16.3 Radiation, Systemic, Transplant, Other & Palliative Treatment Coding (STORE 2025)

Radiation

Phases

"A course of radiation is made up of one or more phases, and each phase reflects a distinct delivered prescription." STORE provides items for up to three phases. Number of Phases of Radiation Treatment [1532] records how many phases were actually given (01–98), so users can tell whether only part of the course was captured.

Phase I must be coded. Phases II and III may be blank if not given.

Modality codes [1506]

A radioiodine scan is diagnostic and is not recorded.

Planning technique codes [1502]

Dose rules

• In general, dose per fraction × number of fractions = phase total dose.
• Record the actual dose delivered, not the prescribed dose.
• 1 rad = 1 cGy. Round fractions of a cGy to the nearest whole number.
• For radioisotopes (modality 13–16), dose per fraction is 99998 and total dose is 999998.
• For brachytherapy, code the actual cGy if it is available.

Other radiation items

• Radiation Treatment Discontinued Early [1531]:
  • 00 none; 01 completed as prescribed;
  • 02 stopped for toxicity; 03 contraindicated or progression;
  • 04 patient decision; 05 family decision; 06 patient died; 07 reason not documented.
  • STORE example: cord compression after 5 of 10 fractions leads to surgery, with no return to radiation, giving 03.
• Reason for No Radiation [1430]:
  • 0 radiation given; 1 not part of the planned first course; 2 contraindicated;
  • 5 died before; 6 recommended, not given, no reason; 7 refused;
  • 8 recommended, unknown if given; 9 unknown.
• Radiation/Surgery Sequence [1380]:
  • 0 no radiation and/or no surgery; 2 radiation before surgery; 3 radiation after surgery;
  • 4 radiation both before and after surgery; 5 intraoperative radiation; 6 intraoperative radiation plus other radiation before or after;
  • 7 surgery both before and after radiation; 9 sequence unknown.
  • "Surgery" here means primary site surgery, regional node surgery (excluding code 1, biopsy or aspiration) or other-site surgery.

Systemic therapy

Coding points:

• Use SEER*Rx to classify drugs.
• Chemoembolization is coded 01–03 by the number of agents. With alcohol as the agent, it is Other Treatment.
• Code 00 vs. 86/87: if the plan offered alternatives and the patient chose one without chemotherapy, the code is 00, not refusal. 87 is used when recommended treatment was refused, including a blanket refusal of all treatment.
• Code 88 means "recommended, not yet confirmed." The registry must follow these cases. If follow-up shows the patient never went to the specialist, change the code to 00.
• Hormone therapy:
  • Prednisone counts only when given with chemotherapy for the cancer.
  • TSH-suppressive thyroid hormone is 01.
  • Replacement hormones given only to restore normal function are not coded.

Hematologic Transplant and Endocrine Procedures [3250]

Other Treatment [1420]

Codes: 0 none; 1 other, for example phlebotomy, transfusion or aspirin for specific heme diseases per the Heme manual, or alcohol embolization; 2 experimental; 3 double-blind clinical trial; 6 unproven (given by nonmedical personnel); 7 refused; 8 recommended, unknown if given; 9 unknown.

Systemic/Surgery Sequence [1639]

Codes:

• 0: no systemic therapy and/or no surgery.
• 2: systemic therapy before surgery.
• 3: systemic therapy after surgery.
• 4: systemic therapy before and after surgery.
• 5: intraoperative systemic therapy.
• 6: intraoperative systemic therapy plus other systemic therapy before or after.
• 7: surgery both before and after systemic therapy.
• 9: sequence unknown.

STORE's example of code 2 is hormone therapy before a radical prostatectomy.

Palliative Care [3270]

Palliative treatment that is also cancer-directed is coded in both the modality item and Palliative Care. For example, palliative radiation to a bone metastasis goes in the radiation items and Palliative Care 2.

Worked examples

1. Breast: whole breast 4,005 cGy in 15 fractions with 3-D planning, then a tumor bed boost of 1,000 cGy in 4 fractions.
   • Number of Phases = 02.
   • Phase I: modality 02, technique 04, dose per fraction 267, fractions 15, total 4005.
   • Phase II: dose per fraction 250, fractions 4, total 1000.
   • Radiation/Surgery Sequence 3.
2. Thyroid: I-131, 150 mCi, after thyroidectomy. Modality 13, planning technique 88, total dose 999998, Hormone Therapy 01 if TSH-suppressive levothyroxine is prescribed.
3. Myeloma: multiagent induction, then an autologous stem cell transplant. Code each drug in the item for its SEER*Rx category (for example, Chemotherapy 03 for a multiagent chemotherapy regimen), and code Hematologic Transplant and Endocrine Procedures 11 (autologous).
4. Pancreas: unresectable disease, with a biliary bypass for jaundice and a celiac block for pain. Palliative Care 6 (surgery + pain management), and the bypass does not count as primary site surgery.