MRA Thought of the Day – What Else is New in 2013?

Elizabeth R. Patena, M.D., CTR Vice President of Cancer Registry Elizabeth R. Patena, M.D., CTR
Vice President of Cancer Registry

Three sets of new data items are added for 2013: Country, Secondary Diagnoses, and Over-rides for CS 1-19. In my last blog (read here) I discussed the new data item Country. Now we will focus on the new items that identify Secondary Diagnoses, and Over-rides for CS 1-19.

Secondary Diagnoses:

Federal rules require that hospitals upgrade from ICD-9-CM coding to ICD-10-CM during 2014. ICD-10-CM codes have more potential characters (7) than ICD-9-CM (5) and the codes are different (however, there is some overlap). Therefore, ten new data fields have been added for entering them, Secondary Diagnoses #1-10.

During 2013, ICD-9-CM codes should continue to be recorded in Comorbidities and Complications #1-10. If your facility is one that is collecting ICD-10-CM codes now, those should be recorded in the new Secondary Diagnosis #1-10 fields. Any ICD-10-CM codes collected for 2013 diagnoses must be recorded in the new fields.

Over-ride CS 1-19:

Twenty (20) over-ride flags have been added for use with the Collaborative Stage Data Collection System (CS) edits. Over-ride CS 20 is defined specifically for use by non-CoC accredited facilities and must remain blank for CoC programs. Over-ride CS 1-19 are added to FORDS: Revised for 2013 for potential use, and specific definitions will be announced when edits are released that reference these items.

Also, beginning with cases diagnosed in 2013, the following data items are no longer required. They must continue to be abstracted for cases diagnosed from 2007 through 2012. The rules for abstracting cases based on ambiguous terminology (Section One) remain unchanged.

Ambiguous Terminology Diagnosis
Date of Conclusive Diagnosis
Date of Conclusive DX Flag
Date of Multiple Tumors
Date of Mult Tumors Flag
Type of Multiple Tumors Reported as One Primary
Multiplicity Counter

With all these changes mentioned for 2013, more are coming.

So what else is new?

Distributed August 2013: According to our standard setters “After careful consideration, the American Joint Committee on Cancer (AJCC), Centers for Disease Control and Prevention (CDC), the Commission on Cancer (CoC), and the National Cancer Institute (NCI) have determined that it is not feasible to continue support of Collaborative Staging beyond diagnosis year 2015. Beginning with cases diagnosed in 2016 support of Collaborative Stage will cease and CDC, CoC and NCI will transition to direct coding of the AJCC TNM staging. We believe that direct coding of AJCC along with the careful collection of clinically significant biomarkers and prognostic factors will provide our programs with a more precise and stable method for the collection of staging data that is positioned to keep pace with future medical advances. The Canadian Council of Cancer Registries (CCCR) is aware of the forthcoming changes and has started a process to determine how staging will continue in Canada.

2014 and 2015 will be a transition period for all of us. During this transition the Collaborative Stage v2.05 Data Collection System will be used. {We are now currently using v2.04 for 2013 and prior years, so expect training for v2.05 for 2014 and 2015.} At the same time the AJCC, CDC, CoC, NCI and CCCR will devote resources and support for training and other activities to ensure the continued collection of high quality data. Training will focus on procedures for directly coding clinical and pathological AJCC T, N, and M and stage group, as well as identifying optimal methods to capture biomarkers and prognostic factors. Although planning for this transition is just beginning we will be depending on the surveillance community, in coordination with NAACCR and NCRA, for expertise and insights into effective training development and delivery; and the needed changes in reporting standards and software as we move forward. Together we will build new processes which will ensure the continued collection of high quality data to inform research based on more meaningful clinical information and improve our ability to support best practices for patient care.”

As cancer registrars, changes are not new to us. Through the years, change in cancer reporting is one that has remained constant. Sometimes we tend to find comfort in the old routine and frightened about the unknown (C80.9). But somehow, just like through the years, we adapt and prepare for its eventuality. I leave with you a bit of advice that I learned from the book “Who Moved My Cheese?” by Spencer Johnson, “Get ready for the cheese to move.”

What are your thoughts?

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