1/24/2023

NCRA 2023 CTR Exam Prep Webinar 2

Abstracting & Coding,

Part 1
Presented by
Monica Reece, RHIT, CTR
Information Resources:
International Classification of Oncology for Oncology (ICD-O)
Standards for Oncology Registry Entry (Store Manual)
Cancer Registry Management Principles & Practice, 4th Edition

2023 CTR Exam Prep Webinar #2

Learning Objectives – 2023 exam

 Medical terminology and standard definitions

 Guidelines for reportable case identification

 Types and characteristics of cancer

 Data items required by standard setters (e.g. CoC, SEER)

 Organization and content of source documents (e.g. medical records)

 Diagnostic and staging procedures

 Electronic pathology reporting

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Medical Terminology

 Word roots, prefixes and suffixes

 Bronchitis – Bronch (root) + itis (suffix)

 Bronch pertains to the bronchial tree
 Itis pertains to inflammation of

 Pericarditis – Peri (Prefix) + card (root) + it is (suffix)

 Peri means around or about
 Card means heart
 Itis means inflammation

Medical Terminology

• Morbidity • Prophylactic • Interval data

• Mortality therapy • Nominal
• Probability • Palliative data
treatment • Ordinal data
• Prognosis
• Cancer • Ratio data
• Prognostic Surveillance
Factors • Aggregate
• Adjuvant data
treatment
• Neoadjuvant
Treatment

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Exercise 1
Medical Terminology
 Which term describes a situation or condition, or a characteristic of a patient,
that can be used to help assess the outcome of a disease?

 A: Morbidity
 B: Mortality
 C: Probability
 D: Prognostic Factor

 Answer: D – Prognostic Factor

Medical Abbreviations

Abdomen/Pelvis Abdomen - Diagnosis - DX Excision/Excised Alcohol -

– A/P ABD - EXC ETOH
Contralateral - Grade - GR Follow-up - FU Hormone - HORM Bilateral –
CONTRA B/L
Gastrointestinal Biopsy - BX Family History Adenocarcinoma Fine Needle
stromal tumors - - FHX - ADENOCA Aspiration -
GIST FNA
Ductal Hematology/ External beam Circumferential Acute
Carcinoma In Oncology – radiotherapy - resection margin Myelogenous
Situ - DCIS HEM/ONC EBRT - CRM Leukemia -
AML
Epidermal Consistent I-131 – Iodine Digital rectal Intensity
growth factor with – C/W 131 exam - DRE modulated
receptor - EGFR radiation
therapy -
IMRT 6

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Medical Abbreviations
Irregular - Lobular Malignant – MAL or Janus No evidence of
IRREG carcinoma in MALIG kinase 2 – disease - NED
situ - LCIS JAK2
Non-Hodgkin Outpatient - Neuroendocrine Palpated - Moderately
Lymphoma - OUTPT tumor - NET PALP differentiated –
NHL MOD DIFF or MD
Lymphovascular Interior vena Non small cell Isolated Sentinel lymph
Invasion - LVI cava - IVC lung carcinoma - tumor cells node - SLN
NSCLC - ITC
International Metastatic - Prostatic Right upper Year old – Y/O or
prognostic METS intraepithelial quadrant - YO
index - IPI neoplasia, grade RUQ Year(s) – YR(s)
III – PIN III or PIN 3

Robotic assisted Transurethral Lymphadenopathy Transrectal

radical resection - LAD ultrasound
prostatectomy - bladder - TURB - TRUS
RARP 7

Reportable List

 Identifies types of cases to be included in the cancer

registry database
 Criteria for eligible cases depends on the governing
agencies of the registry and includes:
 State-specific reportable cases (NPCR and SEER) PLUS
 CoC-defined reportable list PLUS
 Reportable by agreement (facility-specific or state-specific)
 Review annually to ensure updates are incorporated (may
have additions or deletions)
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Characteristics of cancer

