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MRA Thought of the Day – Do You Always Have to Code Grade Path Value and Grade Path System?

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Elizabeth Patena, M.D., CTR VP of Cancer Registry

Elizabeth Patena, M.D., CTR
VP of Cancer Registry

For cases January 1, 2010 and forward, Grade Path Value records the numeric grade reported in the pathology report. It documents the numerator or first number of a tumor grade reported in a two, three, or four grade system. It supplements but does not replace the data item Grade/Differentiation. Grade Path System records whether a two, three, or four grade system was used in the pathology report to describe the grade. It documents the denominator or second number of a tumor grade reported in a two, three, or four grade system. Both data items are in conjunction with each other.

For Grade Path Value:

  • Code from the same tissue as that used to code Grade/Differentiation (6th digit of the ICD-O-3 code).
  • Code the numeric grade from the pathology report if the Grade Path system is 2-4. Code the histology grade in priority over a nuclear or architectural grade.
  • Do not convert the terms well, moderately, or poorly differentiated, low/high, or anaplastic into codes in this field.

Leave the item blank if:

  • Case is diagnosed prior to 2010.
  • Numeric grade is given, but the grading system is not stated. Example: Grade 1 with no information about the grade system.
  • Do not report grading system such as Bloom-Richardson for breast primaries, Fuhrman for kidney, Gleason for prostate, or WHO Grade.
  • Do not report if the case is a lymphoma or hematopoietic malignancy.

Code

Description

Blank

There is no 2, 3, or 4 grade system available.

Unknown.

2

A 2-grade grading system was used (2, II or ii)

3

A 3-grade grading system was used (3, III or iii)

4

A 4-grade grading system was used (4, IV or iv)

Examples:

  • Synoptic report states grade ii of iii. Code Grade Path Value as 2.
  • Final pathologic diagnosis listed as grade 1 / 4. Code Grade Path Value as 1.
  • Microscopic description reports high grade III of III. Code Grade Path Value as 3.
  • Final pathologic diagnosis listed as grade 1. Leave Grade Path Value as blank.
  • CAP summary states BR intermediate grade, nuclear grade 2 / 3. Leave Grade Path Value as blank.

For Grade Path System:

  • Code from the same tissue as that used to code Grade/Differentiation (6th digit of the ICD-O-3 code).
  • Code the value corresponding to the number of grades used in the grading system reported in the pathology report.

Leave the item blank if:

  • Case is diagnosed prior to 2010.
  • No pathology grade is available.
  • Only a verbal description of grade is reported. Example: moderately differentiated.
  • Do not report grading system such as Bloom-Richardson for breast primaries, Fuhrman for kidney, Gleason for prostate, or WHO Grade.
  • Do not report if the case is a lymphoma or hematopoietic malignancy.

Code

Description

Blank

There is no 2, 3, or 4 grade system available.

Unknown.

2

A 2-grade grading system was used (2, II or ii)

3

A 3-grade grading system was used (3, III or iii)

4

A 4-grade grading system was used (4, IV or iv)

Examples:

  • Synoptic report states grade ii of iii. Code Grade Path System as 3.
  • Final pathologic diagnosis listed as grade 1 / 4. Code Grade Path System as 4.
  • Microscopic description reports high grade III of III. Code Grade Path System as 3.
  • Final pathologic diagnosis listed as grade 1. Leave Grade Path System as blank.
  • CAP summary states BR intermediate grade, nuclear grade 2 / 3. Leave Grade Path System as blank.

NOTE:

  • Grade Path Value and Grade Path System, if applicable, should both be coded. If not applicable, should both be blank.
  • If both are coded, Grade/Differentiation must not be 9.
  • Grade Path Value can never be larger than Grade Path System.

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