What the Diff

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					     What’s the Diff?

Sue C. Vest, CTR
Missouri Cancer Registry


This project was supported in part by a cooperative agreement
between the Centers for Disease Control and Prevention (CDC) and
the Missouri Department of Health and Senior Services (DHSS)
(#U55/CCU721904) and a Surveillance Contract between DHSS and
the University of Missouri.
        Acknowledgements

•   Jeannette Jackson-Thompson, MSPH, PhD
•   Nancy Cole, CTR
•   Deborah Smith, CTR
•   Louanne Currence, RHIT, CTR
•   Chester Schmaltz, Graduate Research Asst.
•   All other registrars who offered comments
    and suggestions
     Objectives

• Determine if the use of 8010 rather
  than 8000 is a good quality indicator.
• Identify ways coding uniformity can be
  improved in facilities and central
  registries.
      WHY!!

• Reaction to CDC National Program of Cancer
  Registries (NPCR) QI reports
  • Percentage of cases coded to 8000-8005 is NOT a
    good QI indicator
    • Diagnostic confirmation
    • Reporting Source (Death Clearance Only (DCO))
  • Clear guidelines on how to code non-specific
    histology are lacking
     What?

• Discussions
• Restricted Access File
• MCR data review
• Survey
• Poster presentation at NAACCR 2006
                                  % Non-specific Morphology [420]
                                 All Sites Combined*, Both Genders
                    Individual State Registries and NPCR Registries Combined,
                                         2001 diagnosis year
               10



                8


                                            Non-specific neoplasms
                6                           (8000-8005)
  Percentage




                4



                2



                0




                    Missouri
                          1
                          2
                          3
                          4
                          5
                          6
                          7
                          8
                          9
                         10
                         11
                         12
                         13
                         14
                         15
                         16
                         17
                         18
                         19
                         20
                         21
                         22
                         23
                         24
                         25
                         26
                         27
                         28
                         29
                         30
                         31
                         32
                         33
                         34
                         35
                         36

                         38
                         39
                         40
                         41
                         42
                         43
                         44
                         45
                         46
                      NPCR
                                                           State registries

*Invasive cases only, excludes basal and squamous cell carcinomas of the skin except when these occur on the skin of the genital organs
and in situ cancers except urinary bladder.
              MCR Stats – by Dx Confirmation


                         Missouri Cancer Registry
              Histology by Diagnostic Confirmation - 2001 data

             100%
             80%                                         Hist conf
Percentage




                                                         Cytology
             60%
                                                         Direct visual
             40%
                                                         Radiographic
             20%                                         Clinical
              0%                                         Unknown
                       8000-8005               8010      Other
                                   Histology
     MCR Stats – Reporting Source
                            Missouri Cancer Registy
                    Histology by Reporting Source - 2001 data

             100%

             80%
Percentage




             60%                                                Hospital
                                                                DCO
             40%                                                Other

             20%

              0%
                          8000-8005               8010
                                      Histology
      NPCR Restricted Access File
      (RAF)

• Record level 1999-2002 data
  • 37 states meeting NPCR publication criteria
    (= NAACCR silver certification)
  • 358,960 cases
• Limited release (2 states applied in ’05)
      NPCR RAF Data

                   Histology by Reporting Source

80%

60%              8000-8005
                 8010
40%

20%

0%
      Hospital    Lab Only   Phys Office   NH     Autopsy   DCO
                               Reporting source
       Death Clearance Only Cases

• 8000 – 8005
  • range = 3.98% - 96.7%
• 8010
  • range = 0.00% - 68.67%
• All other histology
  • range = 3.30% - 46.43%

Based on 1999-2002 data from NPCR RAF
(37 states, 4,289,696 cases)
              NPCR RAF Data

                  Histology by Diagnostic Confirmation

70%
60%                      8000-8005
50%                      8010
40%
30%
20%
10%
 0%


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       Non-microscopically Confirmed

• 8000-8005
  • Range = 15.93% - 83.48%
• 8010
  • Range = 0.00% - 52.70%
• Other
  • Range = 15.74% - 40.84%

