OCCR news flash

              By Leslie Dill
The North American Association of
Central Cancer Registries (NAACCR)
and the Centers for Disease Control
and Prevention (CDC) National Pro-gram
of Cancer Registries (NPCR) have
awarded Oklahoma its highest Gold
Standard Award for data quality, time-liness
and completeness. This is excit-ing
news for all of us because our high
quality data is not possible without all
of you! With budget cuts and staff
shortages in many facilities across the
state, submitting high quality data can be
a real challenge. We at the OCCR would
like to thank those of you who partner
with us to achieve this high standard. We
appreciate your dedication and commit-ment
as we work together to eliminate
cancer in Oklahoma.
Gold Certification
Oklahoma Central Cancer Registry Oklahoma State Department of Health
OCCR NEWSFLASH August 2011
Summer Issue
Inside this issue:
OK2Share 2
Anne Earns PhD 2
New OCCR Staff 2
NAACCR Webinars 4
CSv2.03 Issues 5
Questions & Answers 6
Coding 101 7
NCRW with
Gov. Mary Fallin
8
NAACCR Registry Certification on Quality, Completeness & Timeliness of 2008 Data
Registry Element Gold
Standard
Silver
Standard
Actual
Measure
Measurement
Error Allowed
Standard
Achieved
Completeness of case ascertainment
95% 90% 95.40% 1.00% Gold
Completeness of information
recorded
< = 2%
< = 2%
< = 3%
< = 2%
< = 3%
< = 3%
< = 5%
< = 3%
0.0%
0.0%
1.9%
0.0%
-0.4%
-0.4%
-0.4%
-0.4%
Gold
Gold
Gold
Gold
*Missing/unknown "age at diagno-sis"
*Missing/unknown "sex"
*Missing/unknown "race"
*Missing/unknown "State &
county"
Death certificate only cases < = 3% < = 5% 2.50% -0.4% Gold
Duplicate primary cases < =1 per 1000 < =2 per
1000 < =0.3 per 1000 -0.4 per 1000 Gold
Passing EDITS 100% 97% 100.00% Not applicable Gold
Timeliness Data submitted within 23 months of close of accession year Gold
Certification Status Gold
By Anne Pate, MPH, PhD
The OCCR would like to share that we are now posting preliminary data
on the OK2Share website. We have 2009 and 2010 diagnosis years avail-able,
and the data will be updated regularly. If you have any data re-quests
or individuals who want access to more up-to-date data, please
feel free to point them to the website: www.health.ok.gov/ok2share.
Please keep in mind that these years of data are preliminary and are
subject to change.
If you have any questions, or if you have a data request that OK2Share
doesn’t have enough information to answer, please contact the OCCR
Epidemiologist, Anne Pate, at 405-271-9444, ext 57111 or email
AnneB@health.ok.gov.
OK2Share
OCCR NEWSFLASH Page 2
By Leslie Dill
OCCR would like to introduce the newest member of our staff,
Christina Panicker. Born and raised in the Yukon, OK, area,
Christina is a graduate of Southern Nazarene University. She has
a bachelor’s degree in Biology and Chemistry and is currently fin-ishing
up her MBA in healthcare.
Christina brings with her experience from both the hospital and
laboratory settings. Previous employers include OU Medical Cen-ter
and Diagnostic Laboratory of Oklahoma.
OCCR welcomes Christina and is excited to have her as a member
of our team!
CONGRATULATIONS, Anne!
By Judy Hanna, HT(ASCP)
Please join OCCR in congratulating Anne Pate, Epidemiologist for
OCCR. Anne has just completed the PhD program at the Univer-sity
of Oklahoma. After several years of hard work, commitment
and dedication, Anne presented and defended her dissertation to
her committee on July 28, 2011. It is official—she is Anne Pate,
MPH, PhD. We are extremely proud of her for this accomplish-ment.
Way to go, Dr. Pate!