Breast Bladder
Quadrants of the Breast – 9 Mushroom shaped tumors with
different topography codes their stem attached to the inner
lining of the bladder are most
Breast tissue is drained by common
lymphatic vessels that lead to Bladder has muscular walls
axillary nodes & internal three layers thick – mucosa,
mammary nodes submucosa & muscularis
Bloom-Richardson grading Two main types of bladder
system is also known as Modified cancer are flat (sessile) and
Bloom-Richardson (BR) or BR papillary type.
grading

Characteristics of cancer

Colon Lung
Cecum, ascending colon, hepatic Lungs are divided into three
flexure and right half of lobes in the right lung and two
transverse colon = right colon lobes in the left lung

Left half of the transverse colon, Pancoast tumor is a tumor of

splenic flexure, descending colon the apex of lung which invades
and sigmoid = left colon brachial plexus nerves causing
pain in the arm
The ileocecal valve is considered
part of the cecum Atelectasis is the failure of the
lung to expand completely

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Histology Codes

• Malignant • Invasive Ductal • Diffuse Large B

Neoplasm Carcinoma Cell Lymphoma
• 8000/3 • 8500/3 • 9680/3

• Adenocarcinoma • Ductal • Chronic

• 8140/3 Carcinoma In lymphocytic
Situ leukemia/small
• 8500/2 lymphocytic
• Squamous Cell
lymphoma
Carcinoma
• Urothelial • 9823/3
• 8070/3
Carcinoma
• 8120/3 • Malignant
• Sarcoma
Melanoma
• 8800/3
• 8720/3

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Where To Find Information

➢ Admission Note(s) ➢ Operative Report(s)

➢ History and Physical ➢ Pathology Report(s)
➢ Discharge Summary ➢ Nuclear Medicine Report(s)
➢ Consultation Report(s) ➢ Treatment Records
➢ Cancer Screening Report ➢ Specialty Lab Test/Markers
➢ Diagnostic Imaging Report(s) ➢ Cancer Conference Notes
➢ Scopes ➢ Physician Progress Notes(s)
➢ Scans ➢ Expert Review/2nd Opinion

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Accession Number

 Unique

 Protects Identity

 Nine-digit Number

 Deletions

 Gaps

 Reassigning Numbers

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Exercise 2
Accession Number
 Patient had ultrasound guided breast biopsy at reporting facility on 12/20/22.
Patient had lumpectomy at reporting facility 01/13/23.

 A: 2023
 B: 2022
 C: 2012

 Answer: B - 2022
 Rationale: Year the patient was first seen at the reporting facility

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Sequence Number
Malignant Neoplasms (in-situ or invasive)
• Codes 00-59
• Code 00 indicates a patient with only one malignant primary in the
patient’s lifetime.
• Code 01 indicates the primary/cancer case is the first of multiple
malignancies the patient has.
• Code 03 indicates the cancer case is the 3rd malignant cancer in the
patient’s lifetime with 2 previous malignant cancers.
Non-Malignant Neoplasms
• Codes 60-88
• Code 60 indicates that the primary/cancer case is the only non-
malignant/benign primary of the patient’s lifetime.
• Code 61 indicates the primary/cancer case is the first of more non-
malignant primary or benign cancer case the patient has/had.
• Code 62 indicates the patient has one previous benign or non-malignant
cancer.

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Exercise 3
Sequence Number
 Patient diagnosed and treated for benign meningioma at another facility 11/2/21.
Patient biopsied and received first course of treatment for breast cancer at another
facility 06/13/22. Patient has wide excision for melanoma at reporting facility
01/02/23.
 Brain Primary Sequence Number:
 A: 00 B: 60
 Answer: 60

 Breast Primary Sequence Number:

 A: 00 B: 01
 Answer: 01

 Skin Primary Sequence Number:

 A: 01 B: 02
 Answer: 02

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Medical Record &

Social Security Numbers
 Medical Record Number
 Assigned by health information management (HIM) department
 Identify multiple reports on the same patient

 Social Security Number

 Patient’s with similar names
 Central Registry Matching
 Link to Government Records

