What's NOT New (but important nonetheless)
No Topography Changes
The first edition of ICD-O was published in 1976, and a substantial
revision - primarily of the topography codes - was published
in 1990. There are no changes to any of the topography terms
or codes in ICD-O-3.
The Matrix Principle
Although many more specific diagnoses and code-behavior combinations
have been added to ICD-O-3 to accommodate electronic reference
files, the matrix principle that was introduced in the first
edition of ICD-O should be reinforced as another coding tool.
The matrix concept is the rule that says it is permitted to
change the behavior code of a reported diagnosis so that it
truly reflects what the pathologist describes as the behavior.
Thus if a pathologist reports a diagnosis of "malignant adrenal
rest tumor," the coder may take the 4-digit histology code
for adrenal rest tumor, 8671, and change the behavior code
/0 to /3. While this will probably generate an edit check
or advisory message in a computerized registry database, the
system should have the ability to over-ride the message and
save the case with a histology-behavior combination that is
not printed in ICD-O-3.
Old Terms, New Meanings
Because of changes in the terminology used
by pathologists, there is some potential for confusion
by non-physicians and coders. For example, pathologists
use the term "grade" as a synonym for "type" or "category."
Registrars, on the other hand, recognize the term "grade"
as an indicator of cell differentiation which is coded
in the 6th digit of the ICD-O morphology code. Therefore,
it is important to |
![](images/illustration_miscommunication.jpg) |
recognize when the term "grade" refers to category and when
it refers to biologic activity.
Similarly, to a pathologist, the terms "adult" and "mature"
describe cell characteristics rather than the age of the patient.
"Transitional" has two meanings: it could be a cell type,
or it could be a neoplasm that is converting to something
else. Careful communication and explanation of new terms is
necessary to assure that the new information is coded correctly.
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