understanding and coding cancer treatment
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Understanding and Coding Cancer Treatment. FCDS 2002 Educational Teleconference Series Jackie Button, MS Steven Peace, CTR Mayra Alvarez, RHIT, CTR October 16, 2002. Cornerstones for Treatment Decision-Making. First Course of Therapy.

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understanding and coding cancer treatment

Understanding and Coding Cancer Treatment

FCDS 2002 Educational Teleconference Series

Jackie Button, MS

Steven Peace, CTR

Mayra Alvarez, RHIT, CTR

October 16, 2002

first course of therapy
First Course of Therapy
  • For most cancers - Treatment usually begins within four months from the date of initial diagnosis
  • If treatments begins beyond four months from the date of initial diagnosis please document it & send FCDS a copy of the documentation so we can ‘force’ it
first course of therapy1
First Course of Therapy
  • Exception to 4-month rule - Leukemia
  • Treatment begins within two months from the date of initial diagnosis
  • Why only two months for leukemia?
  • What about treatment consolidation or maintenance?
first course of therapy2
First Course of Therapy




first course of therapy3
First Course of Therapy

Usual Treatment

Treatment Interruption

Change in Treatment Plan or Regimen

first course of therapy4
First Course of Therapy

Treatment Failure

Disease Progression

Co-Morbid Conditions

first course of therapy5
First Course of Therapy
  • FCDS Edits
    • 240 Days - 4 Month Rule / 2 months Leukemia
    • 365 Days - Prostate & Breast Only
  • Why have these date edits?
  • Why can’t FCDS just fix or override these edits?
subsequent therapy
Subsequent Therapy

Therapy that starts after

the first course of treatment has failed


the cancer has recurred

no treatment
NO Treatment

Watch and Wait

Patient or Family Refused


Due to Other Medical Conditions


curative therapy
Curative Therapy

Treatment intent is to eliminate all traces

of cancer in the patient

Goal is to cure the patient

adjuvant therapy
Adjuvant Therapy

Treatment intent is to prevent or delay recurrence of original cancer.

Treatment is given after other method(s) have destroyed all clinically detectable cancer.

Multi-modality Treatment

palliative therapy
Palliative Therapy

Intent is to reduce the size and bulk of cancer and to alleviate symptoms caused by the cancer

Treatment is not intended to cure

the patient of cancer

ancillary therapy
Ancillary Therapy
  • Does not attack or destroy cancer cells
  • Supports the body’s immune system or other body systems without affecting the cancer directly
  • Examples: Mesna, steroids, Procrit
fda approval process
FDA Approval Process
  • Adult Clinical Trials
    • Phase I
    • Phase II
    • Phase III
    • Phase IV
  • Pediatric Clinical Trials
  • FDA Drug Info - http://www.fda.gov
cancer gov

NCI Cancer Information Web - http://cancer.gov

SEER, PDQ & Cancer Information Service

NCI - sponsored databases containing extensive and monthly updated information on cancer diagnosis, staging and treatment, including clinical trials.

There is also a patient-oriented query available.

coding co morbidity complications
Coding Co-morbidity & Complications
  • Required for COC-approved cancer programs beginning with January 1, 2003 cancer diagnoses
  • FCDS will not require this information
  • Refer to FORDS
  • http://www.facs.org/dept/cancer
date of first course of treatment
Date of First Course of Treatment
  • Record the date on which treatment (surgery, radiation, systemic, or other therapy) of the patient began at any facility
  • Record the earliest of the following dates:
    • Date of First Surgical Procedure
    • Date Radiation Started
    • Date Systemic Therapy Started
    • Date Other Treatment Started
date of first course of treatment1
Date of First Course of Treatment

In cases of non-treatment, in which a physician decides not to treat a patient or a patient or patient’s family declines all treatment, the date of first course of treatment is the date this decision was made

  • Date of First Surgical Procedure
  • Surgical Procedure of Primary Site - Site-Specific
  • Scope of Regional Lymph Node Surgery
  • Surgical Procedure/Other Site
  • Reason for No Surgery of Primary Site
radiation therapy
Radiation Therapy
  • COC requires collection and coding of several detail-specific radiation therapy data items including;
    • Location of Radiation Treatment
    • Radiation Treatment Volume
    • Regional Treatment Modality
    • Regional Dose and other specific radiation dose info
  • NPCR requires state registries to collect only
    • - Rx Summ Radiation Therapy
  • Change in Field Length to 2 characters
  • SEER recommends 1-digit historical codes be stored in the second character position preceded by a zero.
  • COC recommends that historic codes be converted to the current codes, using the algorithm it has developed
  • SEER/FDA Update to SEER Book 8
hormone therapy
Hormone Therapy
  • Change in Field Length to 2 characters
  • No more coding surgical procedures for orchiectomy, oophorectomy or other surgically-administered hormonal manipulation
  • Clarification - coding Prednisone & other steroids
  • SEER/FDA Update to SEER Book 8
brm immunotherapy
BRM - Immunotherapy
  • No change in field length
  • Anti-angiogenesis agents (endostatin)
  • Antisense agents
  • Vaccine therapies
  • Antibiotic therapy for lymphoma associated with Helicobactor Pylori
  • SEER/FDA Update to SEER Book 8
hematologic transplant and endocrine procedures
Hematologic Transplant and Endocrine Procedures
  • New Data Item
  • Bone Marrow Transplant
  • Stem Cell Harvest
  • Radiation-directed endocrine therapy
  • Endocrine Surgery
  • Combination of any of the above
treatment dates
Treatment Dates
  • Some software vendors will modify programs so you do not have to code treatment-specific dates
  • Some software vendors will not
  • Code 88888888 for recommended therapy
links to cancer information
Links to Cancer Information
  • FCDS - http://www.fcds.med.miami.edu
  • CDC/NPCR - http://www.cdc.gov/cancer/npcr
  • NAACCR - http://www.naaccr.org
  • CAP - http://www.cap.org
  • SNOMED - http://www.snomed.org
  • NCI Main Cancer Info - http://cancer.gov
  • NCI/SEER - http://seer.cancer.gov
  • ACoS/COC - http://www.facs.org/dept/cancer
  • Florida DOH - http://www.doh.state.fl.us
  • Florida C-CRAB - http://www.moffitt.usf.edu/ccrab
  • Florida Legislature - http://www.leg.state.fl.us/Statutes