Cancer Registry Best Practices

BLANK VS. X

CTR’S Whose CE Cycle Ends 12/31/2017

Credentialed individuals are required to comply with a new continuing education standard as set forth by NCRA’s Council on Certification.  At least four (4) of the required 20 CE hours must fall within “Category A” which covers the specific topic(s) of: directly assigned stage and/or site specific coding principles.

Subscribe for Updates

Enter your name and email in the section below to subscribe to ERS Email Updates. Our emails allow clients to stay informed about new cancer registry case study releases and product features.

Email Subscription

The Saga Continues With A High Potential for Errors

Has 2016 felt both a little chaotic and a lot confusing to you?  It has for me and I’ve been working in the registry field for over 20 years.  It all comes down to the clarifications on AJCC Staging rules that left me, well less than clarified. 

After numerous discussions with other CTRs who were feeling the same, I decided to do some research.  I worked with some registrars and we pulled lists of cases diagnosed in 2016, and transferred the AJCC TNM & Group Staging Fields and Cancer Directed Surgery Codes to excel to evaluate areas of potential misunderstanding. 

30% of Our Sample Had Coding Errors 

To our dismay, we found at least 30% of the cases, albeit a small sample, contained questionable staging coding errors!  One of the biggest areas of confusion still seems to be when to code an X versus a Blank. 

Here’s what I did to determine these errors and evaluate the data . . . 

·    Once the data was in Excel, using Filters, I set up different scenarios to look for potential coding issues. 

·      This was tricky because of the X vs Blank rules, and sometimes it’s hard to differentiate if the Blank value is correct or if the abstractor just forgot to code it, or if the X is valid or not.

·   From this data, I have created the following questionable scenarios with suggestions for Abstracting.

·       Keep in mind some of the scenarios below will not yield an “edit” but the coding is either outright wrong or at the very least questionable and worthy of review.

2016 Scenarios Yielding High Error Rates

Scenario to Review Rationale Abstracting Suggestions
Valid pT & pN and pM of BLANK  If the rules for Classification for pathologic T have been met, then the pT, pN and pM fields cannot be blank.  Thousands of cases are being sent to the State Registries with a blank pM field when the case can be pathologically staged, this is incorrect and it’s causing the State Registries to have to manually do corrections on their end to derive a stage If you enter a valid pT and valid pN, then you must enter a pM of c0 if there are no mets, do not leave that field BLANK.
pStage Group of BLANK

 

Beginning with cases diagnosed January 1, 2016 and later, both clinical and pathologic AJCC stage will be required for data submission to the NCDB The requirement will be enforced via edits; thus, this field cannot be left blank.
cStage Group of BLANK

 

Beginning with cases diagnosed January 1, 2016 and later, both clinical and pathologic AJCC stage will be required for data submission to the NCDB. The requirement will be enforced via edits; thus, this field cannot be left blank.
pTX pNX pM equal BLANK or c0 and Surgery Code of 00

 

If the patient did not have Surgery and there is no Pathologic mets, why is there a pTX and pNX, doesn’t make sense, please review. Review based on absence of surgery.
pTX pNX pM c1, c1A, c1B, c1C, c1D and Surgery Code of 00

 

If the patient did not have surgery, why are there X in the pT and pN fields when there is only evidence of clinical mets. The pT pN and pM fields should be BLANK if the case cannot be pathologically staged.
pT BLANK pN BLANK pM pM c1, c1A, c1B, c1C, c1D

 

If you left the pT and pN blank it means the patient did not meet the rules for pathologic classification, then why did you fill the pM field with only evidence of Clinical mets? Review based on blank pT and pN fields.

Now’s the Time to Review Your 2016 Cases

Based on this data, I highly recommend reviewing your 2016 data for these scenarios.  You can also continue to sharpen your understanding with such national resources as the AJCC website for Registrar Education or your state-specific educational resources.

The field of cancer registry is quickly changing.  It’s up to all of us to stay abreast.

Happy abstracting, 

Janet Vogel, CTR

Manager of Education

Electronic Registry Systems