# Presentation: 782955

## MP/H Coding Rules General Instructions

**Notes:**
These instructions apply to all sites covered by the 2007 MP/H rules.

## MP/H Instructions

- Apply to all rules unless otherwise noted
- Equivalent Terms
- Definitions
- General information

**Notes:**
Instructions apply to all rules unless otherwise noted.
MP Instructions include:
Equivalent Terms
Definitions
General information

To be used with all of the new rules
These instructions are not repeated in the site-specific rules

## MP/H Instructions

- How to use the rules
- Priority order for use of documents
- Ambiguous terms for coding histology

**Notes:**
And the Instructions include step-by-step instructions to tell the registrar:
How to use the rules
Priority order for use of documents
Ambiguous terms for coding histology

## Equivalent or Equal Terms

## Equivalent or Equal Terms

- Multicentric, multifocal
- Tumor, mass, lesion, neoplasm

**Notes:**
Equivalent or Equal Terms for MP Instructions apply to all site-specific rules unless otherwise noted.

Each site-specific section will also include a set of site-specific equivalent or equal terms for that site only.

For the purposes of these rules, these terms are equivalent:
Multicentric, multifocal
Tumor, mass, lesion, neoplasm

These terms are interchangeable for all rule sets, unless otherwise noted

## Definitions

**Notes:**
There are a number of definitions, but we’d like to bring your attention to a few in particular.

## Definitions

**Focal:** An adjective meaning limited to one specific area. A focal cancer is limited to one specific area or organ. The area may be microscopic or macroscopic.
**Foci:** Plural of focus.

**Notes:**
Focal: An adjective meaning limited to one specific area. A focal cancer is limited to one specific area or organ. The area may be microscopic or macroscopic.
Foci: Plural of focus.

Also remember that multifocal and multicentric are equivalent terms for the purposes of the new rules

## Definitions

**Focus:** A term used by pathologists to describe a group of cells that can be seen only by a microscope. The cells are noticeably different from the surrounding tissue either by their appearance, chemical stain, or other testing.

**Notes:**
Focus: A term used by pathologists to describe a group of cells that can be seen only by a microscope. The cells are noticeably different from the surrounding tissue either by their appearance, chemical stain, or other testing.

## Definitions

**Most representative specimen: **The pathologic specimen from the surgical procedure that removed the most **tumor **tissue.

**Notes:**
Our definition for most representative specimen has not changed:  Most representative specimen: The pathologic specimen from the surgical procedure that removed the most tumor tissue.

## Definitions

**Recurrence** has two meanings:
- The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy.

**Notes:**
Recurrence is a particularly important definition for our new rules.  We need to start off with an understanding that the term ‘recurrence’ has two meanings.  They are similar, but the differences make use of the term very confusing to many registrars.

The first definition is:  The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy.

## Definitions

- 2.	A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer. A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense – a new occurrence of cancer.

**Notes:**
The second meaning is:  A new occurrence of cancer arising from cells that have nothing to do with the earlier (first) cancer. A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense – a new occurrence of cancer.

Now, why is it so important that we understand the difference and how does it impact the new rules?  You will see as we go through the site-specific rules.  We have taken the guesswork out of trying to interpret what a physician means when he/she uses the term.  We have done this with the acknowledgement and approval of numerous physicians and physician groups who agree this has presented a significant problem to registrars for many years.

## Determining Multiple Primaries

## General Information

- Use these rules to determine the number of reportable primaries
- Do not use rules to determine if a case is reportable, to stage or to assign grade
- 2007 rules replace all previous rules

**Notes:**
The rules are used to determine the number of reportable primaries for solid malignant tumors...that is, how many case abstracts do you have to complete for each person.

You do not use rules to determine if a case is reportable, to stage or to assign grade

AND...The 2007 rules replace all previous rules – let me say that again – THE 2007 RULES REPLACE ALL – YES ALL – PREVIOUS RULES !!!