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Race & Ethnicity

 Race
 5 fields of race

 Primary race of person

 Multiracial

 Spanish Origin

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Exercise 4
Race
 79Y/O M presents with middle-eastern decent
 Answer: 01 White
 81Y/O F presents with black and Hawaiian race
 Answer: 07 Hawaiian (always first race code) and 02 Black
 32 Y/O M presents with Polynesian race
 Answer: 25 Polynesian
 45 Y/O F presents with Native American race
 Answer: 03 Native American
 66 Y/O M presents with Pakistani decent
 Answer: 17 Pakistani
What are the race codes for each example?

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NPI Physicians

Managing Following Primary

Physician Physician Surgeon

#3 Radiation #4 Medical
Oncologist Oncologist

NPPES NPI Registry ([Link]

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Case Eligibility
 Malignancies with ICD-0-3 behavior code of 2 or 3
 5 Exceptions

 Non-Malignant Brain & CNS System Tumors

 Required on or after 1/1/2004 diagnosis date

 Gastro-Intestinal Stromal Tumors (GIST) & Thymomas

 Required effective 1/1/2021 with a behavior code of 3

 Reportable-by-agreement
 Not required by the CoC
 Come from the facility’s cancer committee or central registry

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Ambiguous Terminology

 Ambiguous Terms at Diagnosis

 Terms that constitute a diagnosis

 Ambiguous Terms Describing Tumor Spread

 Only as a last resort

 Physician
 Refer to physician who diagnosed and/or staged the patient, when
possible

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Ambiguous Terminology

 Apparent(ly)  Presumed
 Appears  Probable
 Comparable with  Suspect(ed)
 Compatible with  Suspicious (for)
 Consistent with  Tumor*
 Favors  Typical of
 Malignant appearing
 Most likely  * Neoplasm (beginning with 2004
diagnoses and only for C70.0-
 Neoplasm*
C72.9, C75.1-75.3

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Non-Ambiguous Terminology

Ambiguous Terms that Do Not Constitute a Diagnosis without additional

information

 Cannot be ruled out  Questionable

 Equivocal  Rule out

 Possible  Suggests

 Potentially malignant  Worrisome

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Class of Case

 Determine Facility’s Role

 Key Words
 Elsewhere
 First course of treatment
 Palliative Care

 Analytic (00-22)

 Non-analytic (30-49 & 99)

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Analytic Cases
 Class 00
 Initial diagnosis at the
reporting facility and all ❑ Reminder: These are included in
treatment elsewhere the first course of treatment.
➢ Palliative Care

 Class 10-14 ➢ Refusal

 Either diagnosis at reporting ➢ Not Recommended

facility or at least some/all
first course treatment or both

 Class 20-22
 Initial diagnosis elsewhere with
some/all first course treatment
elsewhere

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Non-Analytic Cases

 Initial diagnosis and treatment elsewhere

 Patient in-transit

 History of Disease

 Recurrence, progression or metastasis of disease

 Diagnosed prior to facility reference date

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Exercise 5
Class of Case
 What is the class of case for a patient who is initially diagnosed at a staff physician
office and then has a surgical resection at the reporting facility with no other
treatment?
 Answer: Class 12
 What is the class of case for a patient who is seen for a recurrent, active, lung
adenocarcinoma and was initially diagnosed and treated at another facility?
 Answer: Class 32
 What is the class of case for a patient who was initially diagnosed at the reporting
facility and all first course treatment was at the reporting facility?
 Answer: Class 00
 What is the class of case for a patient who was initially diagnosed at the reporting
facility and refuses all treatment?
 Answer: Class 14

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Date of First Contact

 Date of facility’s contact with the patient for diagnosis or treatment of cancer

 Quality of Care

 Date patient became analytic

 Autopsy

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Date of First Contact

Analytic Cases Autopsy or Death

Certificate
• Date patient became analytic • Date of Death

Non-analytic cases Diagnosed in Staff

Physician Office
• Date patient first qualified for • Date patient physically seen at
abstracting reporting facility

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Date of Initial Diagnosis

 Date of diagnosis by physician  Ambiguous Terms

 Clinically or histologically  Treatment Date

 Retrospect  In Utero

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Exercise 6
Date of Diagnosis & Date of First Contact
 Patient biopsied (TRUS) at another facility 06/01/22. Positive prostate
adenocarcinoma.
 Patient admitted to the reporting facility for cardiac evaluation 08/01/22.
Patient received radical prostatectomy and bilateral pelvic lymph node
dissection 08/03/22.

