3.3 NCRA Code of Ethics & ODS Credential Maintenance
Key Takeaways
The NCRA Code of Ethics has five parts: General Guidelines, Job Orientation, Conflict of Interest, Professionalism and Association.
Suspected breaches of the Code are reported in writing, with supporting evidence, to the NCRA Ethics Committee; possible sanctions are suspension or revocation of NCRA membership or of the NCRA credential.
ODS holders must earn at least 20 CE credits per two-year cycle ending December 31, including at least 4 Category A credits on directly assigned stage and/or site-specific coding.
Since 2025, ODS holders in the contiguous U.S. and DC must also earn 8 NCRA-approved in-person (CEIP) credits per four-year cycle, counted within the 20-credit requirement.
A revoked ODS can be reinstated with a $200 restoration fee, but anyone who has not submitted fees or CE for three or more years since the last completed cycle must retake the exam.
Why ethics is a scored domain
The NCRA Professional Practice Code of Ethics is one of four testable references on NCRA's 2026 list. It was established in 1986, revised in 2023, and updated in October 2024 to reflect the ODS name. Every applicant also signs a statement on the exam application saying they have read the Code. Ethics questions are usually short scenarios in which someone pressures a registrar to change data, release information or hide a problem. The correct answer protects accurate data, patient confidentiality and proper reporting channels.
Structure of the Code
| Part | Core principle | Examples of guiding practices |
|---|---|---|
| I. General Guidelines | (A) Bring honor and dignity to the profession; (B) uphold confidentiality and privacy; (C) cooperate with other health professions | Decide without bias; follow "fitness for duty" rules (no work under the influence of alcohol, marijuana or unprescribed Schedule I or II drugs); follow HIPAA's Privacy, Security and Breach Notification Rules; do not shield a colleague guilty of unethical practice |
| II. Job Orientation | (A) Carry out delegated duties conscientiously; (B) preserve and secure registry records | Give a truthful accounting of your work; never take part in improper preparation, alteration or suppression of records; report suspected rule violations only to proper authorities |
| III. Conflict of Interest | Avoid conflicts through full disclosure | Disclose to your employer or client any interest in a provider of services or products |
| IV. Professionalism | Represent credentials truthfully; keep learning; help develop the profession | Use earned titles only (ODS, or ODS-C or ODS-Certified); make a duality-of-interest statement available on request; attend continuing education; mentor students |
| V. Association | Serve the Association honorably; report breaches of the Code | Keep committee and exam information confidential; report breaches in writing to the Ethics Committee; accept that the Ethics Committee, not individuals, judges conduct and recommends sanctions |
Key rules to remember
- Data integrity. A registrar "shall not participate in any improper preparation, alteration, or suppression" of records. The Code makes one clarification for central registries: during case consolidation, a registrar may use professional judgment to keep the most accurate information, which can mean changing inaccurate or incomplete submitted data.
- Escalation path for wrongdoing. Report conduct that violates internal policy to the proper internal authorities first. Report conduct believed to be illegal to regulators or law enforcement only after informing the institution and seeing that no corrective action was taken.
- Reporting a colleague. Evidence of illegal, unfair or incompetent practice or unethical conduct by a member or credential holder goes to the NCRA Ethics Committee, in writing, with supporting evidence. Individuals do not impose judgments themselves.
- Sanctions. A finding that the Code was violated may lead to suspension or revocation of NCRA membership and/or suspension or revocation of the NCRA credential.
- Confidentiality. Patients can expect identifiable registry information to stay confidential unless they waive that right or release is compelled by statute, regulation or other legal means. Release follows institutional policy.
- Exam confidentiality. Members who serve on NCRA committees must keep exam information confidential. Candidates are prohibited from discussing specific exam items.
Applying the Code: a pressure scenario
A cancer program administrator asks the registrar to code "cN0" on 30 lung cases whose staging workup is not documented, so that a report "looks complete" before a site visit.
- Refuse to enter unsupported codes. Assigning a stage without documentation is falsification, and pressure from a supervisor does not excuse it.
- Offer an accurate alternative. Explain that unknown values are coded as unknown under AJCC and STORE rules, and give a status report showing which documents are pending.
- Escalate through proper channels. If the pressure continues, go to the compliance office or the cancer committee. Contact outside authorities only if the conduct is illegal and the institution fails to act.
