ICD CODING FOR COMMON CANCERS DR. DEBARSHI LAHIRI, M.D. KOLKATA, INDIA
ICDINTERNATIONAL CLASSIFICATION OF DISEASES (and related health problems) published by the WHO (the 10th revision of which (WHO, 1992) is in current use)It is used to code and classify diseases and otherhealth problems recorded on many types of healthand vital records including death certificates.Designed to promote international comparability inthe collection, processing, classification, andpresentation of morbidity and mortality statistics.
ICD-10 Translates diagnoses of diseases and other health problemsfrom words into an alphanumeric code, which permits easy storage, retrieval and analysis of the data. (Till ICD-9 , Numeric coding system was followed) (ICD-10 is an Alpha numeric coding system)
22 ChaptersChapter II – Deals with Neoplasms C00 to D48C00-C14: Malignant neoplasms of Lip, Oral Cavity & PharynxC15-C26: Malignant Neoplasms of Digestive OrgansC30-C39: Malignant Neoplasms of Respiratory System & Intrathoracic OrgansC40-41: Malignant Neoplasms of Bone & Articular Cartilage
In situ & Benign NeoplasmD00-D09: In-situ NeoplasmD10-D36: Benign NeoplasmsD37-D48: Uncertain or Unknown Behaviour
Classification of NeoplasmsTwo most important items of information:LOCATION OF THE TUMOUR IN THE BODY:Synonyms- Anatomical Location/Site/TopographyMORPHOLOGY: Appearance of the tumour when examined under the microscope (synonyms- Histology/Cytology)- Indicates its Behaviour ( Malignant/Benign/in situ/uncertain).
ICD Classification- Describes only Topography and BehaviourMORPHOLOGY ??CARCINOMA LUNG NOS: C34.9 doesnt distinguish between NSCLC (adeno/Squamous)/SCLC/other morphologyBenign Neoplasm: D14.3In situ: D02.2
Cancer Registries were coding forMorphology even before ICD-O came1951- 1st coding manual for Morphology developed by American Cancer Society ( MOTNAC)- Manual of Tumour Nomenclature & Coding (Cancer Registries at that time used malignant neoplasm section of ICD-6 for coding Topography and MOTNAC for Morphology) WHO-1956- published Statistical Code for Human Tumors (based on Topography code based on ICD-7 and Morphology, including behaviour code of MOTNAC) CAP in 1965 published SNOP (systematized nomenclature of Pathology)
1968- ACS Revised MOTNAC-Topography based on ICD-8, Morphology code taken from SNOP1976-WHO and IARC collaborated- The worldwide need for a logical, coherent and detailed classification for neoplasms was recognised- Developed the International Classification of Diseases for Oncology (ICD-O).-Topography based on ICD-9 and Morphology on MOTNAC- which was further modified.1977-CAP revised SNOP to SNOMED Incorporated the ICD-O morphology section.
What is ICD-O?Not a true classification system:Includes codes from multiple classification Systems.Actually a coded nomenclature for :Topography (primary site of origin)Morphology (histology, behavior, grade)
Rationale for ICD-OTo Standardize Cancer Data CollectionTo Compare Data:RegionalNationalInternational
ICD O3 TOPOGRAPHY3rd Edition of ICD-O, Published in Year 2000TOPOGRAPHY- ICD 10 Classification codes of Malignant Neoplasms applied for all types of tumours(whether malignant/Benign/In situ/uncertain)Four digit code: C_ _._ ; 3 Digits for the Primary site followed by Sub-site after a Point.RANGE: C00.0 – C80.9
Topography Code, ExamplesLIP:C00.0: External Upper LipC00.1: External Lower LipC00.2: External Lip, NOSC00.3: Mucosa of the Upper LipC00.4: Mucosa of the Lower LipC00.5: Mucosa of the Lip, NOS
LUNG: C34.0: Main Bronchus C34.1: Upper Lobe C34.2: Middle Lobe C34.3: Lower Lobe C34.8: Overlapping Lesion C34.9: Lung NOS
Lymphoma Arising from the Nodes:C77.0: Head/Face/NeckC77.1: IntrathoracicC77.2:IntrabdominalC77.3: Axilla or ArmC77.4: Inguinal/LegC77.5: PelvicC77.8: Multiple RegionsC77.9:L.N. NOS
If a tumor is metastatic and the primary site is unknown, code primary site to C80.9All leukemias have a site-specific code of bone marrow (C42.1) except:Myeloid sarcoma (rare) – leukemic deposit in an organ and should be coded to that organMultiple myeloma – code site to C42.1
MorphologyICD-O morphology describes histology and behavior as separate variables, recognizing that there are a large number of possible combinations.In ICD-O, morphology is a 4-digit number ranging from 8000 to 9989, and behavior is a single digit which can be 0, 1, 2, 3, 6 or 9.
Morphology - BehaviorBehavior is the fifth digit (after the “/”) of the morphology codeBehavior code indicates the pathologic behavior of the neoplasm - benign, in situ, malignantMost registries in the world only collect cancer with behavior codes 2 (in situ) and 3 (malignant)
Morphology – Grade/DifferentiationGrade/Differentiation is the sixth digit (after the /) of the morphology codeDescribes how much or how little a tumor resembles the normal tissue from which it aroseIf a pathology report gives more than one grade/diff, code to the highest grade/diff
6 Digit Code for Leukemia/Lymphoma th5- T Cell6- B Cell, Pre-B, B- Precursor7- Null cell Non T- Non B8- N K Cell (natural Killer)9- Cell type not determined, not stated, or not applicable