS • 8140/3 – Adenocarcinoma NOS • 8500/3 – Infiltrating ductal carcinoma NOS (C50._) • Answer = 8500/3 – Infiltrating ductal carcinoma NOS (C50._) March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  7. http://en.wikipedia.org/wiki/Uncinate_process_of_pancreas

  8. Example #4 - Histology • Right breast lumpectomy, upper outer quadrant: Microscopic description: 1 cm right breast tumor with ductal carcinoma in situ and lobular carcinoma in situ. Focally present between ducts involved with ductal carcinoma in situ are minute tubular structures associated with stromal fibrosis and chronic inflammation. These foci are suspicious for micro-invasive carcinoma. Final pathologic diagnosis: Ductal carcinoma in situ and lobular carcinoma in situ. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  9. Example #4 (continued) - Histology • What is the ICD-O-3 histology code? • 8500/2 – Intraductal carcinoma • 8522/2 – Intraductal carcinoma and lobular carcinoma in situ • 8522/3 – Infiltrating duct and lobular carcinoma • 8523/3 – Infiltrating duct mixed with other types of carcinoma • Answer = 8522/2 – Intraductal carcinoma and lobular carcinoma in situ March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  10. Example #5 – Multiple primaries & topography • Patient diagnosed in March 2011 with three non-invasive papillary urothelial carcinomas of the bladder. Treatment was cystonephroureterectomy in April 2011. Path resection showed single non-invasive papillary urothelial carcinoma of the renal pelvis. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  11. Example #5 (continued) – Multiple primaries • How many primaries should be coded? • One primary per rule M6 – Bladder tumors with any combination of the following histologies: papillary carcinoma (8050), transitional cell carcinoma (8120-8124), or papillary transitional cell carcinoma (8130-8131) are a single primary. • One primary per rule M8 – Urothelial tumors in two or more of the following sites are a single primary (see Table 1): renal pelvis (C65.9), ureter (C66.9), bladder (C67.0-C67.9), urethra/prostatic urethra (C68.0). • Two primaries per rule M9 – Tumors with ICD-O-3 histology codes that are different at the first (xxxx), second (xxxx) or third (xxxx) number are multiple primaries. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  12. Example #5 (continued) – Multiple primaries • Two primaries per rule M10 – Tumors in sites with ICD-O-3 topography codes with different second (Cxxx) and/or third characters (Cxxx) are multiple primaries. • Answer = One primary per rule M8 – Urothelial tumors in two or more of the following site are a single primary (see Table 1): renal pelvis (C65.9), ureter (C66.9), bladder (C67.0-C67.9), urethra/prostatic urethra (C68.0). March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  13. Example #5 (continued) - topography • What is the ICD-O-3 topography code? • C65.9 – Renal pelvis • C67.9 – Bladder • C68.9 – Urinary system NOS • C67.9 and C65.9 – two primaries • Answer = C68.9 – Urinary system NOS March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  14. Example #6 – multiple primaries • CT scan of chest: Right upper lobe lung mass, 3 x 4 cm, most likely malignant. Consolidation in upper lobe of left lung; wavering between 2nd primary lung cancer and metastatic disease. Biopsy of right lung mass: adenocarcinoma. How many primary tumors does this patient have and what M rule was used to determine that? • One primary per rule M2 – A single tumor is always a single primary. • Two primaries per rule M6 – A single tumor in each lung is multiple primaries. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  15. Example #6 (continued) – multiple primaries • Two primaries per rule M11 – Tumors with ICD-O-3 histology codes that are different at the first (xxxx), second (xxxx) or third (xxxx) number are multiple primaries. • One primary per rule M12 – Tumors that do not meet any of the above criteria are a single primary. • Answer = Two primaries per rule M6 – A single tumor in each lung is multiple primaries. • Rule M6 note clarification: When there is a single tumor in each lung abstract as multiple primaries unless stated orproven to be metastatic. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  16. Example #7 – multiple primaries • Patient had transurethral resection of bladder neck for a papillary urothelial cell carcinoma in March 2007. Patient has transurethral resection of bladder wall tumors in April 2011 and path showed transitional cell carcinoma. How many primary tumors does this patient have and what M rule was used to determine that? • One primary per rule M6 – Bladder tumors with any combination of the following histologies: papillary carcinoma (8050), transitional cell carcinoma (8120-8124), or papillary transitional cell carcinoma (8130-8131), are a single primary. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  17. Example #7 (continued) – Multiple primaries • Two primaries per rule M7 – Tumors diagnosed more than three (3) years apart are multiple primaries. • Two primaries per rule M9 – Tumors with ICD-O-3 histology codes that are different at the first (xxxx), second (xxxx) or third (xxxx) number are multiple primaries. • One primary per rule M11 – Tumors that do not meet any of the above criteria are a single primary. • Answer = One primary per rule M6 – Bladder tumors with any combination of the following histologies: papillary carcinoma (8050), transitional cell carcinoma (8120-8124), or papillary transitional cell carcinoma (8130-8131), are a single primary. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  18. Example #8 – CSv2 Data items • Debulking path report: Gross: Tumor involves both ovaries and fallopian tubes with seeding of peritoneum, none of which are greater than 2 cm in size. Microscopic: Cystadenocarcinoma of left and right ovaries and fallopian tubes with peritoneal carcinomatosis. There is no metastasis outside of the peritoneum. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  19. Example # 8 (continued) – CSv2 Data items • What is the code for CS Extension? • Code 200 – Tumor limited to both ovaries, capsule(s) intact, no tumor on ovarian surface, no malignant cells in ascites or peritoneal washings • Code 650 – Tumor involves one or both ovaries with pelvic extension, NOS • Code 710 – Macroscopic peritoneal implants beyond pelvis, less than or equal to 2 cm in diameter, including peritoneal surface of liver; FIGO Stage IIIB • Code 730 – Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside of the pelvis, NOS March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  20. Example # 8 (continued) – CSv2 Data items • Answer = Code 710 – Macroscopic peritoneal implants beyond pelvis, less than or equal to 2 cm in diameter, including peritoneal surface of liver; FIGO Stage IIIB March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  21. Example #9 – CSv2 data items • Patient presented with an enlarged cervical lymph node. The entire lymph node was excised and the patient was found to have squamous cell carcinoma from a laryngeal primary. The patient was treated with radiation only. What is the code for CS Lymph Nodes Eval? • Code 0 – Non-invasive clinical evidence • Code 1 – Other invasive techniques • Code 3 – Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation • Code 4 – Unknown • Answer = Code 1 – Other invasive techniques March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  22. Example #9 (continued) – CSV2 data items Code 0 Staging Basis = c Does not meet criteria for AJCC pathologic staging: No regional lymph nodes removed for examination. Evaluation based on physical examination, imaging examination, or other non-invasive clinical evidence. No autopsy evidence used. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  23. Example #9 (continued) – CSV2 data items Code 1 Staging Basis = c Does not meet criteria for AJCC pathologic staging based on at least one of the following criteria: No regional lymph nodes removed for examination. Evaluation based on endoscopic examination or other invasive techniques, including surgical observation without biopsy. No autopsy evidence used. OR Fine needle aspiration, incisional or core needle biopsy, or excisional biopsy of regional lymph nodes or sentinel nodes as part of the diagnostic workup WITHOUT removal of the primary site adequate for pathologic T classification (treatment). March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  24. Example #9 (continued) – CSV2 data items Code 3 Staging Basis = p Meets criteria for AJCC pathologic staging based on at least one of the following criteria: Any microscopic assessment of regional nodes (including FNA, incisional or core needle biopsy, excisional biopsy, sentinel node biopsy or node resection) WITH removal of the primary site adequate for pathologic T classification (treatment) or biopsy assessment of the highest T category. OR Any microscopic assessment of a regional node in the highest N category, regardless of the T category. March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  25. Example #10 - treatment • A patient with recently diagnosed lung cancer received radiation treatment at your facility. The patient completed a full course of Cyber knife ® stereotactic ablative radiosurgery (SABR) to the primary tumor. The patient received 45 Gy to each tumor in 3 fractions. No additional radiation treatment was given. What is treatment modality? • Code 20 – External beam, NOS • Code 41 – Stereotactic radiosurgery, NOS • Code 42 – Linac radiosurgery • Code 43 – Gamma knife • Answer = Code 42 – Linac radiosurgery March 1, 2012 NAACCR 'Abstracting and Coding Boot Camp' Webinar

