MCR MINI-UPDATE FEBRUARY 2014
Fellow Registrars,
Let’s hope for moderating temperatures outdoors in February. I’m hoping for an early spring! Meanwhile there is much registry work to be done. I have so much information to convey this month, that I am cutting my Resources section a bit shorter to conserve time and space. I hope you find one or both of the attached documents useful.
Due Dates
Large hospitals (>500 cases/yr) are to report July 2013 cases by February 15, 2014.
EDUCATION
NAACCR Webinars – Get 3 CEUs By Viewing Recorded Webinars. Request Access Now! Check out our Education and Training page to find out how you can receive access to the recorded NAACCR Webinars.
February 6, 2014 – Collecting Cancer Data: Treatment Data
Live Meetings - Visit our Education and Training page to listen to previous Live Meetings. They are available to listen to for one year after they are presented.
February 12, 2014 – Casefinding: Should I Report That?
Presented by Angela Martin
To register for any of our educational opportunities, call 1-866-240-8809 or contact Shari Ackerman at .
MCR NEWS
Class of Case
I have attached a handout from the January Live Meeting that some attendees found was a useful reference for abstracting. It is based on the most used Class of Case rules in the MCR and FORDS manuals but instead of presenting those in numeric order, it presents them in a matrix designed for decision-making. Work down the columns and across the rows to find the situation that applies followed by its code and reportability.
During that Live Meeting, it also became clear that MCR needed to restate our policy on reporting Class of Case 30 patients. These cases are seen at your facility only for treatment plan consultation or supplemental diagnostic/staging workup, etc. Their initial diagnosis, treatment and follow-up care are done elsewhere. These are not reportable to MCR from your facility. In the past, we may have caused some confusion about MCR requirements for reporting these cases when we would occasionally ask a facility to send in a specific Class 30 case. We apologize for sending a mixed message on this issue and reiterate Class 30 cases are not reportable to MCR.
Adenocarcinoma in situ of the Cervix
Change in reportability – Adenocarcinoma in situ of the cervix will no longer be reportable to Missouri Cancer Registry for cases diagnosed starting 1/1/2014. This is in line with the stance of national standard setters.
Conversion to v14
The timing plan is the same as last year: hospitals should plan to convert to NAACCR v14 when 2013 cases have been exported or by July, whichever comes first. MCR plans to be ready to accept in v14 cases in August. Within the next month we will provide to vendors and reporters: a list of MCR required fields for 2014 as well as MO Edit metafile v14. We are currently waiting on clarifications from NPCR. After FORDS 2014 is released we will complete updates to the MCR Manual.
Selecting Contractors
MCR occasionally gets requests for information from facilities interested in hiring contract registrars to assist with their registries. While we no longer publish a list of potential contractors, we do offer a list of parameters that might be considered during such a selection process (attached). It is adapted from a publication by the Georgia Comprehensive Central Registry.
Abstracting Tips
1) Larynx. When abstracting laryngeal carcinomas (C32.0 – C32.9), please be sure to note in text the mobility of the vocal cords. Many CS Extension codes specify the presence of normal or impaired mobility, or vocal cord fixation according to subsite as shown below. Cord mobility should be confirmed in your text documentation when the CSE code calls for it.
Glottis (C32.0) CSE codes 110 – 400
Supraglottis (C32.1) CSE codes 100 – 625
Subglottis (C32.2) CSE codes 100 – 400
Other larynx (C32.3, C32.8-C32.9) CSE codes 200, 350 and 410
2) Personal History. The following tips should help you troubleshoot problems with clearing edits on the personal history fields. When abstracting cases that have previous, synchronous or subsequent primaries, always keep in mind that the tumor for which the abstract is being prepared should never be listed in the Personal Hx/Year data items.
Other malignancies / Sequence # of current abstract / Personal Hx 1/Yr 1 / Personal Hx 2/Yr 2No other malignancies / 00 / Blank / Blank
1 prior malignancy / 02 / Malignancy #1 / Blank
≥ 2 prior malignancies / ≥ 03 / Malignancy #1 / Malignancy #2
Synchronous malignancies / 01 / Malignancy #2 / Blank
Synchronous malignancies / 02 / Malignancy #1 / Blank
Synchronous malignancies / ≥ 03 / Malignancy #1 / Malignancy #2
Subsequent malignancy / 02 / Malignancy #1 / Blank
Subsequent malignancies / ≥ 03 / Malignancy #1 / Malignancy #2
3) RT codes. Are you confused by various surgical procedures or radiation treatment techniques and don’t know how to pick a proper code?
