Скачать презентацию What s the Diff Sue C Vest CTR Missouri Скачать презентацию What s the Diff Sue C Vest CTR Missouri

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What’s the Diff? Sue C. Vest, CTR Missouri Cancer Registry This project was supported What’s the Diff? 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) (#U 55/CCU 721904) and a Surveillance Contract between DHSS and the University of Missouri.

Acknowledgements • • • Jeannette Jackson-Thompson, MSPH, Ph. D Nancy Cole, CTR Deborah Smith, Acknowledgements • • • Jeannette Jackson-Thompson, MSPH, Ph. D Nancy Cole, CTR Deborah Smith, CTR Louanne Currence, RHIT, CTR Chester Schmaltz, Graduate Research Asst. All other registrars who offered comments and suggestions

Objectives • Determine if the use of 8010 rather than 8000 is a good 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.

WHY!! • Reaction to CDC National Program of Cancer Registries (NPCR) QI reports • 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

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

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

MCR Stats – by Dx Confirmation MCR Stats – by Dx Confirmation

MCR Stats – Reporting Source MCR Stats – Reporting Source

NPCR Restricted Access File (RAF) • Record level 1999 -2002 data • 37 states 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)

NPCR RAF Data NPCR RAF Data

Death Clearance Only Cases • 8000 – 8005 • range = 3. 98% - 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)

NPCR RAF Data NPCR RAF Data

Non-microscopically Confirmed • 8000 -8005 • Range = 15. 93% - 83. 48% • 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)

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

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

Survey Questions Survey Questions

Survey Case Scenario #2 LEFT KIDNEY: Poorly differentiated malignant neoplasm with … See comment. 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)

Case Scenario #3 CT: …poorly defined area of decreased enhancement suggesting pancreatic head mass. 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)

Survey Case Scenario #4 Non-hospital case Lung primary with mets to liver and skeleton. 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)

Case Scenario #5 • Non-hospital case (nursing home): • Prostate cancer. No stage given. Case Scenario #5 • Non-hospital case (nursing home): • Prostate cancer. No stage given. Observation only 8000 8010 8140 N/R = 65% (26) = 17. 5% (7) = 12. 5% (5) = 2. 5% (1)

Case Scenario #6 Non-hospital case (nursing home): 2 x 5 cm mass in right 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)

Case Scenario #9 Death Certificate Only case Cause of death = Metastatic breast carcinoma 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)

ICD-O-3 Morphology • 8000/3 – Neoplasm, malignant • • • Tumor, malignant NOS Malignancy 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”

Other Guidelines • I&R • “…Can we assume if a physician does not state 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” = ? ? ?

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

Conclusions • Need more info to answer the questions • Is the use of 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?

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

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