11.2 Analytic Classes of Case (00, 10–14, 20–22): Definitions & Decision Rules
Key Takeaways
Class 00 means diagnosed at the facility and all treatment, or the decision not to treat, happened elsewhere; code it only when it is known that the patient went elsewhere, otherwise use 10.
If a patient diagnosed at the facility refuses recommended treatment or a decision is made not to treat, the Class of Case is 14, not 00; if there is no information about whether or where the patient was treated, it is 10.
Classes 11 and 12 cover diagnosis in the office of a staff physician (employed, under contract, or with routine admitting privileges) with part (11) or all (12) of first-course treatment at the facility.
Classes 13 and 14 cover diagnosis at the facility with part (13) or all (14) of first-course treatment at the facility; 20, 21 and 22 cover diagnosis elsewhere with treatment at the facility NOS, part, or all.
Class of Case can change during the first course of care; continuation of first-course maintenance therapy at the facility (not in-transit) can make a case diagnosed and started elsewhere Class 21.
Two questions decide the code
- Where was the initial diagnosis made?
- At the reporting facility (including services covered by its FEIN).
- In the office of a staff physician, meaning one who is employed by the facility, under contract with it, or has routine admitting privileges there.
- Elsewhere, meaning another hospital or a non-staff physician.
- How much first-course treatment, or decision not to treat, occurred at the facility?
- None, part, all, or not specified (NOS).
The analytic codes (STORE 2025, item 610)
| Code | Diagnosis | First-course treatment at the reporting facility |
|---|---|---|
| 00 | At the reporting facility | None: all treatment, or the decision not to treat, was done elsewhere |
| 10 | At the facility or in a staff physician's office | Part or all, or a decision not to treat, NOS |
| 11 | In a staff physician's office | Part at the facility |
| 12 | In a staff physician's office | All, or the decision not to treat, at the facility |
| 13 | At the reporting facility | Part at the facility, part elsewhere |
| 14 | At the reporting facility | All, or the decision not to treat, at the facility |
| 20 | Elsewhere | All or part at the facility, NOS |
| 21 | Elsewhere | Part at the facility, part elsewhere |
| 22 | Elsewhere | All, or the decision not to treat, at the facility |
Mnemonic for the second digit: 1 = part, 2 = all in the 11/12 and 21/22 pairs; in the 13/14 pair, 3 = part, 4 = all. Codes ending in 0 (10, 20) are "NOS."
Rules that change the answer
00 versus 10 versus 14
- 00 requires knowing the patient went elsewhere. STORE instructs registrars to document the referral (for example, NPI–Institution Referred To [2425] or the treating physician's NPI) to establish this.
- If it is not known whether or where the patient was treated, code 10. STORE's example is a homeless patient whose biopsy was positive at the hospital, with no information about later care.
- If the patient refuses recommended treatment, or the physicians decide not to treat (for example, active surveillance, or the patient is too ill), and that decision was made at the facility, code 14. Class 00 is used for "decision not to treat" only when that decision was made elsewhere.
- Class 00 is analytic: it is abstracted and submitted to the NCDB, but CoC does not require Class 00 cases to be staged or followed.
Staff physician offices
- A biopsy done in a staff physician's own office counts as a diagnosis in a staff physician's office (11 or 12), not at the facility.
- Treatment given in a staff physician's office is treatment "elsewhere," because the office is not within the hospital's responsibility.
- If the hospital buys a physician practice, determine whether the practice is now legally part of the hospital. If it is not, treat its physicians like any other physician, with or without admitting privileges.
- A biopsy by a staff physician off site, with a specimen the facility never reads, is not required to be abstracted unless the patient then receives first-course care at the facility. In that case the class is 11 or 12. If the diagnosing physician is not a staff physician, it is 20 or 21.
Treatment started elsewhere, continued here
- In-transit care (temporary care while the patient is away from the usual practitioner) is nonanalytic Class 31. Monitoring an oral medication started elsewhere is also Class 31.
- If first-course radiation or chemotherapy infusion begins elsewhere and continues at the reporting facility and the care is not in-transit, the case is Class 21.
- Maintenance therapy that is part of the first-course plan (for example, continuing hormone therapy prescribed elsewhere), documented as prescribed or administered by your facility, makes the case Class 21, even if active disease is gone.
Class of Case can change
STORE: "If information for coding Class of Case changes during the patient's first course of care, change the code accordingly." Examples:
- A 00 patient returns for part of the planned treatment, so the case becomes 13. Date of First Contact does not change.
- A consult-only 30 patient returns for treatment, so the case becomes 20, 21 or 22, and Date of First Contact moves to the date the case became analytic.
STORE examples, decoded
| Scenario | Code | Why |
|---|---|---|
| Leukemia diagnosed at the facility; all care in the office of a physician with practice privileges | 00 | Diagnosis at the facility; care in a staff physician's office is "elsewhere" |
| Breast cancer diagnosed and operated on at the hospital; radiation at a hospital across the street under an agreement | 13 | Diagnosis at the facility; part of treatment elsewhere |
| Cancer found in a biopsy at the hospital; unable to learn whether the homeless patient got treatment | 10 | Diagnosis at the facility; treatment location unknown |
| Diagnosed by a staff physician; neoadjuvant radiation at another facility; resection at the reporting facility | 11 | Staff physician diagnosis; part of treatment at the facility |
More worked scenarios
- Melanoma: a punch biopsy in a staff dermatologist's office is read by the hospital's pathology department, and the patient has a wide re-excision at the hospital, which is all first-course treatment. The code is 12, and Date of First Contact is the re-excision date. STORE's Date of First Contact example uses exactly this setup.
- Prostate: a biopsy at the hospital, and the patient chooses active surveillance with the hospital's urologist. A decision not to treat at the facility gives 14.
- Lung: diagnosed by EBUS at another hospital, chemoradiation entirely at the reporting facility, so 22.
- Colon: diagnosed at the facility, and the patient travels to a cancer center for all treatment, documented with the referral NPI. The code is 00, and the case is not staged or followed under CoC rules.
A patient is diagnosed with pancreatic cancer by an endoscopic ultrasound biopsy at the reporting hospital. The hospital's tumor board recommends chemotherapy, but the patient refuses all treatment and enters hospice at home. What is the Class of Case?
00, because no treatment was given at the facility
10, because treatment information is incomplete
14, because the patient was diagnosed at the facility and the decision not to treat occurred there
30, because the facility only provided a diagnostic workup
A urologist with routine admitting privileges performs a prostate biopsy in his private office, and the specimen is read by the hospital's pathology department. The patient then receives external beam radiation at the hospital, which is his entire first course of treatment. What is the Class of Case?
14
12
22
11
A patient with breast cancer began first-course chemotherapy infusions at another hospital, moved to the reporting facility's city, and completed the planned infusions and surgery there. This is not in-transit care. What is the Class of Case?
21
22
31
20
Sections you finish are checked off in the contents.