Lesson 3: Class of Case Flashcards
(118 cards)
1
Q
the facility’s reportable list combines…
A
-the reporting requirements of the central registry
-CoC-accreditation (if applicable)
-and any reportable-by-agreement requests
2
Q
Class of Case describes the role that _____ plays in the _____ of this cancer.
A
the reporting facility (your facility); management
3
Q
what manual are the class of case codes defined in?
A
STORE
4
Q
questions to ask to determine the class of case AND if a case is analytic or non-analytic
A
- Is the patient receiving diagnostic workup at the facility?
- Is the patient receiving treatment at the facility?
- Was any care given in a staff physician’s office?
- Is the reason for admission related to the patient’s cancer?
- Was the visit for a consult or second opinion only?
- Was the patient diagnosed and treated prior to coming to the facility and is now being seen for a recurrence or progression of disease?
5
Q
True or False? Analytic cases are not required by CoC to be abstracted.
A
False. Analytic cases are required by CoC to be abstracted.
- because of the program’s primary responsibility in managing the cancer
6
Q
Analytic cases are grouped according to both:
A
- location of diagnosis
- first course of treatment
7
Q
Nonanalytic cases are grouped according to:
A
- reason a patient who received care at the facility is nonanalytic
- reason a patient who never received care at the facility may have been abstracted
7
Q
cases that may be abstracted by the facility to meet central registry requirements or in response to a request by the facility’s cancer program (reportable by agreement).
A
non-analytic cases
8
Q
analytic class of case codes
A
00-22
9
Q
non-analytic class of case codes
A
30-49 and 99
10
Q
Central cancer registries use class of case to…
A
qualify the data received from the reporting facility and to determine the perspective by which the information was reported.
11
Q
Most central cancer registries have a case completeness goal of _____ percent of the expected number of cases for both the central registry and hospital registries.
A
95
- The case number is based on population and the relative average number of cases from a facility over the years.
- Some states may require a higher percentage of completeness, and some hospitals may establish different internal case completeness benchmarks.
11
Q
If after thorough review using the criteria noted above, a case is determined not to be reportable…
A
it can be deleted from the suspense system
12
Q
to make sure all sources have been reviewed in a timely manner and monitor how often they identify cases not found through other sources, registrars may…
A
run reports or create tools, such as tracking sheets and status reports
13
Q
Historical analysis is used to
A
compare the current year’s number of cases with numbers from prior years
14
Q
Historical Analysis can identify _____ and is a simple way to _____.
A
oddities that flag incomplete casefinding; check accuracy with minimal resources and time
15
Q
Historical analysis may also examine case numbers by…
A
histology, site, stage, service type, and/or class of case.
16
Q
During an audit, all cases for a _____ are reviewed.
A
month (or several months)
17
Q
During an audit, a _____ can be reviewed if there is suspicion of a problem with a type of cancer.
A
site or histology
18
Q
The audit is conducted by requesting…
A
all casefinding sources, including pathology reports, medical and oncology treatment summaries and logs, disease indices, and secondary sources
19
Q
Through the death clearance process, a death from cancer may be identified that was not reported by ____.
A
a facility
- In such cases, the central registry will report the missed case to the facility and request that it is abstracted.
19
Q
At the end of each calendar year, central registries are required to conduct _____ on all residents of their state or territory who died during that year by linking their database of _____ with _____ from their state’s department of vital statistics.
A
death clearance; alive cancer patients; the mortality files
20
Q
The department of _____ include all deaths and the causes
A
vital statistics data
21
Q
Death certificates are signed by a _____ and include _____.
A
physician; location of death
22
True or False? If the death occurred at a hospital, the central registry will contact that facility.
True
* Central registries can also reach out to the physician who signed the death certificate to help identify the facility.
23
Cases diagnosed and/or administered any of the first course of treatment at the accessioning facility are _____.
analytic
24
The CoC is aligned with the _____ for your hospital/facility.
Federal Employer Tax ID (FEIN)
25
Any services or facility covered under your FEIN would then be covered under your _____ and you would be responsible for _____ as defined in the STORE Manual.
CoC accreditation; reporting the associated data that is reportable
26
Generally, any facility/service included in your FEIN is included within your accreditation and therefore reportable to _____.
NCDB
27
Analytic cases Class of Case ____ are included in treatment and survival analysis.
10-22
28
Analytic cases Class of Case _____ are not required to be staged or followed, regardless of the year of diagnosis.
