CNS Part 1 Highlights
FCDS thanks everyone who joined the CNS Part 1 webcast on brain and CNS tumor reporting.
The webcast provided an overview of brain and CNS tumor facts, reviewed reportability guidelines, discussed anatomy and the WHO grading system, reviewed coding-specific data items, reviewed findings from the National Program of Cancer Registries (NPCR) Data Quality Evaluation (DQE) audit, and discussed the use of STRs. FCDS QC staff reviewed cases from the NPCR DQE audit and recoded them if the text documentation did not support the abstract coding.
Results from the quiz and audit case scenarios reveal some misunderstanding in applying the coding rules to determine reportability, using ambiguous terms, coding tumor size, radiation modality, the primary site, assigning WHO grade to non-malignant CNS tumors, and surgery coding.
This Q&A recap highlights key lessons from the CNS Part 1 webcast, emphasizing careful review of diagnostic terms, reportability rules, and supporting documentation for coding brain and CNS tumors.
Review of Quiz results from Q&A
Q: Is a brain lesion on CT reportable?
A: No. “Lesion” alone is not a reportable CNS histology term.
Q: Is a brain tumor on MRI reportable?
A: Yes. “Tumor” is reportable for non-malignant CNS tumors when no more specific histology is available.
Question from webcast: IT STATES TUMOR; MASS; TUMOR MASS, LESION, AND NEOPLASM ARE ONLY USED FOR DETERMINING MULTIPLE PRIMARIES. THEY ARE NOT TO BE USED FOR CASE FINDING OR DETERMINING REPORTABILITY. SO WOULDN'T QUESTION 2 BE NON-REPORTABLE BASED ON THE VERBIAGE?
Ambiguous Terms - Benign and borderline primary intracranial and CNS tumors
• Use the “Ambiguous Terms that are Reportable” list to identify benign and borderline primary intracranial and CNS tumors that are reportable. If any of the reportable ambiguous terms precede either the word “tumor” or the word “neoplasm,” the case is reportable. Abstract and report the case.
o EXAMPLE: The mass on the CT scan is consistent with a pituitary tumor. Abstract and report the case.
Q: What diagnosis date is used when imaging identifies the reportable tumor before biopsy?
A: Use the imaging date that first identified the reportable tumor.
NPCR Case Scenarios
Case 1: Cerebellar lesions were confirmed as hemangioblastoma, followed by stereotactic radiosurgery.
Q: What diagnosis date is coded when imaging says “likely”?
A: Code the confirmation date because “likely” is ambiguous.
Q: What Tumor Size Summary is coded when imaging on CT reveals a 4.1cm lesion, MRI shows 4.2 cm, and there is no mention of size in pathology?
A: Code 042 for TS from imaging technique when no other information is available.
Q: How is stereotactic radiosurgery coded?
A: Code 02, photons.
Comment from webcast: I THOUGHT SRS COULD ALSO BE DONE WITH PROTONS...
Treatment planning using stereotactic radiotherapy/radiosurgery
Do not record stereotactic radiosurgery (SRS), Gamma knife, Cyber knife, or Linac radiosurgery as surgical tumor destruction. All of these modalities are recorded in the radiation treatment fields
• Radiation Modality is coded 02, external beam, photons
• SBPT stereotactic body proton therapy, code 03, external beam, protons
Case 2: Brainstem cavernoma was confirmed on MRI, and the patient underwent tumor excision.
Q: What primary site code is used for brainstem?
A: Code C717.
Q: Is pathologic grade 1 coded after excisional biopsy only?
A: No. Code 9: In this case, only an excisional biopsy was performed; no subtotal or gross resection was performed.
Q: What surgery code applies to excision/excisional biopsy only?
A: Code 20 when subtotal or gross total resection is not documented.
Always confirm diagnostic terminology, reportability, and source documentation before coding brain and CNS cases.
In summary, benign and borderline brain tumors are diagnosed more frequently than malignant tumors, and accurate coding depends on careful review of age, histology, tumor location, and supporting documentation. Among malignant tumors, glioblastoma is the most common in adults, while meningioma is the most common benign tumor. Reporting requirements for benign and borderline brain and central nervous system (CNS) tumors apply to cases diagnosed in 2004 and forward. STRs differ for malignant and non-malignant brain and CNS tumors, and primary brain tumors must be distinguished from metastatic brain tumors. For meningioma cases, laterality must be coded when applicable. Pathologic grade should not be coded when surgical resection is not performed, and the WHO Grade 1 may be assigned automatically for certain diagnoses. To code WHO grade accurately, refer to the CNS CAP Protocol for applicable histology. When abstracting brain and CNS cases, always consult the SEER manual, STORE, STRs, and FCDS manuals for guidance. Remember that complete text documentation is required and helps support audit review.
The recording, handouts, and quizzes/answers for the CNS Part 1 webcast have been posted on our website under What’s New and Education and are available on FlccSC. You must take the quiz to get CEUs.
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