  26. Reportable examples • Carcinoid of the appendix found on appendectomy. Patient returns later with metastases in regional lymph nodes. This case is reportable because of the metastatic lymph nodes – this is a malignant carcinoid. Code the date of diagnosis to the date of the appendectomy and the first course of treatment to the appendectomy date. • Ovarian mucinous borderline tumor with foci of intraepithelial carcinoma. This case is reportable because there are foci of intraepithelial carcinoma (carcinoma in situ). SEER Program Coding and Staging Manual 2012 – Page 2

  27. Reportable examples • GIST with lymph nodes positive for malignancy. Report the case and code the behavior as malignant (/3). SEER Program Coding and Staging Manual 2012 – Page 2

  28. Not reportable examples • Left thyroid lobectomy shows microfollicular neoplasm with evidence of minimal invasion. Microscopic portion of path report states, “The capsular contour is focally distorted by a finger of the microfollicular nodule which appears to penetrate into the adjacent capsular and thyroid tissue.” Do not report this case based on the information provided. There is no definitive statement of malignancy. Search for additional information in the record. Contact the pathologist or the treating physician. SEER Program Coding and Staging Manual 2012 – Page 3

  29. Not reportable examples • Sclerosing hemangioma of the lung with multiple regional lymph nodes involved with sclerosing hemangioma. This case is not reportable. The lymph node involvement is non-malignant. According to the WHO Classification of Lung Tumours, sclerosing hemangioma “behaves in a clinically benign fashion…Reported cases with hilar or mediastinal lymph node involvement do not have a worse prognosis.” SEER Program Coding and Staging Manual 2012 – Page 3

  30. Not reportable examples • Carcinoid, NOS of the appendix that extends into mesoappendiceal adipose tissue. This case is not reportable. Extension does not make a carcinoid, NOS of the appendix reportable. Benign and borderline tumors can and do extend into surrounding tissue. • Carcinoid tumorlets are not reportable. • “VIN II-III” and “VIN II/III” are not reportable. • Squamous cell carcinoma of the perianal skin (C44.5) is not reportable. Squamous cell carcinoma of the anus (C21.0) IS reportable. SEER Program Coding and Staging Manual 2012 – Page 3

  31. Reminder… • KCR purchases the NAACCR educational webinars and posts them on the KCR website under ‘Training’ in the ‘Technical Resources’ section. They can be viewed, free-of-charge, by all Kentucky registrars, and CE’s are earned for viewing these webinars.

  32. Questions? Contact Rhonda Paul: rhonda@kcr.uky.edu

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