Maintaining the ODS credential
NCRA's credential maintenance rules as of the 2026 cycle are:
| Requirement | Rule |
|---|---|
| CE credits | At least 20 CE credits in each two-year CE cycle. Cycles end December 31, and credits must be earned within the cycle dates. |
| Category A | At least 4 of the 20 must be Category A: directly assigned stage (SEER Summary Stage, Extent of Disease, AJCC clinical and pathologic TNM) and/or site-specific coding. If Category A credits are missing, NCRA allows a 45-day extension; not meeting the requirement after that is grounds for disapproving certification maintenance. |
| CEIP | Since 2025, at least 8 Continuing Education In-Person credits every four-year cycle, earned at NCRA Program Recognition–approved in-person events. They count within the 20 CE credits, not in addition to them. The requirement applies to holders living in the 48 contiguous states and DC; it excludes Alaska, Hawaii, U.S. territories, international holders and those aged 70 or older. Attending an in-person event virtually does not qualify. |
| Annual fee | A certification maintenance fee is due every year. |
| "Other" credits | Beginning with December 31, 2027 submissions, no more than 5 non-NCRA-approved ("Other") CE credits may count in a two-year cycle. |
What counts, and how credits are calculated
- Eligible programs must be cancer registry–related and go beyond the level required for certification.
- Programs recognized by NCRA's Program Recognition Committee qualify, as do other registry or oncology programs, workshops, conferences and group video-teleconferences.
- Credit is awarded to the completed quarter hour after the first 30 minutes. For example, 45 minutes is 0.75 credits, and a session of 2 hours 25 minutes counts as 2.25 credits, not 2.5.
- Ineligible activities include introductory or "basic" programs at or below certification level, meetings held as part of your job, writing policies or manuals for work, tours and exhibits, undocumented self-study, unpublished papers, and archived programs published more than two years before your submission deadline.
If you cannot meet the requirements
- Extension: credits missing from one cycle can be earned in the next two-year cycle (or four-year CEIP cycle). The 4 Category A credits must be completed before an extension is granted.
- Medical disability release: a release for the current cycle, signed by a healthcare professional. Back-to-back releases are not allowed, and annual fees are still due.
- Caregiver release: available for one four-year CEIP cycle at a time.
- Retirement: permanently releases the holder from CE and fees. The holder then uses the designation "ODS (Retired)."
- Reinstatement after revocation: request reinstatement and pay a $200 restoration fee. However, anyone who has not submitted recertification fees and/or CE for three or more years since the last completed CE cycle must retake the ODS exam.
Related CoC continuing education rule
CoC Standard 4.3 separately requires registry staff without the ODS credential, including staff abstracting under ODS supervision, follow-up staff and non-credentialed supervisors, to complete three hours of cancer-related continuing education each calendar year.
An ODS holder in Ohio earned 22 CE credits in the 2025–2026 cycle: 18 from recorded webinars and 4 from an in-person state association meeting approved for CEIP. Two of the credits covered AJCC staging. What is still missing for full compliance?
Nothing, because the 20-credit minimum was exceeded
At least 2 more Category A credits this cycle, plus 4 more in-person CEIP credits before the four-year CEIP cycle ends
A separate 8 CEIP credits in addition to the 20, due this cycle
A retake of the ODS exam, because recorded webinars do not count
A registrar learns that a colleague who holds the ODS credential has been entering fabricated follow-up dates to raise the program's follow-up rate. Under the NCRA Code of Ethics, where should a report about the colleague's conduct as a credential holder be directed?
To a local newspaper, because falsified hospital data are a matter of public interest
To the colleague directly, and no further, because disparaging a fellow member is prohibited
In writing, with supporting evidence, to the NCRA Ethics Committee, which judges the conduct and recommends any sanction
To the state central registry, which has authority to revoke the ODS credential
An ODS holder's credential was revoked after the holder stopped paying maintenance fees and submitting CE. Eighteen months after the last completed CE cycle, the holder wants the credential back. What does NCRA require?
A reinstatement request and a $200 credential restoration fee, because fewer than three years have passed since the last completed cycle
A new application and a passing score on the ODS exam, because every revoked credential requires re-examination
Forty CE credits earned within the next six months and no fee
A petition to the Commission on Cancer, which oversees ODS credentials
Sections you finish are checked off in the contents.