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Newsletter Fall 2022



Be Aware of Coding in Cancer Research
and Informatics Software
Preparing for ICD-O3 Code Updates


Understanding what you do not know will assist you in coding the ICD-03 primary site or histology (morphology) in your cancer research software (CRStar, Oncolog, METRIQ etc.).  The look up dialog boxes for primary site or morphology are amazing tools. 

These ICD-03 look ups have transformed how we abstract a patient case.  The coding look up can assist you in coding a new case (suspense) case and abstracting a patient case, but there are limitations.  Depending on the dialog search box to give you the correct code for certain morphologies or new codes is not always the best option.

The ICD-03 search box will give you the correct primary or histology code for certain primaries.  If the code is new or different code entirely, it may not tell you the specific code or you may need to scroll down several histology codes to find the correct code number and the description. 

If you do not know if the code is new or different, how will you know?  What is changed? What is deleted?  What to look for?  When you cannot find the code for primary site or histology, access your hard copy of the manual International Classification of Diseases for Oncology ICD-O.  You can find the updates for ICD-O-3 or  It is up to you the cancer researcher and informatics specialist (CTR) to understand what has changed and the correct code for the patient abstract.  You staying informed about the updates every year is important. 

Through the NAACCR Website, our monthly training webinars, and talking with CTRs, other researchers or NAACCR staff, you can stay attuned to the changes, deletions, or updates.  The ICD-03 Lookup Code Dialog Box for searching is a powerful tool but it cannot do the work of a researcher.  

Juliet Hinton, BSB, MBA, CTR FGH Cancer Registry Manager—Research and Informatics

North MS Medical Center—Tupelo received full 3-year accreditation on their recent NAPBC re-accreditation survey with no deficiencies.


Steps for Coding Histology


Using the Solid Tumor Rules

  1. Read the General Instructions
  2. Apply the Multiple Primary (MP) Rules to Determine the # of Primaries
  • Start with the first rule in the appropriate module and stop at the first rule that describes your case:
  • Unknown if single or multiple tumors
  • Single tumor
  • Multiple tumors (may need to use Histology (H) rules to assign a working histology to each tumor BEFORE applying the M rules)
  1. Apply the Histology Rules (to each primary separately)
  • Start with the first rule in the appropriate module and stop at the first rule that describes your case
  • Modules vary by site group, but all have:
    • Single tumor
    • Multiple tumors abstracted as a single primary


Liver cases with an LI-RADS category LR-4 or LR-5

Use the date of the LR-4 (probable HCC; high probability but not 100% certainty observation is HCC) or LR-5 (definitely HCC; 100% certainty observation is HCC) scan as the date of diagnosis when it is the earliest confirmation of the malignancy. If there is no statement of the LI-RADS score but there is reference that a lesion is in the Organ Procurement and Transplantation Network (OPTN) 5 category, report based on the OPTN class of 5. OPTN class 5 indicates that a nodule meets radiologic criteria for hepatocellular carcinoma.

Prostate cancer cases with a PI-RADS category 4 or 5

PI-RADS categories 4 (high-clinically significant cancer is likely to be present) and 5 (very high-clinically significant cancer is highly likely to be present) are reportable, unless there is other information to the contrary.


Breast cases designated BIRADS 4, 4A, 4B, 4C or BIRADS 5 without any additional information

The American College of Radiology defines Category 4 as “Suspicious.” The descriptions in categories 4, 4a, 4b, and 4c are not diagnostic of malignancy. They all represent a percentage of likelihood, the highest being 4c which is greater than 50% but less than 95% likelihood of malignancy. The ACR states "This category is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy." Category 5 is "Highly Suggestive of Malignancy." "Suggestive" is not reportable ambiguous terminology. ACR states that Category 5 has a "very high probability" of malignancy, but again, it is not diagnostic.

Lung cases designated "Lung-RADS 4A," 4B, or 4X

Lung: Do not use the ACR Lung Imaging Reporting and Data System (Lung-RADS™) to determine reportability. Look for reportable terminology from the managing physician or other sources.

Liver cases based only on an LI-RADS category of LR-3

Do not report liver cases based only on an LI-RADS category of LR-3.

                                                                     Source:  Appendix E - 2021 SEER Program Coding and Staging Manual

AJCC Cancer Staging Manual

Cases with a diagnosis date of 01/01/2018 and forward should be staged using AJCC 8th Edition Cancer Staging Manual. The 3rd printing 2018 Edition is now available.

Please visit for all 8th Edition updates and corrections. For all other information, visit

Summary Stage 2018

The 2018 version of Summary Stage applies to every site and/or histology combination, including lymphomas and leukemias. Summary Stage uses all information available in the medical record; in other words, it is a combination of the most precise clinical and pathological documentation of the extent of disease. The Summary Stage 2018 manual is available at

Site Specific Data Items (SSDI)

Site Specific Data Items (SSDI) are similar to the Site Specific Factors (SSF) collected with Collaborative Stage. These data items are specific to certain site/histology combinations. For example, the SSDI’s for breast will be used to collect information such as estrogen receptor status, progesterone receptor status, Her2 status, Nottingham grade, and additional information related to primary tumors of the breast. The information collected in these data items are specific to breast. The SSDI manual is available at


Beginning with cases diagnosed in 2018 grade information will be collected in three fields; Clinical Grade, Pathological Grade, and Post-Therapy Grade. Within the Grade Manual you will find definitions for the three new grade data items, coding instructions, and the site/histology specific grade tables. The Grade manual is available at

SEER Hematopoietic and Lymphoid Neoplasm Database

This provides data collection rules for hematopoietic and lymphoid neoplasms for 2010+. The SEER Hematopoietic and Lymphoid Neoplasm manual is available at Hematopoietic_Instructions_and_Rules.pdf.

Solid Tumor Coding Manual

Use the 2018 Solid Tumor coding rules to determine the number of primaries to abstract and the histology to code for cases diagnosed 2018 and forward. The Solid Tumor coding rules replace the 2007 Multiple Primary and Histology (MP/H) Rules. The manual is available at The change log contains updates made to the FINAL module sections. This does not include changes made to the drafts.

STORE Manual

The STORE Manual has replaced the FORDS Manual. The STORE is now available at



Director UMMC & MCR: Deirdre Rogers,

MCR Manager: Angel Davis,

Clinical Systems Analyst-Intermediate: Tresheena Boyd,

Data Quality Analyst–Trainer: Lisa Hamel,

Data Quality Analyst-Auditor: April Wright,


Cancer Registrars:                                            

Stacy Major,                      

Laken A. Frederick,

Madeline N. Hall,

Mallory R. Israel,


Administrative Assistant:

Michelle Smith,


University of MS Medical Center

2500 North State Street

Jackson, MS 39216

Phone: 601-815-5482

Fax: 601-815-5483