Transcript Slide 1

Finding Cases
for Low Volume Hospitals
This training is provided by the Missouri Cancer Registry
MCR gratefully acknowledges Louanne Currence, RHIT, CTR
who developed the Power Point presentation used as the basis
for this training and Debra Douglas, CTR who developed the
policies and procedures for cancer reporting by low volume
hospitals.
Disclaimer- Missouri Cancer Registry presents this training as a learning tool for
hospital staff who report cancer cases to the central registry. This tool should not be
used to determine medical diagnoses. Persons seeking CMEs or CEUs should check
with their accrediting organization to determine if this training meets their criteria for
educational credits.
This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention
(CDC) and the Missouri Department of Health and Senior Services (DHSS) (#U58/DP000820-03) and a Surveillance
Contract between DHSS and the University of Missouri.
There are several Missouri laws about cancer reporting.
• Missouri Cancer Registry (MCR) Regulations
Reporting of cancer cases to the Missouri Department of Health
(now the Missouri Department of Health and Senior Services) for
Missouri hospitals became mandatory in 1984 when the State
General Assembly passed a bill to require inpatient reporting by
hospitals. Due to changes in the health care delivery system, an
increasing number of cancer cases are now being treated outside
the hospital setting. Therefore an expanded cancer reporting law
was passed in 1999 (RSMo 192.650, 192.653, 192.655, 192.657
and CSR 70-21.010[pdf]). This law requires that pathology
laboratories, ambulatory surgery centers, freestanding cancer clinics
and treatment centers, physicians and long-term care facilities also
report cancer cases.
The laws are applied to low-volume facilities as follows:
• A hospital with 75 or fewer cases annually
is classified as low volume.
• Low volume facilities:
– Identify potential cases, copy and submit relevant
parts of the medical record for abstraction by
central registry staff.
– Submit cases on a quarterly basis.
– Submit cases to MCR within 6 months of patient’s
initial contact with the facility.
The main role of low volume hospitals is case finding & submitting
charts in a complete and timely fashion.
•
By law, facilities are required to report cases
diagnosed and/or treated for cancer in their facility.
•
Unlike larger hospitals, low volume hospitals are
not required to submit fully-abstracted cases
electronically.
•
Related duties involve keeping complete records of
cases submitted, correspondence from MCR, etc.
Case-Finding Basics
• Designate a specific person to perform casefinding and allow adequate time to identify
cases, copy and submit charts.
• Conduct case-finding activities on a regular
basis at least quarterly.
• Collaborate with the laboratory and other
departments/sources that may provide tumor
information.
How do I identify
reportable cases?
Reportable Cases
●Inpatient and outpatient hospital cases are required
●Cases with specified ICD-9 codes
In order to report a case to MCR, you first must be able to determine if
a case is eligible.
Case eligibility is usually determined by a combination of factors, which
include the behavior of the disease (benign, malignant, in situ, etc.),
and when and where the case is treated.
Look in the MCR Abstract Code Manual or on the MCR website for a
reportable list of the ICD-9 codes (http://mcr.umh.edu/downloads/ICD9-CM%20Low-Volume%20Codes.pdf).
The following slides discuss different aspects of how to determine if you
should report a case to MCR.
If your facility owns the medical record you should report the case!
•
The general rule of thumb is that the hospital that owns the medical
record where the patient’s diagnosis and/or treatment occurs is the
facility required to report the case. For many low volume facilities, the
patient will be diagnosed in your facility, but referred elsewhere for
treatment. Examples:
•
A patient has a mammogram at your hospital and the radiologists says
the test is suspicious for breast cancer. The patient is referred to
another hospital for the biopsy. This case is reportable.
•
A patient has a colonoscopy at a surgery center owned by the hospital.
The test shows cancer. This case is reportable.
•
A patient is diagnosed with prostate cancer by a prostate biopsy
performed in a physician’s office whose practice is owned by your
hospital. This case is reportable.
ICD-9-CM Inclusions and Exclusions
While the ICD-9-CM list mainly includes
malignancies, there are a few inclusions
and exclusions you need to know.
Inclusion: Benign brain tumors are reportable
Beginning with cases diagnosed in 2004
benign brain tumors are required to be
reported to MCR.
Codes for benign brain tumors that must be reported are:
ICD-9-CM Codes
225.0 – 225.4 (for Benign Meninges and Brain)
225.8 – 225.9 (for Spinal Cord, Cranial Nerves and other)
227.3 – 227.4 (for other endocrine glands, etc.)