 What is the date of diagnosis?

 Answer: 06/01/22
 What is the date of first contact?
 Answer: 08/03/22

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Cancer Characteristics

Primary Site Laterality

ICD-0-3 Paired Sites

SEER Metastatic Sites

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Exercise 7
Laterality

Code 0 = not a Melanoma, Code 5 =

paired site Left Lobe Skin, Midline Tumor
Prostate Middle of
Trunk

Code 4 =
Code 9 =
Bilateral Bilateral Ureter, Unknown
Ovaries NOS

What is the laterality code?

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Characteristics of Cancer

 Histology

 Behavior

 Grade
 Clinical

 Pathologic

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Diagnostic Confirmation

 Solid Tumors
 Priority Order
 Lowest numeric value with multiple diagnostic methods

 More definitive method confirms diagnosis at any time during 1st

course of disease

 Hematopoietic or Lymphoid Tumors

 No Priority Order

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Exercise 8
Diagnostic Confirmation
What is the diagnostic confirmation?

 Elderly gentleman was admitted due to a fall. Workup was performed and his PSA
was 100 with a DRE (digital rectal exam) positive for nodular prostate cancer
 Answer: Code 5 = positive laboratory test/marker
 Fine Needle Aspirate of pleural effusion was positive for small cell carcinoma
 Answer: Code 2 = positive cytology
 Excisional biopsy of right upper quadrant, breast
 Answer: Code 1 = positive histology
 CT Chest showed multiple pulmonary lesions and metastatic liver nodules
 Answer: Code 7 = radiography and other imaging techniques without microscopic
confirmation

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Diagnostic Procedures
History & Physical Exam

Lab Tests

Tumor Markers

X-rays

Nuclear Scans

Ultrasound

Endoscopies

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Surgical Diagnostic and Staging

Procedures
 Date of Procedure

 Procedure
 Initial Diagnosis

 Positive Procedures

 Lymph Nodes coded in scope of regional lymph node surgery

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Exercise 9
Surgical Diagnostic & Staging Procedure
What procedures fall into this data item?

 TRUS  Bronchoscopy with biopsy

 Yes  Yes
 TURBT  Excisional biopsy of RT breast mass
 No  No
 Mediastinoscopy  Breast Primary – biopsy of axillary
 No
lymph node
 No

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Sentinel Lymph Nodes

 Date of Sentinel Lymph Node Biopsy

 Sentinel Lymph Nodes Examined

 Sentinel Lymph Nodes Positive

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Regional Lymph Nodes

 Date of Regional Lymph Node Dissection

 Regional Lymph Nodes Examined

 Regional Lymph Nodes Positive

 Know the nodes

 Based on pathology
 Use of code 00
 Cumulative nodes removed & examined

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Regional Lymph Nodes – Cont.

 Priority of lymph node counts  Dissection – code 97

 Use of code 95  Multiple lymph node procedures

 Lymph Node biopsy  Code 99

 Sampling – code 96

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Exercise 10
Regional Lymph Nodes

Para-
Pelvic Lymph Nodes, RT Lymph nodes, LT
Pelvic regional Aortic para-aortic,
dissection, seven regional dissection,
lymph nodes, one of four lymph
negative for nodes positive for
metastasis metastasis

Lymph nodes, LT Lymph nodes, RT

pelvic regional para-aortic
dissection, one of regional dissection,
five lymph nodes two lymph nodes
positive for negative for
metastasis metastasis

