Download Mini-Update - August 2013 - Missouri Cancer Registry

MCR MINI-UPDATE AUGUST 2013
Fellow registrars,
It hasn’t been very hot outside, but here is some news “hot off the press” for you.
Deadlines
Facilities that are on schedule should be abstracting 2013 cases. Large hospitals (>500
cases/yr) are to report January cases by August 15 and smaller facilities (<300 cases /yr) report
the 1st Quarter of 2013 by Oct. 15. If you have not started 2013 cases, please make every
effort to bring your registry into compliance as soon as is possible.
MCR NEWS
WebPlus Conversion
The conversion of WebPlus was scheduled to happen this week, but has been delayed by the
vendor. We will send a separate blast email when it is taken offline and also when it is back up
and ready for upload of your v13 cases.
Changes at MCR
Wendy Sanders has left us to pursue her goal of becoming a hospital CTR at Boone Hospital
Center. We will miss her talents and smile. Since she’s become a good friend, we’re glad she’ll
still be close by and we wish her all the best!
Look for a job posting soon of her former position in our newly re-organized non-hospital
team. Angela Martin is the head of this team that will foster and process reports from
physician offices, radiation and surgery centers, nursing homes and path labs. Yes, the very
capable Angela will still be our Education Coordinator as well. She will also remain the contact
person for questions from Web Plus and Abstract Plus users.
Brenda Lee will lend her considerable experience to the task of increasing electronic reporting
and will be the liaison to our many low volume facilities (less than 75 cases/yr). We’re excited
about this reorganization and feel it will best position us to meet reporting goals that NPCR has
set for this 5-year cycle.
EDUCATION
Live Meetings
 August 14, 10 am, Special Project #3 - EHR Incentive Program and Meaningful Use by
Alena Headd
 Sept. 11, 10 am, Taking the Pain Out of Palliative Care Coding by Nancy Rold
 October – no Live Meeting – See you at MoSTRA!
We’re always interested in your ideas for new topics – contact Angela Martin.
Please note that the email reminders will be coming from Angela Martin but to register for any
of our educational opportunities, contact Shari Ackerman at [email protected]
or 1-866-240-8809. Please be sure to clarify which you will be attending when you register.
Death Clearance
The vital statistics death file has been processed. In August, look for email with reporting
directions if your facility has DC cases with which we need your help.
ABSTRACTING TIPS
 For thyroid cancer only, the term micropapillary does not refer to a specific histologic
type. It means that the papillary portion of the tumor is minimal or occult. Code
papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS [8260].

For in situ/non-invasive breast cases, when multiple intraductal histologies are present
and one of them is comedocarcinoma the appropriate code is 8501 (not 8523) per
MP/H rule H4. Also keep in mind that comedonecrosis is not the same as
comedocarcinoma and it is not a factor in assigning the histology code.

When entering text documentation of regional lymph node involvement, please specify
which nodes were examined and/or involved rather than show the numbers only (e.g.,
0/10 nodes) to support the CS Lymph Nodes codes you enter. Many CS schemas show
multiple levels of regional lymph nodes, and the code you choose should be justified in
your text. Specifying which regional lymph nodes are dissected also is important to
justify some primary site surgery codes. For example, Surgery Code 30 is entered when
a lobectomy is performed for a lung primary. When mediastinal lymph nodes dissection
is done along with the lobectomy, code 33 is used. Just stating 0/10 nodes doesn’t tell
us whether hilar or mediastinal or some other level nodes were removed. We rely on
accurate text representation of data codes to ensure that the best possible record
consolidation and coding quality is entered into the MCR-ARC database.

When incidental removal of another organ is performed during surgery for the primary
site (meaning there was no prior suspicion of malignant involvement in the incidentally
removed organ, the removal was not for staging and there was no malignant disease
found in the specimen), do not code it in the “Surgery Other/Reg Site” data item. Either
indicate in text that the procedure was not done due to cancer or simply omit any
reference to it from the abstract.