Exclusions: Some malignant tumors are NOT reportable.
Basal Cell Carcinomas (BCC) and Squamous
Cell Carcinoma (SCC) of the skin are no longer
required to be reported. This includes ICD-9-CM
codes 173.3 – 173.9 skin cancers.
MCR does not require CIN (cervix) ICD-9-CM
233.1, PIN (prostate) ICD-9-CM 602.3.
Tricky cases!!
Cases of intraepithelial neoplasia can be tricky.
MCR does require intraepithelial neoplasia for all
AIN (anal) ICD-9-CM code 154.2 – 154.3, Female
Genital Organs 184.0 – 184.9 which includes
VIN (vulvar) and VAIN (vaginal) and Male
Genital Organs 187.1 – 187.9.
Some terms used in reporting cases can be ambiguous.
• Terms that designate a reportable case must always include a
reference to malignancy, cancer or other similar term, except when
the diagnosis is for a benign primary tumor of the intracranial region,
the brain or the central nervous system.
• Some specific ambiguous terms that are used by physicians
constitute a reportable diagnosis, while others do not.
• These terms may originate from any source document such as
pathology, radiology, discharge summary and clinical reports and
may lead to minor problems during case finding as some ambiguous
terms for ICD-9 coding may not mean the same thing regarding
reporting status (i.e.: ‘possible’ cancer may be coded as a
malignancy by ICD-9 coders, but ‘possible’ is a non-reportable
ambiguous term for cancer reporting).
• When reviewing the medical record, if ambiguous terminology is
used in the diagnosis, refer to the following list to determine
reporting status.
Some terms used in reporting test results can be ambiguous.
If one of the following terms is used by the physician (in
combination with “malignancy” or “cancer”) , the case is
reportable:
•apparently
•compatible with
•malignant appearing
•probable
•appears to
•consistent with
•most likely
•typical of
•comparable with
•favors
•presumed
•suspicious
On the other hand, if one of these terms is used, the case is
NOT reportable:
•cannot be ruled out
•potentially malignant
•suggests
•equivocal
•questionable
•worrisome
•possibly
•rule out
Examples of Ambiguous Terminology
• CT scan results state “cancer cannot be
ruled out.” This is NOT reportable.
• CT scan results state “probable cancer.”
This is reportable.
What sources do I use
to identify cases?
Common places to look for reportable cases include:
To identify reportable cases, it is essential to identify potential sources.
• Medical Records/HIM departments: These departments can
produce lists based on the patient’s diagnosis (ICD-9 codes) and/or
the type of procedure done for the patient (CPT codes). These lists
are commonly called medical records disease indices (MRDI).
• Laboratory reports: Pathology reports from surgical procedures are
a good source. Cytology reports from urine, sputum, fluids such as
spinal, pleural, ascites, etc. are also good sources to use when
looking for reportable cases. Pap tests are considered cytology, but
MCR does not require results from those procedures.
• Outpatient department lists: Patient lists from outpatient sites such
as same day surgery clinics, satellite clinics, etc. can provide
possible reportable cases. Clinic charts must be reviewed at least
annually, but it may be easier to do it more often (monthly or
quarterly).
Using the Medical Record Disease Index (MRDI) to locate cases
• The MRDI is one of the most complete sources to locate reportable
cases. It must be designed to include codes to identify all potential
cases based on ICD-9-CM DIAGNOSIS CODES.
• For each admission of the patient include THE TOP SIX ICD-9
CODES (see MCR Abstract Code Manual or the MCR website for
list of reportable codes) and reviewed on a regular basis (at least
quarterly).
• Do not rely on non-specific activities such as discharge lists,
memory or charts being identified by coders.
• The report should be designed to include patient name, date of
birth, ICD-9-CM codes, procedure codes, admission type and
medical record number and sorted by patient name.
• If your department does not have the capability to generate the
report, request assistance from your hospital’s IT department.
Using the pathology report to locate cases
• The use of pathology reports will identify patients
diagnosed and or treated at your facility.
• Collaborate with staff in the pathology department to
route copies of all path reports that mention a
reportable diagnosis.
• Provide pathology department personnel with the
necessary information to identify cancer cases.
• Some facilities may have electronic pathology
records that could be used to produce regular
reports.
