11.1 Class of Case, Date of First Contact, Date of Diagnosis & Accession/Sequence Numbers

Why these items belong together

Class of Case, the dates and the identifiers decide whether a case is analytic (and therefore submitted to the NCDB, followed, and counted in quality measures), when the clock starts for timeliness, staging and treatment, and how the patient and each tumor are identified permanently. Many exam questions combine them: "Which Class of Case, and what Date of First Contact?"

Class of Case [610]: the big picture

STORE ties facility boundaries to the hospital's Federal Employer Identification Number (FEIN). Services covered by the facility's FEIN generally count as "the facility" for analytic status. Care given in a staff physician's own office is coded as given "elsewhere," because the hospital is not responsible for it.

Sections 11.2 and 11.3 define each code.

Date of First Contact [580]

• Definition: the date of the facility's first inpatient or outpatient contact with the patient for diagnosis or treatment of this cancer. For analytic cases, it is the date the patient qualified as analytic.
• Usually it is the date of admission or the outpatient visit for diagnosis or treatment, including a visit for a biopsy, x-ray or laboratory test.
• If the patient was admitted for something else, it is the date cancer was first suspected during that stay.
• If a nonanalytic case becomes analytic (for example, from Class of Case 30 consult-only to Class of Case 21 when the patient returns for treatment), update Date of First Contact to the date the case became analytic.
• Class 00 changes to 13 or 14 when a patient diagnosed at the facility, who went elsewhere for treatment, returns for treatment that was expected elsewhere. The Date of First Contact does not change, because it still marks when the patient became analytic.
• For a Class 40 case (diagnosed and treated entirely in a staff physician's office), it is the date the physician first diagnosed the cancer. For autopsy-only cases, it is the date of death. For Class 43 (pathology only), it is the date the specimen was collected.

Date of Initial Diagnosis [390]

• Use the first date of diagnosis, whether clinical or histologic, made by a physician at any facility.
• If the physician later says the patient in retrospect had cancer at an earlier date, use the earlier date.
• Ambiguous terms from the reportable list establish a diagnosis date when they are later confirmed. STORE example: pathology "suspicious for cancer" on May 17, confirmed positive May 22, so the date of diagnosis is May 17.
• Suspicious cytology later proven by biopsy: use the cytology date. STORE example: cytology suspicious June 12, pathology positive July 2, so the date of diagnosis is June 12.
• If treatment starts before a diagnosis is documented, use the date treatment started.
• For autopsy-only (Class 38) and death-certificate-only (Class 49) cases, the date of diagnosis is the date of death.
• If only the year is known, record the year and leave the month and day unknown. If only a season is documented, STORE approximates: spring = April, summer or mid-year = July, fall = October.
• Procedure date, not report date: the SEER manual states that when a positive pathology or cytology report is the only information, the date of diagnosis is the date the procedure was done, not the date the specimen was received, read or signed out.

Accession Number [550]

• Nine digits: the first four are the year of first contact for a reportable tumor, and the last five are the order of accession within that year (for example, 202600215).
• One accession number per patient, for life. All of the patient's primaries share it.
• Accession numbers are never reassigned, even if a patient is removed from the registry. Once submitted to RCRS or the NCDB they are never changed, even for a clerical error or when an older case is found out of order.

Sequence Number [560] (Hospital)

More STORE rules:

• Count every reportable tumor in the patient's history, including those diagnosed or treated elsewhere and never accessioned by you. STORE example: a patient with three prior malignancies elsewhere, admitted for colon surgery, gets sequence 04 for the colon cancer.
• Simultaneous primaries: give the lower sequence number to the one with the worse prognosis. If prognosis is the same, the choice is arbitrary.
• Update sequence numbers if you later learn of an earlier, unaccessioned reportable tumor. Do not renumber if a previously reportable tumor later becomes non-reportable under a rule change.
• Central registries record their own Sequence Number–Central [380], which follows the same concept and may include tumors your hospital never saw.

Worked timeline

• March 4: colonoscopy at the hospital shows a mass, and a biopsy is taken.
• March 8: the pathology report is signed out (adenocarcinoma).
• March 25: colectomy at the same hospital.
• Result: Date of First Contact = March 4. Date of Initial Diagnosis = March 4 (the date the biopsy was taken; the physician's endoscopic impression that day may also support it). Class of Case = 14 (diagnosed at the facility and all first-course treatment at the facility).