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Tumor Tip of the Week =Coding Nodal Biopsies & Understanding Relationship to Other Fields

Sorry for the length, but these 3 scenarios are important to illustrate some very important concepts.  When these nodal biopsies get coded incorrectly, it affect several fields and can cause a catastrophic ripple effect on the audit and data quality.  Happy Reading!

Scenario: (Needle Biopsy Regional Lymph Node Positive)

1/03/2020 RUL biopsy+ adenocarcinoma done at outside facility

1/06/2020 Fine Needle Aspirate cytology of hilar lymph node + metastatic adenocarcinoma done at my facility.

02/07/2020 Began Chemo & Radiation at my facility

 

Date of diagnosis:  01/03/2020
Date of First Contact:  02/07/2020 STORE: For analytic cases, the Date of First Contact is the date

the patient qualifies as an analytic case Class of Case 00-22.  [On 01/06/2020 the lymph node biopsy is done as part of the diagnostic workup, it is not actually treatment because it does not modify, control, remove or destroy proliferating cancer cells. So technically on that date the class of case would be a 30, but when the patient began treatment at my facility on 02/07/2020 that’s the date the patient became analytic, so that’s the date of first contact. So even though we code this lymph node biopsy as the date of first course treatment, and date of first surgical procedure, it’s not actually considered treatment.]

CAnswer Forum Post

http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/store/case-eligibility-patient-identification-cancer-identification-stage-of-disease-at-diagnosis-tumor-size-and-mets/102414-class-of-case-scope-rx-but-not

Class of Case:  22 Initial diagnosis elsewhere AND all first course treatment or a decision not to treat was done at the reporting facility
Scope of Regional Lymph Node Surgery: 1 (Bx or Aspiration of Regional LN) STORE Scope of Regional Lymph Node Surgery Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.
Date of First Course Treatment: 01/06/2020 STORE Scope of Regional Lymph Node Surgery Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.
Date of First Surgical Procedure: 01/06/2020 (most software’s auto-populate this field)
Date of Most Definitive Surgery: BLANK (most software’s auto-populate this field)
Regional Lymph Nodes Examined: 95 No regional nodes were removed, but aspiration of regional nodes was performed STORE Use code 95 when the only procedure for regional lymph nodes is a needle aspiration (cytology) or core biopsy (tissue).
Regional Lymph Nodes Positive: 95 No regional nodes were removed, but aspiration of regional nodes was performed STORE Use code 95 when a positive lymph node is aspirated and there are no surgically resected lymph nodes.
Date of Regional Lymph Node Surgery: BLANK STORE Records the date non-sentinel regional node dissection was performed.  In this example a dissection was not performed, only a fine needle aspiration
Clinical N Suffix: (f) STORE FNA or core needle biopsy only
Systemic Surgery Sequence: 3 Systemic therapy after surgery STORE Systemic therapy was given after surgical procedure of primary site; scope of regional lymph node surgery; surgery to other regional site(s), distant site(s), or distant lymph node(s) was performed.
Radiation Surgery Sequence: 3 Radiation therapy after surgery STORE Radiation therapy given after surgery to primary site; scope of regional lymph node surgery, surgery to other regional site(s), distant site(s), or distant lymph node(s).

 

 

 

Scenario: (Needle Biopsy Regional Lymph Node Negative)

01/03/2020 RUL biopsy+ adenocarcinoma done at outside facility

01/06/2020 Fine Needle Aspirate cytology of hilar lymph node-negative done at my facility.

02/07/2020 Began Chemo & Radiation at outside facility

 

Date of diagnosis:  01/03/2020
Date of First Contact:  01/06/2020 STORE If the patient’s diagnosis or treatment is as an outpatient of the facility, the Date of First Contact is the date the patient first appeared at the facility for that purpose.
Class of Case:  30 STORE Initial diagnosis and all first course treatment elsewhere AND reporting facility participated in diagnostic workup (for example, consult only, treatment plan only, staging workup after initial diagnosis elsewhere) [Even though the FNA is coded as the date of first course treatment and first surgical procedure, it’s not actually considered “treatment” as it does not modify, control, remove or destroy proliferating cancer cells.]
Scope of Regional Lymph Node Surgery: 1 (Bx or Aspiration of Regional LN) STORE Scope of Regional Lymph Node Surgery Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.

