As a cancer registrar, ask yourself this question: Have you ever been involved in a lengthy discussion about the use of Class of Case 00 vs. 10? Is it frequently difficult to determine which Class of Case is more appropriate?  If you answered “yes” to either or both of these questions, you are not alone.

Setting The Cancer Registry Stage

Before we dive more deeply into Class of Case 00 and 10, let’s look at what the Class of Case generally denotes. In particulate, it helps to capture the following information:

• The facility’s role in identifying and managing a cancer
• Whether that facility is required to report the cancer
• The patient’s relationship with the reporting facility
• Whether the case is analytic or non-analytic (and therefore whether it can be used for surveillance or studies purposes)

Class of Care 00 and 10 both refer to analytic cases. Thus, cancer registrars need to understand the other more subtle differences between these two classes so cases are properly selected for surveillance or studies.

Class of Case Standards And Scenarios

The revised 2015 Facility Oncology Registry Data Standards (FORDS) state that Class of Case 00 is appropriate when “the initial diagnosis at the reporting facility AND all treatment or a decision not to treat was done elsewhere.”

The FORDS state that Class of Case 10 is appropriate when “the initial diagnosis at the reporting facility or in a staff physician’s office AND part or all treatment of first course treatment or a decision not to treat was at the reporting facility, NOS.” Class of 10 can be further subdivided into Class of Case 11, 12, 13, and 14.

The most common scenario that causes confusion between Class of Case 00 and 10 occurs when the reporting facility initially diagnoses the cancer; however, the medical record includes no additional information about the cancer or whether and where treatment was performed. This can occur in the following circumstances:

• A patient is diagnosed at the reporting facility through imaging only
• A patient undergoes only a fine needle aspiration or core biopsy at the reporting facility
• The reporting facility provides only a clinical diagnosis

Five Cancer Registar Treatment Questions To Consider

Consider the following five questions to determine whether Class of Case 00 or 10 is more appropriate:

1. Is the initial cancer diagnosis rendered at your facility?
2. Did the patient receive treatment?
3. Did all or a portion of the treatment take place at your facility?
4. Did the patient decide at your facility that he or she did not want to receive treatment?
5. If the patient did receive treatment, do you know where he or she went for that treatment?

If the patient receives treatment elsewhere, report Class of Case 00. Also report 00 if the patient decides elsewhere not to receive treatment. Report Class of Case 10 if it’s not otherwise specified whether all or part of the first course of treatment is given at the reporting facility. Also report 10 if it’s not otherwise specified whether the decision not to treat was at the reporting facility.  In other words, Class of Case 00 applies only when it is known that the patient went elsewhere for treatment, even when that treatment was refused or not actually administered for another reason.  If it is not known that the patient actually went somewhere else, use Class of Case 10.

The following diagram helps to simplify the decision-making process:

Answers to questions 3-5 will determine which Class of Case to use.

Other Helpful Tips For Class of Case 00 vs. 10

Also keep these other tips in mind when reporting Class of Case 00 vs. 10:

• If you’re unable to code the data item “facility referred to” or “physician referred to” because you don’t know where the patient received treatment, report Class of Case 10.
• The Commission on Cancer (CoC) doesn’t require facilities with an approved cancer program to follow Class of Case 00 patients beyond establishing that the patient went elsewhere for treatment. Therefore, Class of Case 00 is not eligible for the CP3R accountability measures, nor is it eligible for surveillance as required by the program’s standards. If the CP3R case is a Class of Case 10, registrars are required to follow up on the treatment information.

What other tips and strategies have you used to ensure proper reporting of Class of Case 00 vs. 10?

For more information on coding, auditing, and cancer registry, check out the MRA website here.