From CA Forum –
Q: In regard to Collaborative Staging for lung primaries, is the term "consolidation"
equivalent to atelectasis?
A: Atelectasis is a complete or partial collapse of a lung or lobe of a lung and it develops
when the tiny air sacs (alveoli) within the lung become deflated. Consolidation is an old
term for lobar pneumonia. Consolidation in the lungs occurs when the fluid
accumulated causes the lung tissue to become stiff and unable to exchange gases.
These are not the same.
STANDARD-SETTER NEWS
NPCR Audits and Text Documentation
NPCR has begun a new round of central registry audits and we are not sure where their audit of
MCR will fall in their 5-year cycle. The good news for hospitals is that NPCR auditors will not
need to come to hospitals to verify coding according to the medical record as they have in the
past. However NPCR will be auditing the quality of the data you submit by checking to see if
there is text to support the codes in an abstract. They point out that “Text documentation is
not only a required data element; it is an essential component of a complete electronic
abstract. The text information is not only important in quality control – it is critical to the
success of special studies.”
In Year 1 of such audits done nationally, the inadequacies they found included:
1. Lack of text to support date fields
2. CS LN Colon – lack of documentation of the specific LN chains involved
3. CS Ext Colon codes that did not reflect extension details that were noted in the
Operative Text
4. Rad-Regional Rx Modality (errors in 20% of rectum/lung/breast cases) – either no text to
support the energy code (10MV) or wrong code (3D RT coded non-specifically as 20,
external beam rather than 32)
5. CS Ext Lung – 21% of cases had errors: lack of text to support codes or codes that did not
reflect imaging results text
6. Rx Summ-Scope Reg LN Breast – 11% of the cases lacked the documentation re: the # of
nodes removed (1-3 or 4+) or did not apply the combination code when both sentinel
and axillary node dissections were done
7. RxSummSurg Prim Site - 12.3% of the cases did not use the most specific code – for
example, Hysterectomy (NOS) and BSO = 67
8. CS Extent – Clinical, Prostate –14% of the cases lacked text to support the code when
greater than ½ lobe was involved or when there was extracapsular extension to
unilateral vs. bilateral seminal vesicles
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9. Date 1 CRS Therapy –Dates were not always included in the text fields, particularly for
treatment given in physician offices.
We urge you to use this list to improve your own documentation so that we can have ever
more reliable data to use. Chapter 6 of the MCR Abstract Code Manual is also an important
resource. http://mcr.umh.edu/downloads/MCRManual2013.pdf
Let’s show NPCR that Missouri registrars are above average!
NCRA Free Podcast on the Importance of Text (2 minutes)
http://www.cancerregistryeducation.com/resources/#coding2 Go to the tab named Coding
Best Practices.
CS v2.05 for 2014 will discontinue some SSFs
When CS v2.05 goes into effect for 2014 cases, many SSFs will be discontinued. Hold your
applause. A list of the discontinued SSFs is available at
http://cancerstaging.org/cstage/index.html. These are not items that MCR ever required, so
there is no change for MCR reporting. In fact, we are told that they have never been required
by any standard setter. If you have been collecting any of these SSFs at the discretion of your
cancer committee, you may continue (no edits will prevent collection), but check the FAQs at
the above link and coordinate planning with your software vendor. Another change is that
vendors may now remove/hide obsolete codes from the CS schema displays.
SEER has Updated Cancer Statistic Review 1975-2010
Check out this interactive resource that provides data on cancer incidence, prevalence,
mortality and survival for 29 primary sites and sub-sites. Tables are available by sex,
race/ethnicity, age, stage, and geographic area. http://seer.cancer.gov/csr/1975_2010/
Signs of a Controversy Brewing
In an article published this week in the Journal of the American Medical Association, an NCI
workgroup suggests that some cancer screenings lead to overdiagnosis of indolent cancers.
They even suggest the possibility of removing the words that indicate cancer from some
diagnoses like DCIS. I’d expect a debate within the medical community. They call for more
study and discussion of this topic in an effort to redefine what cancer is. The popular press has
picked up this topic. But for now, please note that no changes have been made in registry
requirements. http://jama.jamanetwork.com/article.aspx?articleid=1722196
ICD-O-3 Updates
The World Health Organization made updates to ICD-O-3 for 2012, but North American
registries deferred implementing any of them until they could be studied. A NAACCR
Workgroup headed by April Fritz has now made recommendations and we should expect to
hear more from our standard setters in the future. For 2014 reporting there will be some new
preferred terms, related terms and synonyms to existing ICD-O-3 codes, and the code for
enteroglucagonoma will change from 8157 to 8152. (I had to look, we’ve had no cases with
histology 8157/3 reported to MCR, so you may be unlikely to use that change!) For 2015 there
will be 16 new codes and terms as well as a change of behavior code for one item. We’ll
provide details when the time approaches.
RESOURCES
Active surveillance may not be best of African American men with prostate cancer
http://jco.ascopubs.org/content/early/2013/06/17/JCO.2012.47.0302
Prostate cancer outcomes study
http://onlinelibrary.wiley.com/doi/10.1002/cncr.28213/abstract
Black CLL patients have shorter survival even with equal care
http://health.usnews.com/health-news/news/articles/2013/07/08/even-with-equal-care-racialdisparity-persists-in-blood-cancer-study-finds
Melanoma late recurrence study
http://consumer.healthday.com/cancer-information-5/mis-cancer-news-102/melanoma-mayreturn-a-decade-later-in-some-677821.html
Gleason 5 is strongest predictor of outcomes after RRP and salvage RT
http://consumer.healthday.com/cancer-information-5/mis-cancer-news-102/melanoma-mayreturn-a-decade-later-in-some-677821.html
SEER data shows risk of second cancer after primary colorectal cancer varies by sub-site
http://onlinelibrary.wiley.com/doi/10.1002/cncr.28076/abstract;jsessionid=F0333FC3D1A2F02
7365928ED1213BFB1.d04t03
Risks and benefits of screening asymptomatic women for ovarian cancer
http://www.sciencedirect.com/science/article/pii/S0090825813008627
Young men more likely than young women to die of melanoma
http://www.washingtonpost.com/national/health-science/young-men-more-likely-than-youngwomen-to-die-of-melanoma-study-says/2013/07/01/8c24d7ac-df70-11e2-b2d4ea6d8f477a01_story.html
Presentation of melanoma in children may not display typical adult screening features
http://www.jaad.org/article/S0190-9622(12)02332-8/abstract
Racial disparities in thyroid cancer care
http://www.practiceupdate.com/news/2938?elsca1=emc_enews_dailydigest&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter
New chemoprevention guidelines for breast cancer
http://jco.ascopubs.org/content/early/2013/07/03/JCO.2013.49.3122.full.pdf
Read about Chemoprevention on the MoSTRA News You Can Use page in August.
Happy Abstracting!
Nancy H. Rold, CTR
QA Unit Supervisor
Missouri Cancer Registry and Research Center