Coding Surgery in 2001 and SEER Summary Stage 2000

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Coding Surgery in 2001andSEER Summary Stage 2000

• FCDS 2001 Educational Telephone Conference Series
• June 20, 2001
• Mary OLeary, RHIT, CTR
• Joy Houlahan, CTR

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References

• During this presentation you will need
• 2001 FCDS Data Acquisition Manual
• SEER Summary Staging Manual 2000 Codes and Coding
  Instructions
• All handouts made available on the FCDS website
  in either Word or .pdf format

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References

• 2001 FCDS Data Acquisition Manual, April 2001
• SEER Program Code Manual 3rd Edition, 1998
• Standards of the Commission on Cancer, Volume II
  Registry Operations and Data Standards (ROADS),
  January 1998 revision

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NOTEThe general instructions and codes for all
surgery fields collected by FCDS for 2001 cases,
are identical for SEER, CoC/ACoS and FCDS
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FCDS History of Coding Surgery

• Surgery - Yes/No
• Until 1995 for FCDS
• Not Site-Specific
• Surgery - One field, two-digit code
• Until 2000 for FCDS
• Site-Specific Code Sets
• Represented all types of surgery to remove cancer
  - localized surgery, regional or distant

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FCDS History of Coding Surgery

• Surgery - Five fields, lots of codes
• 2001 Admissions for FCDS
• Site-Specific Code Sets for each data item
• One field for surgery to primary site
• One field for surgery to lymph nodes
• One field for surgery to regional or distant
  sites
• One field to document lymph nodes removed
• One field to explain why no surgery done

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Surgery of Primary Site

• Record surgery of primary site, ONLY
• Use the Site-specific Surgery Codes found in the
  2001 FCDS DAM, Appendix H
• Code first course treatment, ONLY
• Surgery to remove regional tissue/organs is not
  coded in this field unless they are part of an
  en bloc resection along with the primary site.

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Surgery of Primary Site

• If the patient has multiple surgeries of the
  primary site, code the most invasive and
  definitive surgery (highest code)
• If multiple cancers (primaries) are excised
  during the same surgical procedure, refer to each
  site-specific surgery coding scheme for each
  primary site (keep them separate)

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Surgery of Primary Site - Format

• 00 No Surgery of Primary Site
• 10 Minimal Procedure, NOS
• 11 Without detail
• 12 With detail
• 20 More extensive procedure, NOS
• 21 Without detail
• 22 etc.

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Scope of Regional Lymph Node Surgery

• Always refer to the site-specific codes for this
  data item, 2001 FCDS DAM, Appdx H
• Code first course treatment, ONLY
• This data item refers to the surgical procedure
  and does not imply that any lymph nodes were
  found during the pathologic examination of the
  specimen removed

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Scope of Regional Lymph Node Surgery

• Record regional lymph nodes only
• refer to the list of site-specific regional nodes
  found in the 2001 FCDS DAM, Appdx H
• Any other nodes are distant, and should be coded
  in the data field Surgery of Other Regional
  Site(s), Distant Site(s) or Distant Lymph
  Node(s).

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Regional Lymph Nodes Examined/Removed

• Record the number of regional lymph nodes
  examined during the most definitive surgical
  procedure,
• Code first course treatment, ONLY
• Do not add numbers of nodes removed at different
  surgical events.

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Regional Lymph Nodes Examined/Removed

• Important Note This field does not replace or
  duplicate the field documenting the pathologic
  review of Regional Nodes Examined in the Tumor
  Information and Staging section of the abstract.
• Do not copy values from one field to the other.

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Surg of Other Regional Site(s)/Distant
Site(s)/Distant Nodes

• Removal of tissue(s) or organ(s) other than the
  primary tumor.
• The tissue or organ is not removed with the
  primary tumor or organ of origin (not en bloc
  resection).
• Do not code incidental removal of tissue. This
  is defined as tissue removed for reasons other
  than malignancy.

