CTR Coding Break – Abstracting Malignant Brain


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In the Registry Partners March 2023 CTR Coding Break, we will review anatomy, signs, and symptoms of brain cancer, and diagnostic workup. We will also review abstracting aspects such as the Solid Tumor Rules, SSDIs, Staging, and Treatment. 

Common diagnostic workup tests include the MRI of the Brain, CT, PET Scan, and/or cerebral arteriogram. This is used to visualize the tumor, size, extent of disease, and regional or distant metastasis. A biopsy to microscopically evaluate for a histologic diagnosis and biomarker testing may also be performed. The tumor sample is tested for gene mutations, proteins, and other factors unique to specific types of tumors.

Malignant CNS and peripheral nerve tumors has its own chapter in the Solid Tumor Rules which include a priority order for behavior and an imaging priority order as well. For cases diagnosed 1/1/2023 and forward, any pilocytic astrocytoma/juvenile pilocytic astrocytoma cases are now assigned a histology code 9421/1 for all CNS sites. This is a change to cases diagnosed 2022 and prior.

We review different types of treatment for malignant brain tumors including surgery. The STORE Appendix C surgery codes 2023 are now available which include new revised surgery codes. Surgery codes A200-A550 are local excision codes to remove the entire lobe of the brain. A300-A550 codes do not apply to spinal cord or spinal nerve primary sites. Furthermore, A200 surgery code is used for a local excision of tumor, lesion, or mass or an excisional biopsy while A300 is used for a radical, total, gross resection of tumor, lesion, or mass in the brain. If decadron is administered, this is not considered hormone therapy for brain cancer cases per SEER Rx. 

Please note: There is a new AJCC version 9 for brain and spinal cord tumors that applies to cases diagnosed 1/1/2023 and forward. Medulloblastoma staging only consists of assignment of the M category.

With review of many aspects of abstracting malignant brain tumors, we test our knowledge with a case scenario.

Thank you to all who joined us this month for our special 1-hour edition! Click here if you’d like to download this as PDF.