New OCCR Staff
Christina Panicker
Anne Pate, MPH, PhD
By Paula Marshall, BBA, CTR
As part of the quality con-trol
procedures to ensure
complete and quality data,
the Oklahoma Central Can-cer
Registry (OCCR) sends
queries to physicians and/
or facilities for patients
with a diagnosis of cancer
on their death certificate
that appear to potentially
be missing from the OCCR
database. Patients
identified during the OCCR
linkage known as Death
Match program are
selected according to the
following criteria: a death
certificate stated they had
a diagnosis of cancer; they
died in 2009 or 2010; and/
or they were admitted to
and/or died at your facil-ity.
Therefore, OCCR has
mailed Death Clearance
letters requesting your
assistance.
Because these patients
appear to have not been
reported to the OCCR, we
are requesting copies of
medical records, espe-cially
those areas that
document the date and
diagnosis of cancer such as
History and Physical, Dis-charge
Summary, Radiol-ogy,
Pathology, etc. If you
currently report to the
OCCR, you may abstract
the case via your current
reporting system and it is
important for you to notify
us that you are responding
to the request in this man-ner.
Also, you may
respond by calling (405)
271-4072 and speaking to
an OCCR consultant or by
making written notes on
your attached list of
patients and mailing it
back in the business reply
envelope provided for your
convenience.
In the event you did not
treat the patients on your
list, please provide the
referring physician who
indicated a diagnosis of
cancer or the method by
which you became aware
of the patient’s diagnosis
of cancer.
If you have no records on
the patients on your
attached list and you were
only the physician of
record at the time of
death, please provide
information on how you
became aware of the
patient’s diagnosis of and/
or treatment for cancer.
All responses should be
received in the OCCR
office no later than August
31, 2011. If you have any
questions, or if you antici-pate
difficulty meeting the
above deadline, you may
contact us at 405-271-
4072.
Thank you in advance for
assisting the OCCR in the
collection of timely, accu-rate
and complete cancer
data which will be utilized
to improve the health of
Oklahoma residents.
go to: www.ocra-ok.org/
education.asp.
By Leslie Dill
Don’t forget! The Okla-homa
Cancer Registrars
Association (OCRA) Fall
Conference is right around
the corner, September 29
& 30, 2011. The confer-ence
will be held at Rose
State College in Midwest
City, OK. For more details
OCRA Fall Conference
Death Clearance 2009/2010
OCCR NEWSFLASH Page 3
Cancer reporting is
required by both
federal and state
law (PL 102-515
and 63-1-551.1). It
is also considered a
public health
report under HIPAA
(C.F.R. 164-501,
C.F.R. 164.512).
SEER*Rx
SEER*Rx is a helpful tool used for
coding oncology drugs and cate-gorizing
regimen treatments.
This is a FREE program provided
by Surveillance Epidemiology and
End Results (SEER). To
download, go to:
http://www.seer.cancer.gov/
tools/seerrx/
By Delores Greene, CTR
The last NAACCR Webinar in the 2010-2011 Season will be held on Thursday, Septem-ber
1, 2011, 8-11a.m. at Deaconess Hospital in Oklahoma City and at St. John Medical
Center in Tulsa. The topic will be “Coding Pitfalls.”
OCCR has already purchased the 2011-2012 NAACCR Webinars Series which will begin
in October 2011 and end in September 2012. The webinars will be held at Deaconess
Hospital October-December 2011. OU Medical Center will host for the remainder of
the series.
St. John Medical Center will host in Tulsa through the entire series. The webinars are
from 8-11a.m. and are scheduled for the first Thursday of each month. Each partici-pant
will receive 3 hours of continuing education from the National Cancer Registrars
Association.