00
29
Class of Case _____ is reserved for patients who are originally diagnosed by the reporting facility and receive all of their treatment elsewhere or a decision not to treat is made elsewhere.
00
30
If the patient receives no treatment, either because the patient refuses recommended treatment or a decision is made not to treat, the Class of Case is _____.
14
31
If there is no information about whether or where the patient was treated, the Class of Case is _____.
10
32
_____ cases are not usually included in routine treatment or survival statistics.
Non-analytic
32
True or false? The CoC does not require registries in accredited programs to accession, abstract, or follow analytic cases, but the program or central registry may require them.
False. The CoC does not require registries in accredited programs to accession, abstract, or follow NON-ANALYTIC cases, but the program or central registry may require them.
32
For analytic cases, the codes distinguish cases diagnosed in _____ from those diagnosed initially by _____ and patients _____ treated at the facility from those _____ treated by the reporting facility.
a staff physician’s office; the facility; fully; partially
33
Non-analytic cases are distinguished by whether the patient received care at _____ or _____.
the facility; did not personally appear there
34
Patients who did not receive care from the reporting facility are distinguished by
- care given in one or more staff physician offices
- care given through an agency whose cancer cases are abstracted by the reporting facility but are not part of it
- pathology only cases
- death certificate only cases
35
Treatment in staff physician offices is now coded “_____” because the hospital has no more responsibility over this treatment than it would if the patient were treated in another hospital.
treated elsewhere
36
If the primary site or histology is changed, it may also be necessary to revise _____ and _____.
site-specific staging; treatment codes
37
True or False? There is no time limit for making revisions that give better information about the original diagnosis or stage.
True.
* However, if staging information is updated, it is important to adhere to the staging timeframe and criteria for the respective staging system applicable at the time of the original diagnosis.
38
All cases entered into the database are assigned a _____ which is based on the nature of involvement of the reporting facility in the care of the patient.
class of case
39
Most cases that require revision are _____.
unknown primaries
40
_____ determines which cases must be abstracted and followed.
administrative reports
40
_____ cases will conform to CoC standards for accredited facilities
Analytic
40
The class of case affects _____, which are used for planning and evaluation of service areas.
administrative reports
41
The class of case is also useful in doing _____, ensuring that certain types of data are always recorded based on the class of case.
quality studies
42
_____ cases are not required by the CoC and do not have to meet their reporting standards.
Non-analytic
43
Cases diagnosed and/or administered the first course of treatment (FCOT) at the accessioning registry after the registry’s reference date are considered _____ cases.
analytic
44
Analytic codes in Class of Cases range 00-22 are grouped according to the location of the _____ and the location of the _____.
diagnosis; treatment
45
Almost all statistical reports will be based on _____ cases only.
analytic
46
_____ cases are not usually included in routine treatment or survival statistics.
Non-Analytic
* The CoC does not require registries in accredited programs to accession, abstract, or follow these cases.
* The facility may choose to include these cases by request of their facility, to monitor all types of cases seen at the facility and provide statistical information to administration and the physicians on these cases.
47
_____ usually require some or all of these non-analytic cases
Central cancer registries
48
What are the 5 steps to determine the class of case?
Step 1: Define the Reporting Facility
Step 2: Determine Staff Physicians
Step 3: Determine what is Reportable by Agreement
Step 4: Understand the Key Words Used in the Class of Case Data Item
Step 5: Decide What Role Your Facility had in the Overall Management of this Cancer
49
to define the reporting facility, ask...
who owns the medical record (the medical information)?
50
to determine staff physicians, ask...
Who are the medical staff with admitting privileges?
51
______ are on the payroll but may or may not be employed by the facility.
Staff physicians
52
For the purposes of assigning class of case only, staff physicians are assigned specific codes in the _____ class of case category.
analytic
53
to determine what is reportable by agreement, ask...
- What are the central cancer registry requirements?
- In addition to the CoC requirements, what is the facility required to report ?
54
The reportable list should be clearly defined by ____.
the facility
* For example, your cancer committee may require you to report the cases for a free-standing radiation center even though it is not “owned” by the facility. Or, they may require you to report a type of cancer that is not required by the CoC, such as carcinoma in situ of the cervix.