## General Information

- Three formats: flowchart, text, and matrix. The **rules are identical**, only the formats differ.
- Notes and examples highlight key points or add clarity to rules

**Notes:**
Three formats: flowchart, text, and matrix. The rules are identical, only the formats differ.

Notes and examples are used to highlight key points or to add clarity to the rules

## General Information

**Do not use **a physician’s statement to decide whether the patient has a recurrence of a previous cancer or a new primary.
- Reportable solid malignant tumors only

**Notes:**
Here we go back to the term recurrence and this specific instruction - Do not use a physician’s statement to decide whether the patient has a recurrence of a previous cancer or a new primary.  Use the RULES to determine if the patient has a new primary or if this is recurrence of a previous cancer. 
The only exception is:  when a pathologist compares the present tumor to the “original” tumor and states that this tumor is a recurrence of cancer from the previous primary. 

And again...these rules are for reportable solid malignant tumors only – next slide

## Lymphoma and Leukemia

- Use the Determining Multiple Primaries: Hematopoietic Primaries (Lymphoma and Leukemia) rules
- Use the table “Definitions of Single and Subsequent Primaries for Hematologic Malignancies”

**Notes:**
Use the Determining Multiple Primaries: Hematopoietic Primaries (Lymphoma and Leukemia) rules 

And

Use the table “Definitions of Single and Subsequent Primaries for Hematologic Malignancies”

Use the existing rules and table until the lymphoma and leukemia rules have had a chance to be thoroughly researched and rewritten – perhaps in a couple of years.

## How to Use the MP Rules

- Use the **site-specific rules **for:
- Brain, malignant (intracranial and CNS)
- Breast
- Colon
- Head and neck

**Notes:**
Use the site-specific rules for:
Brain, malignant (intracranial and CNS)
Breast
Colon
Head and neck
Continued on next slide...

## How to Use the MP Rules

- Use the **site-specific rules **for:
- Kidney
- Lung
- Malignant melanoma of the skin
- Renal pelvis, ureter, bladder, and other urinary

**Notes:**
Use the site-specific rules for:
Continued from previous slide...
Kidney
Lung
Malignant melanoma of the skin
Renal pelvis, ureter, bladder, and other urinary

## How to Use the MP Rules

- Use the **Other Sites rules **for solid malignant tumors that occur in primary sites not covered by the site-specific rules.

**Notes:**
Use the Other Sites rules for solid malignant tumors that occur in primary sites not covered by the site-specific rules.

## How to Use the MP Rules

- Each module is an independent, complete set of coding rules.
- Use the primary site documented by the physician on the medical record
- Do not count metastatic lesions

**Notes:**
Each module (Unknown if Single or Multiple Tumors, Single Tumor, Multiple Tumors) is an independent, complete set of coding rules.

Use the primary site documented by the physician on the medical record

Do not count metastatic lesions

## How to Use the MP Rules

- Multicentric or multifocal, if the number of tumors is unknown, use the “Unknown if Single or Multiple Tumors” module
- Single tumor, use the “Single Tumor” module.
- Multiple tumors, use the “Multiple Tumor” module.

**Notes:**
How do you know which module to use:
Multicentric or multifocal when the number of tumors is not stated, use the “Unknown if Single or Multiple Tumors” module
Single tumor, use the “Single Tumor” module.
Multiple tumors, use the “Multiple Tumor” module.

## How to Use the MP Rules

- Separate microscopic foci, ignore the separate microscopic foci and use the “SingleTumor” or “Multiple Tumor” modules as appropriate

**Notes:**
Separate microscopic foci, ignore the separate microscopic foci and use the “SingleTumor” or “Multiple Tumor” modules as appropriate

## How to Use the MP Rules

- Rules are in hierarchical order
- Use the first rule that applies and **STOP**

**Notes:**
The rules are in hierarchical order within each module.

Use the first rule that applies and STOP.

## How to Use the MP Rules

- Single primary, prepare one abstract
- Multiple primaries, prepare two or more abstracts

**Notes:**
If single primary, prepare one abstract
If multiple primaries, prepare two or more abstracts

## Histologic Type ICD-O-3

## General Information

- Histology describes the microscopic composition of cells and/or tissue for a specific primary.
- Basis for staging
- Basis for determining treatment options
- Prognosis and disease course

**Notes:**
The data item Histologic Type ICD-O-3 describes the microscopic composition of cells and/or tissue for a specific primary. 

The tumor type or histology is a basis for staging and determination of treatment options. It affects the prognosis and course of the disease.