NAACCR Webinars
OCCR NEWSFLASH Page 4
By Delores Greene, CTR
Exciting news! NAACCR has given permission for OCCR to place recorded webinars on
a secure website. The details are currently being worked out, but the plan is to have
this available no later than November 2011. To participate, each user will be assigned
a user name and a password to access the recorded webinars. Once this is available
you will be able to view from work or home at a time that is best for you. This will
allow for greater participation and access for those who could not attend in Oklahoma
City or Tulsa. OCCR will continue the live webinars at Deaconess Hospital/OU Medical
Center in Oklahoma City and St. John in Tulsa for those who wish to participate in the
live productions of the webinars.
Coming Soon...
A helpful link to
verify patient date
of death is http://
ssdi.rootsweb.ance
stry.com. Searches
can be done using
first/last name or
social security
number.
October 6, 2011 Collecting Cancer: Larynx Including Mucosal Melanoma of Larynx
November 3, 2011 Collecting Cancer Data: Ovary
December 1, 2011 Collecting Cancer Data: Thyroid and Adrenal Gland
January 5, 2012 Collecting Cancer Data: Pancreas
February 2, 2012 Collecting Cancer Data: Hematopoietic
March 1, 2012 Abstracting and Coding Boot Camp: Cancer Case Scenarios
April 5, 2012 Collecting Cancer Data: Lower Digestive System
May 3, 2012 Collecting Cancer Data: Lung
June 7, 2012 Using and Interpreting Data Quality Indicators
August 2, 2012 Collecting Cancer Data: Melanoma of Skin
September 6, 2012 Coding Pitfalls
By Delores Greene, CTR
As you know starting with our 2011 cases we will be utilizing CSv203. This manual can be accessed at http://
www.cancerstaging.org/cstage/manuals/coding0203.html. This issue was last updated on June 12, 2011. The next
release will be sometime in the fall. In the meantime, the CS Team has developed a known issue document that can
be useful when coding in CSv2.03. This document contains important information for a few schemas and fields where
there is a known issue with CSv2.03 which will be resolved in the upcoming release. The CS Team created this docu-ment
so you would be aware of the issues you may be encountering with these few fields in CSv2.03 and they will be
resolved in SCV2.04.
CSv2.03 Known Issues from FAQs: Update from NAACCR
OCCR NEWSFLASH Page 5
Schema Name CS Fields(s) Description
Part 1 Use Lymph-Vascular Invasion code 8 only for Hematopoietic and Lymphoid disorders.
Use code 9 for non-Hematopoietic and Lymphoid disorders where there is no micro-scopic
examination of a primary tissue specimen. See CS Manual, Part1, Section1, page
83 for CSv0203. This use of code 9 is a change from the definition in CSv0202, but a
conversion from code 8 to code 9 for appropriate cases is NOT automatically applied in
the upgrade to CSv0203. If you wish to do your own conversion, search for 2010+ diag-nosis
cases with Lymph-Vascular Invasion code 8 and all histology codes less than
9590/3, and change 8 to 9. 06/30/11
Colon, Rectum
CS Extension We will modify the notes in v0204 to clarify that code “050” may be used when there
are tumor deposits without lymph node metastasis in T1, T2 T3 and T4 cases. Previ-ously,
the v0203 instructions state that you could only use this code for T1and T2 cases.
06/03/2011
Colon, Rectum CS SSF2, Extra Table Code 030 is not relevant for SSF2 and we will be making it obsolete in the next version.
This is because tumor deposits are identified histologically and SSF2 is used to code the
clinical assessment of regional lymph nodes. We are not supposed to include informa-tion
from surgical observation or lymph node biopsies in this SSF. Cases that were ab-stracted
with this code will need to be reviewed and corrected 6/3/2001.