Based on 1999-2002 data from NPCR RAF
(37 states, 4,289,696 cases)
     Survey

• Info
  • Demographics
  • Trainings/conferences attended
• Case scenarios
  • Excerpts from hospital cases
  • Non-hospital cases
  • Death Certificate Only (DCO) cases
     Survey Results

• # of responses = 40
• Place of employment
  • 45% hospital
  • 45% central registry
  • 10% other (vendor/contractor/consultant)
• CTR = 40
• Attended conferences/workshops = 40
    Survey Questions
                       Survey Answers by Question

              1

             0.8
Percentage




             0.6

             0.4

             0.2

              0
                   1   2      3      4      5         6          7          8   9
                                         Question

                           8000   8010   8312   N/R       8140       8500
      Survey Case Scenario #2

LEFT KIDNEY: Poorly differentiated malignant
  neoplasm with … See comment.
  COMMENT #1: The differential diagnosis
  includes poorly differentiated renal cell
  carcinoma and a renal sarcoma such as
  synovial sarcoma. The pathologic material is
  being referred for consultation and a final
  report will follow (no final report available in
  chart).
  8000=87.5% (35)           8010=2.5% (1)
  8312=10.0% (4)
      Case Scenario #3
CT:…poorly defined area of decreased
  enhancement suggesting pancreatic head
  mass. Onc. consult: obstructive jaundice
  with pancreatic mass very suggestive of
  pancreatic cancer. Await the cytology from
  biliary drainage, as well as ca-19-9. It will
  likely be difficult to establish the diagnosis.
Discharge summary diagnosis:
1. Pancreatic mass, likely pancreatic cancer.
  8000 = 67.5%(27) 8010 = 17.5%(7)
  N/R = 12.5% (5)
     Survey Case Scenario #4

Non-hospital case
Lung primary with mets to liver and
 skeleton. Patient treated with radiation
 at unknown facility.

8000 = 67.5% (27)
8010 = 30.0% (12)
    Case Scenario #5

• Non-hospital case (nursing home):
 • Prostate cancer. No stage given.
   Observation only

 8000   = 65% (26)
 8010   = 17.5% (7)
 8140   = 12.5% (5)
 N/R    = 2.5% (1)
     Case Scenario #6

Non-hospital case (nursing home):
2 x 5 cm mass in right outer breast.
  Patient refused biopsy. Diagnosed with
  mammogram. Treated with Tamoxifen.
8000 = 57.5% (23)
8010 = 27.5% (11)
8500 = 2.5% (1)
N/R = 10% (4)
     Case Scenario #9

Death Certificate Only case
Cause of death = Metastatic breast
 carcinoma

8000 = 12.5% (5) 8010 = 82.5% (33)
8500 = 2.5% (1)
      Clear Guidelines for Coding?

• Answers to exercises not consistent
  • Standards not adequate?
  • Interpretation not correct?
• Guidelines utilized
  • ICD-O-3
  • Inquiry & Response (CoC)
  • FORDS
  • SEER Inquiry System
        ICD-O-3 Morphology

• 8000/3 – Neoplasm, malignant
  •   Tumor, malignant NOS
  •   Malignancy
  •   Cancer
  •   Unclassified tumor, malignant
  •   Blastoma, NOS
• 8010/3 – Carcinoma, NOS
  • Epithelial tumor, malignant
• “often (incorrectly) used interchangeably”
     Other Guidelines

•I&R
  • “…Can we assume if a physician does not
    state carcinoma, 8000/3 should be used?”
• FORDS
  • “codes for cancer, NOS and carcinoma,
    NOS are not interchangeable”
• SEER Inquiry
  • …abbreviation “ca” = ???
     Effective QI Tool?

• Maybe!!
  • Coding of 8010 must have supporting
    documentation
  • Reporting source and diagnostic
    confirmation must be considered
      Conclusions

• Need more info to answer the questions
  • Is the use of more specific histologies a
    good QI indicator?
  • Are there adequate guidelines for
    determining when to use 8000-8005
    histology codes?
     Lessons Learned

• More definitive guidelines needed
• Training
• Review of non-specific histologies and
  carcinoma coding
• Edits??
          Thank you

Questions?

Sue C. Vest, CTR
vests@health.missouri.edu
http://mcr.umh.edu

				
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