Coding Grade
Coding grades can be challenging. Because every case is unique, there is no “one-size-fits-all” set of instructions. It is essential to remember that each site has a preferred grading system. While it is occasionally permissible to use the general A–D grading scale, other scenarios will require you to code 9.
To ensure you are coding with confidence, always review your specific primary site in the grade tables, either via the alphabetical list or the schema ID. Taking this step ensures that you select the most accurate code for the specific schema.
The following pointers for these common sites are designed to help guide you through this process.
CODE GRADE 2
For ENDOMETRIOID carcinomas only (in CORPUS UTERUS)
If “LOW grade” is documented for corpus uterus, remember to code 2 as if it was FIGO Grade2
If “HIGH grade” is documented for corpus uterus, remember to code 2 as if it was FIGO Grade2
CODE GRADE 3
For Corpus UTERUS and CERVIX SARCOMA (Schema ID Name) remember that the following histologies are coded GRADE 3:
SEROUS carcinoma
Clear cell carcinoma
Undifferentiated/Dedifferentiated carcinoma
Carcinosarcomas
Mixed mesodermal tumors (Mullerian/MMMT) are high risk (high grade)
(Please note that these grading instructions do not apply to the cervix site in general. They are specific to the Cervix Sarcoma schema, which includes Cervix Carcinosarcoma).
CODE GRADE L, H, or 9
In OVARY, Primary PERITONEAL, and FALLOPIAN Tube with SEROUS Carcinoma and Immature TERATOMA use code L (low grade), H (high grade) or 9 for the following histologies: 8441/3 (serous carcinoma), 8460/3 (Low grade serous carcinoma), 8461/3 (High grade serous carcinoma), 8474/3 (Seromucinous carcinoma), 9080/3 (Teratoma).
Other histologies for these primary sites, code Grade 1-3
CODE S
When coding grade for Corpus Uterus Adenocarcinoma with sarcomatous overgrowth code Sarcomatous overgrowth grade S as sarcomatous overgrowth (S) has priority over Low or High grade.
Code grades 1-3 take priority over codes A-D
GI NETs
When coding NETs of the stomach, duodenum, Ampulla of Vater, jejunum/ileum, appendix, colon/rectum, and pancreas you may use the generic A-D grading system.
However, codes 1-3 take precedence and should be used whenever possible.
I hope the information provided here proves useful as you navigate the challenging world of coding.
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