Corpus Carcinoma,
Corpus Sarcoma
Schema Page For corpus uterine/uterus NOS primaries, histology codes 8950 and 8951 should have
been included in the Corpus Carcinoma schema. This will be fixed in CSv0204. Do NOT
Kidney Parenchyma CS SSF 3 For Kidney Parenchyma SSF3, code 998 for “No histologic examination to determine
ispsilateral adrenal gland involvement”, will be added. In the meantime, code 999
should be used for cases without histologic examination that determines ipsilateral
adrenal gland involvement. 0/10/2011
Lung CS Extension, Extra
Table
A tumor involving the carina, regardless of size, should be a T4, per AJCC. If you code
250, for confined to carina, you will derive based on tumor size. “Confined to carina”
will be moved to a T4 (in a future version.) For now, the best code to use is code 700,
which includes the description extension to carina and will derive a T4. In your ab-stract
you can note this situation. The confusion arises since Summary Stage focuses
strictly on how big or how many structures are involved, making a tumor strictly in the
carina a localized tumor. Whereas AJCC assign stage based on treatment guidelines and
prognosis (survival). We know that a tumor in the carina, even if it is small and strictly
confined to the carina, will be unresectable and will have poor outcomes, since the
tumor can easily spread to both lungs due to the location (tumor can spread from the
carina down BOTH mainstem bronchus into both lungs) it has a very poor prognosis
(survival). 06/30/2011
Testis CS SSF 8, CS SSF 14 The measurements in SSFs 8 & 14 were incorrectly entered as ng/ml and will be up-dated
to mlU/ml in v0204. 06/03/2011.
By Delores Greene, CTR
Question:
When the final path report reads: Mixed Germ Cell Tumor composed of 70% Em-bryonal
Carcinoma, 20% Yolk Sac Tumor and 10% Teratoma. Table 2 in the MPH
instructs us to code 9081 Teratocarcinoma when you have Embryonal Carcinoma
and Teratoma. Code 9085 Mixed Germ Cell when you have a Yolk Sac Tumor and
Teratoma, but nothing for all three histologies. How would you code the histology?
Answer:
If the pathologist states the final diagnosis is Mixed Germ Cell then this is what you would code regardless of what
percentage the mixed components are. You would code to Mixed Germ Cell 9085.
Question:
How would you code the histology for a diagnosis of squamous carcinoma and large cell undifferentiated neuroendo-crine
carcinoma of the lung?
Answer:
For cases diagnosed 2007 or after, apply rule H7 and code the numerically higher ICD-O3 code, 8070/3 (squamous cell
carcinoma). See Chart 1 on page 35 MPH Manual, the histology tree in lung equivalent terms. Large cell neuroendo-crine
carcinoma is histology code 8013/3. The other histology is squamous cell carcinoma, 8070/3 which is numeri-cally
higher.
Question:
How do you determine the correct subsite of the colon when there is conflicting information in different reports? The
path report for a hemicolectomy says, “specimen left colon” and the microscopic also says, “designated left colon,”
but the operative report states, “splenic flexure tumor.” The text in the operative report says, “mobilizing the
splenic flexure mass difficult” and the surgeon goes on to describe how he resected the colon. The discharge summary
says, “carcinoma of the splenic flexure.”
Answer:
Use the information from the operative report to code the primary site in this case. It is more accurate. In the opera-tive
report the surgeon states the splenic flexure. The operative report is usually a better source since the pathologist
can only reiterate the location as it was reported to him/her.
Clarification within the Surgery Codes for Bladder submitted by Dulce Bramblett, CTR
Prior to 2010, radical cystoprostatectomies were coded to the 60-64 range. However with the 2010 cases forward, if
the prostate is removed at the time of radical cystectomy, surgical code 71 would be used. If the prostate is not re-moved,
then surgical codes 60-64 would be used.
Jerri Linn Phillips said this change had been missed and will be added to the updates in the next edition of Appendix
C. Look for a single sentence reference in the 2010 preface, page XV of VORDS; Revised for 2011.
Questions and Answers
OCCR NEWSFLASH Page 6
By Amanda E. Moran
1st Course of Treatment Do’s and Don’ts
Deciding on the date to use for a patient’s first course of treatment can sometimes be tricky. According to FORD’s
(Section 2, Appendix B Coding Instructions), “Record the date on which treatment (surgery, radiation, systemic or
other therapy) of the patient began at any facility.” Notice the list of treatments that are acceptable does not in-clude
the date of a positive biopsy, even if the biopsy was what diagnosed the patient’s cancer. A biopsy is consid-ered
to be treatment if the biopsy removes the entire tumor and has negative margins. In that case, you would code
the procedure as an excisional biopsy which is a surgery code.