## General Information

*International Classification of Diseases for Oncology*, Third Edition (ICD-O-3) is the standard reference for histology codes

**Notes:**
The International Classification of Diseases for Oncology, Third Edition (ICD-O-3) is the standard reference for histology codes

## How to Use the Histology Rules

- Use the format easiest for you to follow
- Notes and examples highlight key points or add clarity
- Rules are in hierarchical order within each section

## How to Use the Histology Rules

- Read General Instructions.
- Read Equivalent Terms and Definitions.
- Follow the rules to make a decision on coding the histology

**Notes:**
1. Read the General Instructions.
2. Read the site-specific Equivalent Terms and Definitions.
3. Use these rules to make a decision on coding the histology for all reportable solid malignant tumors.

## How to Use the Histology Rules

- Rules are in hierarchical order
- Use the first rule that applies and **STOP**

**Notes:**
The rules are in hierarchical order within each module.

Use the first rule that applies and STOP.

## Priority Order for Documents

## Priority Order for Using Documents

- 1. Pathology report:
- 	a. From **most representative **specimen
- 	b. From **final diagnosis**
***	****Note 1:**** ***Use information from **addenda **and **comments **associated with the final diagnosis
- 	*Note 2:**** ***A **revised/amended diagnosis **replaces the original final diagnosis.

**Notes:**
This is the priority order for using documents TO CODE HISTOLOGY.  (Do not apply these instructions to coding behavior, grade, stage, etc).
Medical records frequently include multiple pathology reports and references to histologic diagnosis.   Use the following instructions to identify which reports best represent the histology to be coded.

1. Pathology report:
a. From the most representative tumor specimen examined
b. From the final diagnosis
Note 1: Use information from addenda and comments associated with the final diagnosis to code the histology.
Note 2: A revised/amended diagnosis replaces the original final diagnosis. Code the histology from the revised/amended diagnosis.
For consultations:  If the original final diagnosis is amended based on the consultation, use the consultant’s diagnosis.  There must be an indication that the consultant’s diagnosis replaces the original diagnosis and is now the final diagnosis.  Otherwise, do not use the consultant’s diagnosis.

## Priority Order for Using Documents

- Pathology report (continued)
***	****Note 3:**** ***New rules **limit **information **to the final diagnosis**.
- 	**Only** **use** information from the **micro**scopic portion of the pathology report **when instructed **to do so in the site-specific rules.

**Notes:**
Note 3: The new rules limit the information to the final diagnosis. 

The old rules allowed coding from information in the microscopic description.

You will only use information from the microscopic portion of the pathology report when instructed to do so in one of the site-specific rules

## Priority Order for Using Documents

- 2. Cytology report
- 3. No pathology or cytology report:
- 	a. References to pathology or cytology findings
- 	b. Other mention of type of cancer (histology) in
- 	    the medical record

**Notes:**
If there is no pathology report, the second priority is:
2. Cytology report.

3. When you do not have either a pathology report or cytology report:
	a. Documentation in the medical record that references pathology or cytology findings
	b. From mention of type of cancer (histology) in the medical record

## Ambiguous Terms for Histology

## Ambiguous Terms Used to Code Histology

- Apparent(ly)
- Appears
- Comparable with
- Compatible with
- Consistent with
- Favor(s)

**Notes:**
This is NEW...in the past registrars used a similar list that was intended to determine reportability, not histologic type. 

Now we have a reference list of ambiguous terms that are used to code histology.

When any of the ambiguous terms are used to describe a more specific histology, code the more specific histology.

Ambiguous terms that are characteristic (used to code histology)
Apparent(ly)
Appears
Comparable with
Compatible with
Consistent with
Favor(s)
Continued on next slide...

## Ambiguous Terms Used to Code Histology

- Most likely
- Presumed
- Probable
- Suspect(ed)
- Suspicious (for)
- Typical (of)

**Notes:**
Continued from previous slide...
Most likely
Presumed
Probable
Suspect(ed)
Suspicious (for)
Typical (of)

Example:  Non-small cell carcinoma, most likely adenocarcinoma. Code adenocarcinoma.

If a term is not on this list, do not use it.

## MP/H Task Force