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MP/H Coding Rules General Instructions

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

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MP/H Instructions

• Apply to all rules unless otherwise noted

• Equivalent Terms

• Definitions

• General information– These instructions are to be used with all new

rules– They are not repeated in the site-specific

rules

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MP/H Instructions

• Instructions include:– How to use the rules– Priority order for use of documents– Ambiguous terms for coding histology

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Equivalent or Equal Terms

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

5

Equivalent or Equal Terms

• Equivalent or Equal Terms for MP Instructions apply to all site-specific rules unless otherwise noted.

• Each site-specific section will also include a set of site-specific equivalent or equal terms for that site only.

• For the purposes of these rules, these terms are equivalent:

– Multicentric, multifocal– Tumor, mass, lesion, neoplasm

• These terms are interchangeable for all rule sets, unless otherwise noted.

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There are a number of definitions, but we’d like to bring your attention to

a few in particular.

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

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Definitions

• Focal: An adjective meaning limited to one specific area. A focal cancer is limited to one specific area or organ. The area may be microscopic or macroscopic.

• Foci: Plural of focus.– Also remember that multifocal and

multicentric are equivalent terms for the purposes of the new rules.

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Definitions

• Focus: A term used by pathologists to describe a group of cells that can be seen only by a microscope. The cells are noticeably different from the surrounding tissue either by their appearance, chemical stain, or other testing.

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Definitions

• Most representative specimen: The pathologic specimen from the surgical procedure that removed the most tumor tissue.

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Definitions

Recurrence has two meanings:

1. The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy.

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Definitions

2. A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer. A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense – a new occurrence of cancer.

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Determining Multiple Primaries

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

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General Information

• Use these rules to determine the number of reportable primaries for solid malignant tumors. (That is: how many case abstracts do you have to complete for each person?)

• Do not use rules to determine if a case is reportable, to stage or to assign grade.

• 2007 rules replace all previous rules!

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General Information

• Three formats: flowchart, text, and matrix. The rules are identical, only the formats differ.

• Notes and examples highlight key points or add clarity to rules.

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General Information

• Do not use a physician’s statement to decide whether the patient has a recurrence of a previous cancer or a new primary.

– Use the RULES to determine if the patient has a new primary or if this is recurrence of a previous cancer.

– The only exception exists when a pathologist compares the present tumor to the “original” tumor and states that this tumor is a recurrence of cancer from the previous primary.

• Reportable solid malignant tumors only

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Lymphoma and Leukemia

• Use the Determining Multiple Primaries: Hematopoietic Primaries (Lymphoma and Leukemia) rules

• Use the table “Definitions of Single and Subsequent Primaries for Hematologic Malignancies”

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How to Use the MP Rules

• Use the site-specific rules for:– Brain, malignant (intracranial and CNS)– Breast– Colon– Head and neck

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How to Use the MP Rules

• Use the site-specific rules for:– Kidney– Lung– Malignant melanoma of the skin– Renal pelvis, ureter, bladder, and other

urinary

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How to Use the MP Rules

• Use the Other Sites rules for solid malignant tumors that occur in primary sites not covered by the site-specific rules.

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How to Use the MP Rules

• Each module is an independent, complete set of coding rules.

• Use the primary site documented by the physician on the medical record

• Do not count metastatic lesions

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How to Use the MP Rules

• Multicentric or multifocal, if the number of tumors is unknown, use the “Unknown if Single or Multiple Tumors” module

• Single tumor, use the “Single Tumor” module.

• Multiple tumors, use the “Multiple Tumor” module.

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How to Use the MP Rules

• Separate microscopic foci, ignore the separate microscopic foci and use the “SingleTumor” or “Multiple Tumor” modules as appropriate

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How to Use the MP Rules

• Rules are in hierarchical order

• Use the first rule that applies and STOP

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How to Use the MP Rules

• Single primary, prepare one abstract

• Multiple primaries, prepare two or more abstracts

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Histologic Type ICD-O-3

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

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General Information

• Histology describes the microscopic composition of cells and/or tissue for a specific primary.

– Basis for staging – Basis for determining treatment options– Prognosis and disease course

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General Information

• International Classification of Diseases for Oncology, Third Edition (ICD-O-3) is the standard reference for histology codes

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How to Use the Histology Rules

• Use the format easiest for you to follow

• Notes and examples highlight key points or add clarity

• Rules are in hierarchical order within each section

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How to Use the Histology Rules

• Read General Instructions.

• Read Equivalent Terms and Definitions.

• Follow the rules to make a decision on coding the histology

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How to Use the Histology Rules

• Rules are in hierarchical order

• Use the first rule that applies and STOP

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Priority Order for Documents

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

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Priority Order for Using Documents

1. Pathology report:a. From most representative specimenb. From final diagnosis

Note 1: Use information from addenda and comments associated with the final diagnosis

Note 2: A revised/amended diagnosis replaces the original final diagnosis.

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Priority Order for Using Documents

1. Pathology report (continued)

Note 3: New rules limit information to the final diagnosis.

Only use information from the microscopic portion of the pathology report when instructed to do so in the site-specific rules.

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Priority Order for Using Documents

2. Cytology report

3. No pathology or cytology report:a. References to pathology or cytology findings

b. Other mention of type of cancer (histology) in

the medical record

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Ambiguous Terms for Histology

MP/H Task Force

Multiple Primary Rules

Histology Coding Rules

2007

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Ambiguous Terms Used to Code Histology

– Apparent(ly)– Appears– Comparable with– Compatible with– Consistent with– Favor(s)

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Ambiguous Terms Used to Code Histology

– Most likely– Presumed– Probable– Suspect(ed)– Suspicious (for)– Typical (of)

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MP/H Task Force