· You could use a favorite internet search engine to look up the procedure in question. Sometimes understanding what is done clarifies the most appropriate code for a given technique.
· Asking the doctor for an explanation can be enlightening. Most of them want to be understood and enjoy talking about what they do. If you show them your code choices, they should have an interest in helping you know “when my note says this ___, you should code this ___”.
· NAACCR webinar recordings on our website can help you understand treatments for a particular site and earn CEUs at the same time. Request access at: http://mcr.umh.edu/mcr-education.php
4) Ovary. Serous borderline tumor with focal microinvasion of the ovary is NOT reportable. Microinvasion in a borderline ovarian serous tumor is not an indication of malignancy (per SEER Ask a Registrar).
5) Endometrium. From SINQ (2011)
Question
MP/H Rules/Histology--Corpus Uteri: Which MP/H rule applies in coding histology for a "high grade endometrioid adenocarcinoma with squamous differentiation"?
Answer
Endometrioid adenocarcinoma with squamous differentiation is coded to 8570 [Adenocarcinoma with squamous metaplasia].
NOTE: The following row needs to be added to Table 2 in order to be able to correctly use the MP/H rules to reach this conclusion.
Column 1: Endometrioid adenocarcinoma
Column 2: Squamous metaplasia
Squamous differentiation
Column 3: Adenocarcinoma with squamous metaplasia
Column 4: 8570
The change will be made in the next revision of the rules.
STANDARD SETTER NEWS
CSv2.05
The CS2.05 Release Notes give a table of changes made in this version: https://cancerstaging.org/cstage/coding/Documents/ReleaseNotesv0205.pdf SEER*Educate has added coding exercises for 16 site groups using CSv02.05. There are 10 cases per site group. They have requested 5 CE per site group from NCRA. Log in and look under Training Menu, Practical Application Tests, Case Coding – CSv0205 https://educate.fhcrc.org/LandingPage.aspx.
The CSv2.05 Implementation Guide p. 7-8 provides a hospital registry preparation checklist https://cancerstaging.org/cstage/software/Pages/Version-02.05.aspx
After you convert your data, you may need to correct a few flagged codes for Nasopharynx (level IV nodes), Intrahepatic Bile Duct (some SSF10 codes) or Bladder cases (some SSF2 codes). Some cases where mapping to derived stage has changed may need to be recoded in order to properly derive stage. Tools in the conversion process should produce a report of cases in your database that need your review. SEER*Educate has added coding exercises for 16 site groups using CSv02.05. There are 10 cases per site group. We have requested 5 CE per site group from NCRA.
New Instructions for Grade
The national standard setters have met to clarify and agree on consistent instructions for coding grade starting with 2014 cases. These new instructions will be included in FORDS & MCR 2014 manuals, but you can get a preview now at SEER: http://seer.cancer.gov/tools/grade/ MCR also plans to present a Live Meeting on Grade coding this summer.
New Hematopoietic Database
The new Hematopoietic Database can be used immediately. A few things to help you navigate it:
1. The updated manual and database are applicable for all cases diagnosed January 1, 2010, and forward. Previous versions of the databases and manuals (2010 and 2012) are no longer available.
2. The database format has changed. Please view the User’s Guide on the SEER website to help you navigate the new database http://seer.cancer.gov/django/seertools/static/docs/Web_Hema_Lymph_DB.pdf . There’s also a link at top right of database home screen. The link to the manual itself is no longer found at the top right of the main page, instead, you navigate by year of diagnosis and histology to pages with the appropriate information.
3. 2014 changes to the database are outlined at http://seer.cancer.gov/tools/heme/update.html
4. The SEER Educate website has six sets of coding exercises, 5 exercises in each set. They have requested 2.5 CE from NCRA for each set of heme coding exercises. Log in then look under Training Menu, Practical Application Tests, Heme 2014 https://educate.fhcrc.org/LandingPage.aspx.