If a physician decides not to treat a patient or a patient’s family or guardian declines all treatment, FORD’s (Section
2, page 211 Coding Instructions) instructs that, “the date of first course of treatment is the date the decision not to
treat was made.”
Different Grade/Differentiation Rules
The grade/differentiation of a tumor reflects how much the tumor cells differ from the cells of the normal tissue
from which the tumor originated. According to FORD’s (Section 1: pages 11-12 and Section 2: pages 112-113), “Well
differentiated (Grade 1) is the most like normal tissue and undifferentiated (Grade 4) is the least like normal tissue.”
Determining a tumor’s grade/differentiation is vital because this information is used to evaluate each specific cancer
patient, develop the patient’s individual treatment strategy and predict the patient’s prognosis.
A key instruction for ICD-O-3 coding is to code to the highest grade listed on the patient’s pathology report. This rule
is true, but you must be sure to look at the pathologic specimen’s site location first. FORD’s tells us to, “Code the
grade or differentiation from the pathologic examination of the primary tumor, not from a metastatic site.” If the
primary tumor is not pathologically examined, the histology from the metastatic site is used, but the grade is coded
to a 9 for unknown.
When a path report shows two grades for a specimen (i.e. well-moderately differentiated adenocarcinoma), FORD’s
instructs us to, “Code to the highest grade.” Therefore, this example would be coded 8140/3 with a grade of 2 for
the moderately-differentiated histology. This rule is also used when a path report states, “Moderately differentiated
squamous cell carcinoma with poorly differentiated areas.” This would be coded 8070/3 with a grade of 3. {Rule G
on page 30-31 of the ICD-O book}
Coding 101
OCCR NEWSFLASH Page 7
We acknowledge the Centers for Disease Control and Prevention (CDC) and the National Program of Cancer Registries (NPCR) for its support and the distribution of
this newsletter under cooperative agreement #U58/DP000834-05 awarded to Oklahoma. Its contents are solely the responsibility of the authors and do not represent
the official view of CDC.
This publication is printed and issued by the Oklahoma State Department of Health as authorized by Dr. Terry Cline, PhD, Commissioner of Health. 275 copies have
been prepared and distributed at a cost of $159.50. Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries.
Oklahoma Registrars Receive Proclamation from Gov. Fallin
for National Cancer Registrars Week
Oklahoma State Department of Health
Chronic Disease Service
1000 NE 10th St, Room 1204
Oklahoma City, OK 73117
Phone: 405-271-4072
Fax: 405-271-6315
On the web: http://occr.health.ok.gov
Oklahoma Central Cancer Registry
FOR OCCR STAFF CALL(405) 271-4072
Amanda Moran, RHIA, CTR, ext 57138
Anne Pate, MPH, PhD, ext 57111
Christina Panicker, MS, ext 57108
Delores Greene, CTR, 57103
Judy Hanna, HT(ASCP), ext 57118
Leslie Dill, ext 57120
Paula Marshall, BBA, CTR, ext 57121
Susan Lamb, BA, ext 57117
Fourth Row, left to right: Chrissy Marsh, Barbara Murray, Sue Anderson, Laurie Harder, Darlene Scott. Third row, left to right: Sharon
Abrams, Amanda Moran, Beth Watwood, Anna McIntosh, Darla Dennis. Second row, left to right: Paula Marshall, Charlotte Murphy,
Stacey Hibbets, Denise Baker, Delores Greene. Front row, left to right: Marie Sanders, Shelly Ware, Susan Nagelhout, Governor Mary
Fallin, Abby Williams, Leslie Dill, Carolyne Dale.