Cancer Registry Best Practices
Blank vs. X
CTR's Whose CE Cycle Ends 12/31/17
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.
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 and “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 understandng 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.
Janet Vogel, CTR
Manager of Education
Electronic Registry Systems, Inc.