55
Steps # __ - __ reference background work that is done initially
1 - 3
56
Accessioning facility
Facility, clinic, center, office, or service owned by the facility responsible for reporting to the CoC
57
Staff physician
Medical staff with admitting privileges – they are on the payroll but may or may not be employed by the facility
57
an umbrella term used to mean anything that is NOT considered part of the reporting facility or a staff physician
elsewhere
58
Non-staff physicians
Physicians who are NOT on staff at the reporting facility are NOT considered part of the reporting facility and fall under the category of "elsewhere"
59
"elsewhere", when used to describe class of case, includes ____ that are not part of or owned by the reporting facility.
other facilities, clinics, and non-staff physicians
60
First course of treatment
Includes all treatment that is planned or recommended following the diagnosis
61
Treatment that is part of _____ is included in the analytic class of case categories regardless if the intent was curative or palliative.
the planned first course of therapy
62
If the treatment that the reporting facility delivered was NOT part of _____, then it is NOT included in the analytic class of case category.
the planned first course of treatment
63
If the cancer is NOT a new primary, the case is probably a recurrence or progression of a previous diagnosis and therefore it is ____.
non-analytic
63
care provided to relieve symptoms and is not given with curative intent
Palliative Care
* Provided to prolong the patient's life by controlling symptoms, to alleviate persistent pain, or to make the patient comfortable
64
If the cancer is a new primary, the case will probably be ____.
analytic
65
If the class of case is one that is required to be abstracted....
then the case is reportable.
66
True or False? When reviewing the casefinding sources (disease index, pathology reports, etc.) during the casefinding process, it may NOT be possible to determine the reason for the visit and the class of case.
True.
* The decision as to whether a case is reportable is not always based on a one-time review and decision. The decision may change as more information is made available.
67
Usually, a review of the ____ will be required to determine the class of case.
health record
* A case that may have appeared to be reportable on the disease index based on histology, may turn out not to be reportable when the health record is reviewed, and the class of case determined.
68
You may have to request needed information from the _____ before making a final determination on the class of case, especially when treatment was not given at the reporting facility.
managing physician
69
What Class of Case does the following describe?
- includes circumstances where patients were diagnosed at the reporting facility and you KNOW they received ALL treatment elsewhere
- includes when a decision not to treat the patient was made elsewhere
- includes cases that facilities consider “referred to” another facility for treatment
Class of Case 00
69
Central cancer registries use the class of case to _____ received from the reporting facility, and to _____ by which the information was reported.
qualify the data; determine the perspective
70
The difference between class 00 and class 10-14 is...
that the registrar knows for certain that all treatment was received elsewhere or at a non-staff physician’s office
70
Analytic cases Class of Case ___ are not required to be staged or followed, regardless of the year of diagnosis
00
* reserved for patients who are originally diagnosed by the reporting facility and receive all of their treatment elsewhere or a decision not to treat is made elsewhere
71
Class of Case ____ are for care given at a staff physician’s office
10-22
72
Class of Case ____ are for cases that are considered “referred from” another facility to your facility
20-22
73
Class of Case _____ are distinguished by those in which the patient actually received care at the facility, and those in which the patient did not personally appear at the facility
30-49 and 99
74
Class of Case __ are for cases that were identified by death certificate only
- This category is only used by central registries.
- This is to be used only if the diagnosis was first established on the death certificate.
49
75
Class of Case ____ → describe patients who did not personally appear at the facility
40-49 and 99
76
Class of Case ____ → The cancer registry abstracts cases for an agency that is not owned by the reporting facility
40-42
77
Class of Case ___ → The reporting facility processed the pathology specimen and rendered a pathology report only
43
78
Class of Case __ → when there is not sufficient detail to determine any other class of case
- Non-analytic case and the relationship to the facility is unknown
- This is for use by the central registries only. Hospital registries should be able to determine the class of case.
- This is not an allowable code for CoC accredited programs.