CAnswer Forum Post Code 1 in Scope of Regional Lymph Nodes regardless of whether the result is positive or negative.

http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/fords/initial-diagnosis/scope-of-regional-lymph-nodes/65014-do-we-code-negative-results-in-scope-of-regional-lymph-nodes

Date of First Course Treatment: 01/06/2020 STORE Scope of Regional Lymph Node Surgery Record surgical procedures which aspirate, biopsy, or remove regional lymph nodes to diagnose or stage disease in this data item. Record the date of this surgical procedure in data item Date of First Course of Treatment [1270] and/or Date of First Surgical Procedure [1200] if applicable.
Date of First Surgical Procedure: 01/06/2020 (most software’s auto-populate this field)
Date of Most Definitive Surgery: BLANK (most software’s auto-populate this field)
Regional Lymph Nodes Examined: 95 No regional nodes were removed, but aspiration of regional nodes was performed STORE Use code 95 when the only procedure for regional lymph nodes is a needle aspiration (cytology) or core biopsy (tissue).
Regional Lymph Nodes Positive: 00 All nodes examined are negative
Date of Regional Lymph Node Surgery: BLANK STORE Records the date non-sentinel regional node dissection was performed.  [In this example a dissection was not performed, only a fine needle aspiration.]
Clinical N Suffix: (f) STORE FNA or core needle biopsy only
Systemic Surgery Sequence: 3 Systemic therapy after surgery STORE Systemic therapy was given after surgical procedure of primary site; scope of regional lymph node surgery; surgery to other regional site(s), distant site(s), or distant lymph node(s) was performed.
Radiation Surgery Sequence: 3 Radiation therapy after surgery STORE Radiation therapy given after surgery to primary site; scope of regional lymph node surgery, surgery to other regional site(s), distant site(s), or distant lymph node(s).

 

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Scenario: (Needle Biopsy Distant Lymph Node Positive)

01/03/2020 RUL biopsy+ adenocarcinoma done at outside facility

01/06/2020 Fine Needle Aspirate cytology of Retroperitoneal lymph node-positive for adenocarcinoma from lung primary done at my facility.

02/07/2020 Began Chemo & Radiation at outside facility

 

Date of diagnosis:  01/03/2020
Date of First Contact:  01/06/2020 STORE If the patient’s diagnosis or treatment is as an outpatient of the facility, the Date of First Contact is the date the patient first appeared at the facility for that purpose.
Class of Case:  30 STORE Initial diagnosis and all first course treatment elsewhere AND reporting facility participated in diagnostic workup (for example, consult only, treatment plan only, staging workup after initial diagnosis elsewhere)
Scope of Regional Lymph Node Surgery: 0 No regional lymph node surgery [This biopsy of a distant lymph node is NOT coded in scope of regional lymph node surgery, but as a diagnostic & staging procedure.]
Date of First Course Treatment: 02/07/2020
Date of First Surgical Procedure: BLANK (most software’s auto-populate this field)
Date of Most Definitive Surgery: BLANK (most software’s auto-populate this field)
Regional Lymph Nodes Examined: 00 No nodes were examined [This field only applies to regional nodes, we biopsied a DISTANT node.]
Regional Lymph Nodes Positive: 98 No nodes were examined [This field only applies to regional nodes, we biopsied a DISTANT node.]
Date of Regional Lymph Node Surgery: BLANK STORE Records the date non-sentinel regional node dissection was performed.  [In this example no dissection was done on any regional nodes, just a biopsy of a distant node.]
Clinical N Suffix: BLANK [No biopsy of regional nodes.]
Systemic Surgery Sequence: 0 No systemic therapy and/or surgical procedures STORE No systemic therapy was given; and/or no surgical procedure of primary site; no scope of regional lymph node surgery; no surgery to other regional site(s), distant site(s), or distant lymph node(s); or no reconstructive surgery was performed. It is unknown whether both surgery and systemic treatment were provided.
Radiation Surgery Sequence: 0 No radiation therapy and/or surgical procedures STORE No radiation therapy given or unknown if radiation therapy given; and/or no surgery of the primary site; no scope of regional lymph node surgery; no surgery to other regional site(s), distant site(s), or

distant lymph node(s) or it is unknown whether any surgery given.

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