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What’s the Diff?

What’s the Diff?

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What’s the Diff?

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  1. 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. What’s the Diff?

  2. 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

  3. 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.

  4. 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

  5. What? • Discussions • Restricted Access File • MCR data review • Survey • Poster presentation at NAACCR 2006

  6. % Non-specific Morphology [420]All Sites Combined*, Both GendersIndividual State Registries and NPCR Registries Combined, 2001 diagnosis year

  7. MCR Stats – by Dx Confirmation

  8. MCR Stats – Reporting Source

  9. 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)

  10. NPCR RAF Data

  11. 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)

  12. NPCR RAF Data

  13. 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)

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

  15. Survey Results • # of responses = 40 • Place of employment • 45% hospital • 45% central registry • 10% other (vendor/contractor/consultant) • CTR = 40 • Attended conferences/workshops = 40

  16. Survey Questions

  17. 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)

  18. 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)

  19. 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)

  20. 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)

  21. 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)

  22. 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)

  23. 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”

  24. 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” = ???

  25. Effective QI Tool? • Maybe!! • Coding of 8010 must have supporting documentation • Reporting source and diagnostic confirmation must be considered

  26. 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?

  27. Lessons Learned • More definitive guidelines needed • Training • Review of non-specific histologies and carcinoma coding • Edits??

  28. Thank you Questions? Sue C. Vest, CTR vests@health.missouri.edu http://mcr.umh.edu