When & How to Use the New Rules

Before we start to apply the 2007 rules, here are a few general DOs and DON'Ts.

1. DO read the General Instructions. The general instructions apply to all the site-specific and "other sites" sets of rules unless otherwise noted, both for multiple primaries and histology coding. These rules are not repeated in the site-specific or "other sites" rules.

   The General Instructions consist of several parts, each of which will be explained in more detail in this section:

   • Equivalent or Equal Terms
   • Definitions
   • Determining Multiple Primaries for Solid Malignant Tumors
     • General Information
     • How to Use the Multiple Primaries Rules
   • Histologic Type
     • Information
     • How to Use the Rules
   • Priority Order for Using Documents to Code Histology
   • Ambiguous Terms Used to Code Histology
2. DO use the rules to determine the number of primaries for all solid, in situ and invasive tumors. The 2007 rules do not apply to the following reportable conditions:
   • Hematopoietic Primaries (lymphomas, leukemias, and other blood diseases)
     • Use the "Definitions of Single and Subsequent Primaries for Hematologic Malignancies" table available from the SEER Program.
   • Benign and Borderline Central Nervous System Tumors
   • Rules for the benign and borderline CNS tumors were developed and implemented in 2004 when benign and borderline CNS tumors became reportable throughout the country
3. DON'T use the MPH rules, definitions, word lists, and examples to determine case reportability (in other words, for casefinding or case ascertainment) or to code behavior, grade, stage of disease, or other parts of the cancer abstract. The equivalent terms, ambiguous terms, and other aspects of the 2007 rules were developed specifically for determining the number of multiple primaries and the histology code for each abstract. A case must be determined to be reportable according to casefinding rules before any of the 2007 rules apply. Rules for coding behavior, grade, and stage of disease have not changed and should be used as printed.
4. DO apply the multiple primaries rules before applying the histology coding rules. The number of abstracts to be prepared must be determined before the histology code can be assigned for each abstract. In order to determine the number of abstracts, the registrar must review the multiple primaries rules for the site in question. Most of the time (more than 90% as previously noted), the number of abstracts can be decided easily, because the case involves a single tumor and that means a single abstract. If there is more than one primary, complete the first abstract (including coding the histology by the appropriate rules) and then complete the subsequent abstract(s).
5. DO pay attention to the notes and examples, but DON'T use them alone to code the case. The notes call attention to situations not mentioned specifically in a rule. An example is just that—an example—to illustrate the rule. It does not mean that the rule pertains only to cases similar to the example. Notes and examples highlight key points and add clarity to the rules, but they are not all-inclusive. While the notes and examples are an integral part of the rule, they don't demonstrate every possibility of how the rule can be used and they don't substitute for the rule itself. Do not attempt to code cases by using an example and deciding that your case and the case in the example are very similar, so you will code your case in the same way. Use the rules to make coding decisions, not the examples.