Other Sources
• Outpatient listings
– Same-day surgery centers
– Satellite clinics
• ***Occasionally you will run across a chart that
provides evidence of a diagnosis in a physician’s
office. Cases generated by a patient having
been seen in a physician’s office (not owned by
the hospital) ONLY are optional to report at this
time.
Potential sources (continued)
• Other potential sources:
– Specialty procedures for patients (such as
colonoscopies, bronchoscopies or
orchiectomies) that have a special procedure
code. You should be able to ask for a report
(at least annually) of patients receiving these
procedures.
What constitutes a
diagnosis?
A diagnosis includes:
• Positive pathology reports - examination of
tissue and blood.
– Tissue specimens - incisional biopsy, excisional biopsy,
surgical resection, autopsy and D&C
– Bone Marrow biopsy – aspiration and biopsy
– For leukemia only – Peripheral blood smears, CBCs,
WBCs
What constitutes a diagnosis?
• Positive cytology reports - examination of cells
– Bronchial brushings and washings, sputum smears,
pleural fluid, peritoneal fluid, spinal fluid, gastric fluid,
cervical and vaginal smears, urinary sediment (Pap
tests are considered cytology, but MCR does not
require results from those procedures.)
Diagnosis continued:
Positive radiology tests – these tests may
contain ambiguous terminology & may require
additional manpower for review.
•Mammograms
•Chest x-rays
•CT scans
•MRIs
•Ultrasound
How do you define
treatment?
Definition of treatment
Treatment or therapy for cancer modifies, controls,
removes or destroys cancer tissue.
The first course of treatment includes all cancer-directed
treatments indicated in the initial treatment plan which
are actually delivered to the patient.
A decision not to treat or refusal by the patient to accept
treatment is considered a treatment plan, as is palliative
care.
These patients are all reportable to MCR.
Examples of treatment
Reportable
• During a colonoscopy at another facility a patient is diagnosed
with colon cancer. The patient has a part of the colon
removed at your facility.
• The patient is admitted to your facility during a course of
chemotherapy for low blood counts. During the hospital stay,
the patient receives chemotherapy.
Exclusions – these are not reportable:
Not reportable
• A patient is diagnosed with colon cancer at another hospital.
He comes to your facility for a follow-up annual colonoscopy.
• A patient is receiving chemotherapy at another
hospital/facility. Due to complications or another health
condition, the patient is hospitalized at your facility.
• The patient is coded as having a “history of cancer” in ICD-9.
• Your facility is caring for a patient who has active or
metastatic cancer but is not receiving treatment but may be
receiving hospice care for the cancer at your facility.
Keeping Track…
• A Control Log of charts that have been submitted
to MCR must be maintained.
• This log should include:
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–
–
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Patient name
Date of birth
Social security number
Reporting year
ICD-9 codes
Encounter date(s)
Date submitted to MCR
Other Documentation
• Copies of pathology reports, new patient listings,
end of treatment notes, monthly/quarterly
disease index and other logs and discrepancy
files may be maintained as desired by the
facility.
• All case-finding files should be secured per
HIPAA regulations to prevent unauthorized
access to patient information.
Use of a “non-reportable” list
• To further assist with case-finding activities and possibly
eliminate the need to pull a chart multiple times, a nonreportable list can be maintained. This is a list of cases
that have been reviewed and found to be non-reportable.
• This list should include:
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Patient name
Date of birth or social security number
Encounter date(s)
ICD-9 codes
Brief reason case is non-reportable
Key Elements to Remember
1. Identify potentially reportable patients
2. Locate the charts and other data
3. Review for reporting status
4. Copy pertinent chart documents for reportable
cases
5. Transmit the data to MCR at least quarterly
6. Maintain suspense and control logs
In Summary
• Case-finding should be considered a priority of the
Health Information Management (or other designated)
department.
• A specific person should be designated to perform casefinding. That person should be given adequate time to
identify, copy and submit charts.
• Case-finding activities must be conducted on a regular
basis (at least quarterly).
• MCR must be informed of any staff turnover or changes.
And don’t forget ---
• A Transmittal Form must be submitted for each
reporting period (quarterly) even if no charts are
being sent.
• Please contact MCR if data submission for any
reporting period is going to be late.
• Call MCR at 1-800-392-2829 with questions –
we’re glad to help!!
http://mcr.umh.edu/