A Registrar’s Guide to Chapter 1 of AJCC, 7th edition
- Clinical Staging is related to a time frame (within 4 months after date of diagnosis or from time of diagnosis until first treatment whichever is shorter)
- Central registries requires pathologic exam of one lymph node to assign a pN.
- Assign X when:
- Unknown to physician
- Not unknown to one physician but known to other physicians
- Not unknown to registrar due to lack of documentation in chart
- Assign a lower category if uncertain or unclear information. Often called down staging.
- (does not apply to unknown information, only uncertain)
- TX or NX cases usually cannot have a stage assigned
Transition from Collaborative Staging to Directly coded Staging/ Updates from Collaborative Stage Transition
- AJCC educational modules are available for free and are highly recommended
- Currently, 32 predictive and prognostic biomarkers
- HPV (+) oropharyngeal cancers tend to do better
- SEER will begin reporting breast overall and subtypes
- Will not be using derived stage for diagnosis year 2016
- Treatment dates will become more important with directly coded staging and will be submitted to the CDC
- Text will be needed with Directly Coded Staging to validate codes
- NAACCR’s new webinar series will focus on AJCC Staging and Summary Stage. Less time will be used for lectures, more time on case scenarios and quizzes
CoC Staging Intervention
- Summary stage strictly looks at anatomic involvement
- AJCC stage looks at anatomic involvement, prognostic/predictive factors, and SSFs
- Cannot assign clinical stage for an incidental finding at the time of surgical resection
- Registrars do not have legal authority to document in the medical record. Registrars can code their interpretation of the medical record in the registry database.
- If a physician stage is not accurate, indicate registrars assigned stage in the database
- If no physician stage, registrar assigns stage in database
ICD10: What Every Cancer Registrar Should Know –
- ICD10 will increase up to 7 digits
- ICD10 is more specific with 69,000 codes vs. 13,600 codes in ICD9
- ICD10 introduces laterality with over 5000 diagnoses having right or left distinction
- Canada does not code for reimbursement
- ICD10 has codes for abnormal tumor markers
- The ‘V’ does will be replaced with ‘Z ‘codes
- Malignant codes: C00-C96
- Insitu Codes: D00-D09