MCR MINI-UPDATE MARCH 2012
Fellow Registrars,
This seems to be the winter that never was? As we fly towards spring, I have much news below
about changes for 2012 abstracting. Fortunately they are not major! I hope that you are able to
make progress toward getting back on schedule with 2011 reporting timeliness as we recover
from those major 2010 changes that caused us all setbacks. Thanks to all who worked hard to
get their 2010 cases in to meet our extended deadline.
We are entering spring with some exciting changes in our MCR staff. You should have heard
from Nancy Cole earlier that we are pleased Angela Martin has assumed the role of Education
Coordinator. Please join me in commending Deb Smith for her years of great service and
dedication in that role!! I am so glad to have her wisdom and skills continuing in QA into the
future. Stay tuned for more staffing news and a posting of the remaining QA data coordinator
opening - soon.
MCR NEWS
MCR Reportable Cancer Case List Updated for 2012
The list of ICD-9 codes that hospitals should use to create a Medical Record Disease Index (MRDI) has
been updated for 2012 cases and posted to the MCR website. The MRDI is then used to identify cases
which may need to be reported to MCR. Only two additions were made to the list!
One involves the non-melanoma skin cancer codes 173. A 5th digit has been added to those codes as I
announced in my December Monthly Update. Searching for cases coded 173._0 or 173._9 will gather the
visits that are not basal cell (173._1) or squamous cell (173._2), where _ indicates the anatomic location
that has always been used. This improvement should make it much easier to sift out the non-reportable
skin cancer and to find the rarer reportable histologies.
The second addition to the list is in the Supplementary section: 284.11 Anti-neoplastic chemotherapy
induced pancytopenia.
MCR Required Data Elements for 2012 Posted to Website
The fields which MCR requires to be abstracted have been updated for use with 2012 cases. Good news
– the only new field that we will require is an over-ride flag for CS items, CS Over-ride CS 20, which will
be left blank for all MCR cases. I will advise software vendors accordingly.
March Live Meeting
Been wondering how to annotate or extract information from manuals that are downloaded as pdf
files? Wondering when it makes sense to convert Word documents to pdf? Register now to watch the
presentation “PDFs and Publisher: Handy Tips and Tricks” on March 14 at 10am and get your questions
answered by MCR’s electronic communications guru, Shari El-Shoubasi. To register, contact Fred at
RaithelF@health.missouri.edu. In April Deb Douglas will present a summary of compiled audit findings
for the past year.
Abstracting Tip – Melanoma Surgery Codes
For primary skin malignancies, wide excision or re-excision codes 45, 46 and 47 can be used ONLY when
the pathology report states the distance to the nearest surgical margin is > 1 cm on microscopic exam.
The surgeon’s description of the gross margins taken upon resection may not substitute for the
microscopic findings from the pathology report.
Example: A patient with a right cheek melanoma diagnosed by shave biopsy underwent a re-excision for
margins. The surgeon calls the procedure a “wide excision with 1 cm margins” but the pathology shows
tumor extending to within .8 cm of a lateral margin. The correct surgery code for this scenario is, 31 –
Shave biopsy followed by a gross excision of the lesion. (See FORDS Appendix B: Site-Specific Surgery
Codes.) NOTE: Please state the distance to the closet margin in your pathology text in order to support
your surgery code.
Abstracting Tip – Lung
Remember that pleural effusions are considered malignant unless more than one cytopathologic report
says negative and the fluid is non-bloody and not an exudate.
Abstracting Tip – Personal History
In the MO Personal History and Year fields DO NOT record the tumor that is currently being abstracted
and reported. Those fields are specifically to record the site and year of any other reportable tumors
the patient has.
STANDARD SETTER NEWS
ICD-10 Compliance Date to be Postponed
The US Dept. of Health & Human Services announced on Feb 16 their intent to postpone the date for
compliance by health care entities with ICD-10 coding previously set as 10/1/13. No new date has been
announced.
Revised Hematopoietic Database/Manual for 2012 cases due for release in April 2012
Stay tuned! Preview of a new rule: Plasma Cell Leukemia will be coded as Multiple Myeloma 9732.
From NAACCR – Highlighting Changes for 2012
Cases diagnosed in 2012 will be abstracted using CS Version 2.04. Coding instructions are available in
either hyperlinked or traditional formats. For full information on CSv2.04 see the CS website at:
http://cancerstaging.org/cstage/manuals/coding0204.html . Changes are summarized in a table in the
Release Notes. I urge you to review them.
Clarification is being added to the NAACCR Data Dictionary and standard setter manuals regarding the
use of ambiguous terms. Abstractors will be directed not to substitute terms like ‘supposed’ for
‘presumed’ or ‘equal’ for ‘comparable’ or ‘likely’ for ‘most likely’. It reiterates that we should only use
those words that are on the list. Surgery/Radiation Sequence and Systemic/Surgery Sequence fields will
have clarified coding for situations involving intraoperative radiation/systemic therapy before and/or
after surgery. New codes (7) are added for Surgery both before and after radiation/systemic therapy.
RESOURCES
Website with Tools for Cancer Survivors
http://journeyforward.org/
Update on Emerging Techniques on Breast Imaging
http://www.oncologystat.com/viewpoints/commentary/Update_on_Emerging_Techniques_in_Breast_I
maging.html
BRCA1/2 Mutations Tied to Better Ovarian Cancer Survival
http://www.oncologystat.com/news/BRCA12_Mutations_Tied_to_Better_Ovarian_Cancer_Survival.html
Simultaneous Lymphatic and Breast Reconstruction Is an Option
http://www.oncologystat.com/journals/journal_scans/Microvascular_Breast_Reconstruction_and_Lym
ph_Node_Transfer_for_Postmastectomy_Lymphedema_Patients.html
PET/CT Detects Early Recurrence of Head and Neck Cancer
http://www.oncologystat.com/news/PET_CT_Detects_Early_Recurrence_of_Head_and_Neck_Cancer.html
Thanks for all you do!
Nancy H. Rold, CTR
QA Unit Supervisor
Missouri Cancer Registry and Research Center