11.3 Nonanalytic Classes of Case (30–49, 99) & Why Central Registries Need Them
Key Takeaways
Codes 30–33 cover patients diagnosed and fully treated elsewhere who came to the facility for a workup or consult (30), in-transit care (31), recurrence or persistence (32), or with disease history only (33).
Codes 34 and 36 cover tumor types CoC does not require (for example, benign non-CNS tumors, CIN III, PIN III) diagnosed at the facility (34) or elsewhere (36); codes 35 and 37 cover cases diagnosed before the program's reference date, at the facility (35) or elsewhere (37).
Class 38 is a diagnosis first established by autopsy at the reporting facility when cancer was not suspected before death, and Class 49 is death certificate only.
Codes 40–43 are for patients who never appeared in person: one staff physician's office (40), two or more staff physicians' offices (41), a non-staff physician or unaccredited facility abstracted by the hospital (42), and pathology or other lab specimens only (43).
Class 99 is a nonanalytic case with unknown relationship to the facility and is not to be used by CoC-accredited programs for analytic cases.
Where nonanalytic cases fit
CoC does not require accredited programs to accession, abstract or follow nonanalytic cases, and they are not part of routine treatment or survival statistics. They are still collected when:
- The state or regional central registry requires them. Most states require every facility to report every reportable cancer it sees, whatever the Class of Case.
- The cancer committee asks for them, for example Class 30 cases to measure referral volume. STORE lists this as a reason to accession nonanalytic cases.
- The facility wants a complete patient history, for example to assign correct sequence numbers.
Patient appears in person at the reporting facility (30–38)
| Code | STORE definition | Typical example |
|---|---|---|
| 30 | Initial diagnosis and all first-course treatment elsewhere, and the facility participated in the diagnostic workup, such as consult only, treatment plan only, or a staging workup after diagnosis elsewhere | A second-opinion visit where the tumor board reviews the case and the patient goes home for treatment |
| 31 | Initial diagnosis and all first-course treatment elsewhere, and the facility gave in-transit care, or care that helped treatment elsewhere (for example, stent placement) | Chemotherapy while visiting for a family wedding, then return to the original hospital; monitoring of an oral drug started elsewhere |
| 32 | Diagnosis and all first-course treatment elsewhere, and the patient comes with recurrence or persistence (active disease) | Admission for supportive care after treatment failure |
| 33 | Diagnosis and all first-course treatment elsewhere, and the patient comes with disease history only (no active disease) | A patient with a past lymphoma admitted for a hip replacement |
| 34 | Tumor type not required by CoC, and initial diagnosis and part or all of first-course treatment at the facility | A benign colon tumor; cervical CIN III or PIN III diagnosed and treated at the facility |
| 35 | Diagnosed before the program's reference date, with initial diagnosis and all or part of first-course treatment at the facility | A 2008 case at a program whose reference date is 2010 |
| 36 | Tumor type not required by CoC, with initial diagnosis elsewhere and all or part of first-course treatment at the facility | A benign non-CNS tumor diagnosed elsewhere and treated at the facility |
| 37 | Diagnosed before the reference date, with initial diagnosis elsewhere and all or part of first-course treatment at the facility | A pre-reference-date case diagnosed elsewhere |
| 38 | Initial diagnosis established by autopsy at the facility, and cancer was not suspected before death | An incidental renal cell carcinoma found at autopsy |
STORE assigns 34 or 36 to:
- Benign or borderline tumors (behavior 0 or 1) diagnosed before 2004 at any site.
- Benign or borderline tumors diagnosed in 2004 or later at any site other than the brain and CNS sites: meninges, brain, spinal cord, cranial nerves and other CNS, pituitary, craniopharyngeal duct and pineal gland.
- Cervical CIS and intraepithelial neoplasia grade III of the cervix (CIN III), prostate (PIN III), vulva (VIN III), vagina (VAIN III) and anus (AIN III), coded 8077/2 or 8148/2.
Patient does not appear in person (40–49)
| Code | STORE definition |
|---|---|
| 40 | Diagnosis and all first-course treatment given in the same staff physician's office |
| 41 | Diagnosis and all first-course treatment given in two or more different offices of physicians with admitting privileges |
| 42 | Non-staff physician, or non-CoC-accredited clinic or other facility that is not part of the reporting facility, accessioned by the reporting facility (for example, an independent radiation facility, or a free-standing clinic the hospital abstracts voluntarily) |
| 43 | Pathology or other lab specimens only |
| 49 | Death certificate only |
| 99 | Nonanalytic case of unknown relationship to the facility (not for CoC-accredited programs' analytic cases) |
Boundaries that exam items test
- Class 32 versus a new primary. A patient treated elsewhere who comes to your facility with recurrence is Class 32. If the Solid Tumor Rules make the new tumor a new primary diagnosed at your facility, that tumor gets its own analytic Class of Case.
- Class 30 becoming analytic. If a consult-only patient returns for any first-course treatment, change the code to 20, 21 or 22, and update Date of First Contact.
- Class 43 becoming analytic. If a pathology-only patient later receives first-course treatment at the facility, update both the Class of Case and Date of First Contact to the first in-person contact.
- Class 38 versus analytic. If cancer was suspected before death and the autopsy confirmed it, the diagnosis was not first established at autopsy. Code the case by where it was suspected, diagnosed and treated.
- Class 38 and 49 dates. The date of diagnosis is the date of death for Class 38 and Class 49 cases.
- In-transit (31) versus continued first course (21). Temporary care away from home is 31. Moving care to your facility for the rest of the planned first course is 21.
Central registry uses of nonanalytic reports
Central registries need every reportable tumor in their population, whoever diagnosed it. Nonanalytic reports help them:
- Complete incidence counts, because physician-office (40–41), independent-facility (42) and pathology-only (43) cases may be the only source for a tumor.
- Consolidate multiple reports of the same tumor into a single record, resolving conflicts between facilities.
- Perform death clearance, which is matching death certificates that mention cancer against the registry. Unmatched deaths are followed back to the certifier or the facility. Only tumors that stay unresolved after follow-back remain death certificate only (DCO) cases, which NAACCR limits to 3% or less for Gold certification.
- Update follow-up and vital status, because a Class 32 or 33 admission shows the patient was alive on that date.
A patient diagnosed and fully treated for colon cancer at another hospital two years ago is admitted to the reporting facility with liver metastases and receives chemotherapy for the recurrence. What is the Class of Case?
21, because chemotherapy was given at the facility
30, because the facility participated in the workup
32, because diagnosis and all first-course treatment were elsewhere and the patient presents with recurrence
33, because the patient has a history of cancer
An autopsy at the reporting hospital reveals an unsuspected adenocarcinoma of the prostate in a man who died of a myocardial infarction. What are the Class of Case and the Date of Initial Diagnosis?
Class 38; date of death
Class 99; date of the autopsy
Class 49; date of the autopsy report
Class 43; date the specimen was collected
Cervical CIN III is diagnosed on a cone biopsy at the reporting facility, and the cone is the patient's only treatment. The state registry does not collect CIN III. If the facility chooses to accession the case, which Class of Case applies?
14, because diagnosis and all treatment occurred at the facility
34, because CIN III is a type of case not required by CoC, diagnosed and treated at the facility
36, because CIN III is never analytic
00, because no further treatment was needed
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