RESOURCES
Lung cancer incidence trends
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6301a1.htm?s_cid=mm6301a1_w
Cancer Statistics, 2014 from the American Cancer Society
http://onlinelibrary.wiley.com/doi/10.3322/caac.21208/full
Re-examination of evidence shows benefit to screening mammograms
http://www.valuebasedcancer.com/article/reexamination-evidence-supports-routine-mammography-prevent-breast-cancer-death
Wishing you all the best,
Nancy H. Rold, CTR
QA Unit Supervisor
Missouri Cancer Registry and Research Center
Class of Case Decision Maker
Missouri Cancer Registry - January 2014
Place of Initial Diagnosis / First Course Treatment / Decision not to treat / Other / Class of Case Code / MCR Reportable?Reporting Facility / Known to all be done elsewhere / Or decision not to tx made elsewhere / x / 00 / Yes
PART at reporting facility; part elsewhere / x / x / 13 / Yes
ALL at reporting facility / Or decision not to tx made at reporting facility / x / 14 / Yes
Unknown if tx done / Unknown if decision not to treat made / x / 10 / Yes
Treatment done at reporting facility, unkn if it is all of tx / x / x / 10 / Yes
Staff Physician Office / PART at reporting facility; part elsewhere / x / x / 11 / Yes
ALL at reporting facility / Or decision not to tx made at reporting facility / x / 12 / Yes
Treatment done at reporting facility, unkn if it is all of tx / x / x / 10 / Yes
Elsewhere / PART at reporting facility; part elsewhere / x / x / 21 / Yes
ALL at reporting facility / Or decision not to tx made at reporting facility / x / 22 / Yes
Place of Initial Diagnosis / First Course Treatment / Decision not to treat / Other / Class of Case Code / MCR Reportable?
Elsewhere (cont’d) / Elsewhere (incl. private physician office) / Or decision not to tx made elsewhere / Reporting facility did Consult Only / 30 / No
Elsewhere (incl. private physician office) / x / Reporting facility did tx plan only / 30 / No
Elsewhere (incl. private physician office) / Or decision not to tx made elsewhere / Reporting Facility only did Staging workup after initial dx elsewhere / 30 / No
Elsewhere (incl. private physician office) / x / Reporting facility provided only transient care or port placement / 31 / No
Elsewhere (incl. private physician office) / Or decision not to initially tx made elsewhere / Reporting facility diagnoses or treats active cancer recurrence or persistence / 32 / Yes
Elsewhere (incl. private physician office) / x / Patient followed at reporting facility with only history of ca (dz not active) / 33 / No
Contract Abstract/Cancer Registry Services
Suggested Guidelines for Selecting a Cancer Registry Contracting Service
Facility:
· The facility should understand the reporting requirements for the Missouri Cancer Registry (MCR) in order to make an informed decision about what services are needed.
· The facility should decide who would oversee the contractor's activities and performance.
Contractor:
· The contractor should be an experienced Certified Tumor Registrar (CTR) and produce proof of current credential status.
· The contractor should show proof of attendance at recent continuing education activities including state cancer registry trainings and cancer registry association education meetings.
· The contractor should demonstrate a thorough knowledge of the MCR reporting requirements as well as Commission on Cancer requirements if contracted to work in an ACoS approved hospital registry or a hospital registry seeking approval.
· The contractor should provide a list of facilities, both previous and current, within the past three years. This list should include a contact name and phone number for each facility.
· The contractor should have a working knowledge of abstracting software programs and computer hardware.
Contract:
· The contract should list each specific activity the contractor is expected to complete and the standards for quality accordingly.
· The contract should include a clause that guarantees the quality of work performed, specifically accuracy and completeness. In a cancer registry setting, the managing registrar should perform regular quality checks of the contractor's work.
· The contract should include a statement that the contractor will meet the monthly deadline for reporting cancer data to MCR which includes written notification if there are no cancer cases to report in a given month.
· The contract should include a statement that the contractor will make data corrections free of charge as a result of edit error reports received from MCR or records rejected because they lack supporting English text and/or have missing data elements.
Adapted from the Georgia Comprehensive Cancer Registry (GCCR) website.
http://health.state.ga.us/programs/gccr/services.asp