99
79
Class of Case ____ → cases in which the patient appeared in person at the reporting facility
30-38
80
Class of Case ___ → cases that were diagnosed elsewhere, and all the first course of treatment was performed elsewhere
- These patients are usually coming to your facility for treatment of a recurrence or progression of their disease
- In some instances, your facility may diagnose the recurrence or progression of disease
- They do not statistically fit with patients who are newly diagnosed, as the reporting facility did not have a role in the initial treatment
32
81
Class of Case ___ →
- Diagnosed at reporting facility
- All or part of first course of treatment elsewhere
00
82
Class of Case ___ →
- Diagnosed at reporting facility or office of physician with admitting privileges at reporting facility
- First course of treatment → NOS
10
83
Class of Case ___ →
- Diagnosed at office of physician with admitting privileges at reporting facility
- Part of first course of treatment at reporting facility
11
84
Class of Case ___ →
- Diagnosed at office of physician with admitting privileges at reporting facility
- All of first course of treatment at reporting facility
12
85
Class of Case ___ →
- Diagnosed at reporting facility
- Part of first course of treatment at reporting facility
13
86
Class of Case ___ →
- Diagnosed at reporting facility
- All of first course of treatment at reporting facility
14
87
Class of Case ___ →
- Diagnosed elsewhere
- Part of first course of treatment at reporting facility
21
87
Class of Case ___ →
- Diagnosed elsewhere
- First course of treatment → NOS
20
88
Class of Case ___ →
- Diagnosed elsewhere
- ALL of first course of treatment at reporting facility
22
89
Class of Case ___ →
- Non-analytic cases
- Excluded from CoC reporting
- Patient appears in person at reporting facility
30-38
90
Class of Case ___ →
- Non-analytic cases
- Excluded from CoC reporting
- Patient does not appear in person at reporting facility
40-43, 49, 99
91
_____ → the first date the patient was physically seen at the facility’s inpatient or outpatient departments for the diagnosis or treatment of cancer
* It is usually the patient’s physical presence that denotes contact
Date of First Contact
92
True or False? Visits are not reportable if they are consultations only
True. When assigning date of first contact, consultations are not reportable
93
For autopsy only cases, the Date of First Contact is _____.
the date of death
94
If the Class of Case changes from non-analytic to analytic, the Date of First Contact is updated to...
the date the case became analytic
* The class of case is also updated to reflect the patient’s analytic contact with the facility.
95
If the patient went to your facility for the collection of the specimen, then the Date of First Contact would be...
the date the positive specimen was collected (ex: date of biopsy procedure).
96
Class of Case ___ → Pathology Specimen Only
If a patient’s pathology specimen is sent to your facility to be processed by the pathology department
43
97
If you originally abstracted the case as a class of case 43 (pathology specimen only), and the patient DOES come to your facility for first course of treatment…
you would update the class of case to the appropriate one (10-22), depending on the physician’s status.
* Also update the Date of First Contact to reflect the patient’s first actual in-person contact with the facility. The Date of First Contact would be the date the patient first receives treatment.
98
True or False? The CoC does not specify if radiology only visits should be reported, when the results are positive for cancer (i.e., the imaging reports use language that constitutes a diagnosis).
True
* Part of the reasoning for this → is that casefinding, as well as gathering information necessary for a complete abstract, for radiology only visits can be very time consuming and the information very limited.
99
Whether or not radiology only cases must be reported is determined by ___.
the cancer committee
* These specifications should be clearly documented in the cancer registry policy and procedure manual. If required to report radiology only cases, the Date of First Contact would be the date of the radiology visit.
100
According to the CoC, for registries NOT required to report radiology only visits, the case becomes reportable IF the patient...
returns and has a diagnostic workup for cancer, and/or has cancer-directed treatment
* The Date of First Contact would still be the date of the initial radiology visit.
101
True or False? A staff physician is considered an extension of the facility for determining class of case and Date of First Contact.
False. A staff physician is considered an extension of the facility for determining class of case ONLY, not for determining any other data item, including Date of First Contact.
102
If a patient is diagnosed in a staff physician's office, and then comes to the reporting facility for treatment… What is the Date of First Contact?
the date the patient came to the reporting facility for treatment
* The class of case will be code 11 or 12, depending on what treatment was given by the reporting facility. The patient was not physically in the reporting facility until he was seen for the treatment.
103
Patients who are only seen for a radiation therapy consult are reportable IF...
a treatment plan is developed
* The patient may return to your facility for the treatment or go elsewhere.
* The Date of First Contact would be the date of the consult
104
If there was no suspicion of cancer at the time of admission, and the patient was diagnosed during the admission… The Date of First Contact would be...
the date of diagnosis, not the date of the admission
** The Date of First Contact cannot be before the date of diagnosis.
105
A patient came to your facility on 2/03/xx with a complaint of abdominal pain. An exploratory lap was performed 2/05/xx in which a diagnosis of colon cancer was made.
What is the Date of First Contact?
2/05/xx, because there was no suspicion of cancer at the time of admission, and it was not suspected until they did the exploratory procedure
106
True or False? The Date of First Contact should never be blank or unknown and must be complete for both analytic and non-analytic cases.
True.
Even though unknown is allowed, every effort should be made to determine the date the patient first came to the reporting facility.