Lymph Nodes Examined = 18

Lymph Nodes Positive = 2

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Lymphovascular Invasion

 Indicator of prognosis (outcomes)  Only for primary tumor

 Presence or absence of tumor cells  Primary Sources

 Only found microscopically  Neoadjuvant Therapy

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Surgical Procedure Primary Site

 Site-specific surgical codes:  Regional tissues or organs

Appendix A

 Palliative care
 Codes are hierarchal

 Incomplete treatment
 Excisional biopsies coded here

 Code total or final results

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Surgery Data Items

General Instructions for All Sites
 Surgical Approach  Date of Surgical Discharge

 Surgical Margins  Readmission Same Hospital within

30 days of surgical discharge

 Scope of Regional Lymph Node

Surgery  Reason No Surgery

 Surgical Procedure Other Site

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Appendix A: Site-Specific Surgery Codes

 Oral Cavity
 Lip C00.0-C00.9, Base of Tongue C01.9, Other Parts of Tongue C02.0-
C02.9, Gum C03.0-C03.9, Floor of Mouth C04.0-C04.0, Palate C05.0-
C05.9, Other Parts of Mouth C06.0-C06.9
 Codes:
 00: None; no surgery of primary site; autopsy ONLY
 20 Local tumor excision, NOS
 26 Polypectomy
 27 Excisional biopsy
 30 Wide excision, NOS
 Code 30 Includes:
 Hemiglossectomy
 Partial Glossectomy

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Appendix A: Site-Specific Surgery Codes

 Colon C18.0-C18.9
 Code 30 Partial Colectomy vs Code 40 Subtotal Colectomy/hemicolectomy
 Rectosigmoid C19.9 & Rectum C20.9
 Code 30 Wedge or segmental resection: includes low anterior resection
 Pancreas C25.0-C25.9
 Code 37 Local or partial pancreatectomy & duodenectomy with partial
gastrectomy (Whipple)
 Prostate C61.9
 Codes 21-23 TURP
 Bladder C67.0-C67.9
 Code 27 Excisional biopsy

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Exercise 11
Site-Specific Surgery Codes

 What is the site-specific surgery code for total colectomy with portion of
rectum, small bowel, and bladder?
 A 32
 B 41
 C 50
 D 51
 E 70

 Answer: D Code 51

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Exercise 12
Site-Specific Surgery Codes
 What is the site-specific surgery code for:
 Resection of ovary (wedge, subtotal, or partial) only, NOS; unknown if
hysterectomy done

 A 22
 B 31
 C 26
 D 25

 Answer: C Code 26

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Exercise 13
Site-Specific Surgery Codes
 What is the site-specific surgery code for:
 Robotic-assisted radical prostatectomy

 A 20
 B 23
 C 50
 D 70

 Answer: C Code 50

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Exercise 14
Site-Specific Surgery Codes
 Patient with pancreatic cancer. What is the site-specific surgery code for
Whipple procedure?

 A 30
 B 35
 C 37
 D 80

 Answer: C Code 37

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Exercise 15
Site-Specific Surgery Codes
 What is the site-specific surgery code for VATS lobectomy?

 A 00
 B 12
 C 23
 D 30

 Answer D Code 30

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Electronic Pathology Reporting

 E-path is the electronic transmission of pathology reports from a laboratory

information system to a hospital or central cancer registry or both.

 E-path reporting has expanded over 10 years to be able to transport

information from national and regional laboratories to most state public-
health information systems through the CDC’s messaging system.

 There is a electronic reporting committee called the PERT (Pathology

Electronic Reporting Committee)

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Electronic Pathology Reporting

Automatically delivers real-time updates of the latest

eCCs
Ensures report standardization, including all required
elements for compliance with accreditation standards

Streamlines the submission of cancer data reporting

Captures structured data that can be accessed and
analyzed to help find cases for tumor board, performs
quality improvement, and reviews large amounts of
combined patient data

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Questions?

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Monica Reece, RHIT, CTR

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