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Reason for No Surgery

• Enter a code for the reason that no surgery was
  performed, from the list of codes on page II-70
  in the FCDS DAM 2001.
• If a site-specific surgery is coded then the
  Reason for No Surgery must be coded 0,
  indicating that surgery was performed

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Example...
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Surgery Lung Cancer - lobectomy with excision
of 4 hilar lymph nodes

• Formerly, code 40 summarized this surgery in one
  (two-character) field
• New codes describe the same surgery using 4
  different fields, plus a code for Reason For No
  Surgery

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Surgery Lung Cancer - lobectomy with excision
of 4 hilar lymph nodes

• Surgery of Primary Site
• Code 31 - Lobectomy
• This field only describes surgery for the primary
  site with no information about lymph node
  dissection or regional/distant sites

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Surgery Lung Cancer - lobectomy with excision
of 4 hilar lymph nodes

• Scope of Regional Lymph Node Surgery
• Code 2 - Ipsilateral Hilar Nodes
• When lymph node dissection is part of the
  surgery, determine which nodes were excised and
  use the highest code that accurately describes
  them

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Surgery Lung Cancer - lobectomy with excision
of 4 hilar lymph nodes

• Number of Regional Lymph Nodes Examined/Removed
• Code 04 - 4 nodes removed
• Record the number of regional lymph nodes removed
  during this surgical procedure only. Do not add
  number of nodes removed at different surgical
  events.

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Surgery Lung Cancer - lobectomy with excision
of 4 hilar lymph nodes

• Surgery of Other Regional Site(s), Distant
  Site(s) or Distant Lymph Nodes.
• Code 0 - None
• There was no surgery performed on other regional
  or distant site(s)

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Surgery Lung Cancer - lobectomy with excision
of 4 hilar lymph nodes

• Reason for No Surgery
• Code 0 - surgery was performed
• There was a surgical procedure which removed
  cancerous tissue

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Confused?Surgery Code Clarification Table

• A Surgery Code Clarification Table is available
  on the Commission on Cancer website
  (http//www.facs.org).
• This table addresses changes in the name and/or
  the meaning of current and revised standards
  (March 2000).

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Important Websites for Info

• FCDS - http//www.fcds.med.miami.edu
• SEER - http//www-seer.ims.nci.nih.gov
• CoC/ACoS - http//www.facs.org (click on cancer
  department)
• CDC - http//www.cdc.gov/cancer/npcr
• NAACCR - http//www.naaccr.org

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Time to exercise!

• We will pause in this slide presentation to do
  the Surgery Code exercises included in the
  handouts.

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SEER Summary Stage 2000
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SEER Summary Stage 2000

• Must be used for all cases diagnosed on or after
  January 1, 2001
• Must also be accompanied by FCDS Stage At First
  Contact 2000 for all cases diagnosed on or after
  January 1, 2001

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SEER Summary Stage 2000

• The same staging manual must be used to code
  both SEER Summary Stage at Diagnosis and FCDS
  Stage at First Contact

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SEER Summary Stage 2000

• This applies to all cases diagnosed 2001 and
  after - Use SEER Summary Stage 2000
• You still must use SEER Summary Stage 1977 for
  all cases diagnosed prior to 2001

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SEER Summary Stage 2000

• Major differences between SS2000 and the 1997
  Summary Staging Guide
• Each anatomic site in ICD-O-3 now has its own
  staging scheme

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SEER Summary Stage 2000

• Certain specific histology-defined sites now have
  their own staging scheme (such as Kaposi Sarcoma)
• Colon now has one staging scheme for all subsites
  (sigmoid, ascending, etc.)

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SEER Summary Stage 2000

• More complete documentation of regional sites and
  regional lymph nodes
• Additional anatomic drawings
• Notations at the end of each staging scheme
  describing changes in staging over time

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SEER Summary Stage 2000

• EveryonePLEASE read the expanded Introduction
  Section - it is full of important information for
  both the new and the experienced registrarthis
  means YOU !
• Turn to page 4 to review example of importance of
  terminology, anatomy physiology throughout the
  manual!

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SEER Summary Stage 2000

• Instructions for using the SEER Summary Staging
  Manual - 2000
• Definitions explaining each staging category (In
  situ, Localized, etc.)
• General Guidelines for Summary Staging

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SEER Summary Stage 2000

• How to Assign Summary Stage concise and basic
  guidelines (page 12)
• Explanation of abbreviations and symbols used in
  this manual
• Definitions, including some medical terminology
• Ambiguous terminology relating to staging

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SEER Summary Stage 2000

• Refer to Handout - Respiratory Tract
• Respiratory Tract
• Trachea
• Bronchus and Lung
• Drawings
• Staging Criteria
• Notes Footnotes - IMPORTANT !!!

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SEER Summary Stage 2000

• Primary tumor in lung with extension to adjacent
  rib considered regional in Historic Stage, now
  coded to distant stage
• Separate tumor nodule(s) in different lobe of
  same lung considered localized in Historic Stage
  and 1977 Summary Staging Guide, now coded to
  distant stage

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SEER Summary Stage 2000

• QUESTIONS ?????????
• Please contact FCDS and we will get you the
  answers so we can include them in our Monthly
  Memo and/or Newsletter
• THANKS !!!!!