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
Percentage
6
Non-specific neoplasms
(8000-8005)
4
2
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
Missouri
38
39
40
41
42
43
44
45
46
NPCR
0
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
Percentage
100%
Hist conf
80%
Cytology
60%
Direct visual
40%
Radiographic
20%
Clinical
0%
Unknown
8000-8005
8010
Histology
Other
MCR Stats – Reporting Source
Missouri Cancer Registy
Histology by Reporting Source - 2001 data
100%
Percentage
80%
Hospital
60%
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
Reporting source
Autopsy
DCO
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%
50%
40%
8000-8005
8010
un
kn
ow
n
ni
ca
l
cli
n
ra
di
og
ra
ph
y
at
io
ua
liz
vis
ar
ke
r
m
+
cy
to
lo
gy
+
m
icr
o
NO
S
+
+
hi
s
to
l
og
y
30%
20%
10%
0%
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
Percentage
0.8
0.6
0.4
0.2
0
1
2
3
4
5
6
7
8
Question
8000
8010
8312
N/R
8140
8500
9
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
8010
8140
N/R
= 65%
= 17.5%
= 12.5%
= 2.5%
(26)
(7)
(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