Reporting Guidelines

Every cancer diagnosed in Georgia is required by state law to be reported by health care providers. The Georgia Center for Cancer Statistics has been designated by the Georgia Department of Public Health to collect and keep that information confidential in a registry. This registry was designed to track the cancer burden among Georgia residents and to support studies about cancer to improve public health.

The Notifiable Disease Law, Official Code of Georgia Annotated (O.C.G.A.) § 31-12-2, also available on the Georgia Department of Public Health Disease Reporting website mandates the reporting of certain diseases including cancer. All cancers diagnosed since January 1, 1995, in persons receiving cancer diagnostic and/or management services or who have active disease must be reported to the Georgia Cancer Registry (GCR) unless previously reported by that facility. This includes all cancers indicated in the appropriate version of the International Classification of Diseases for Oncology (ICD-O), with a behavior code of 2 or 3.

As of January 1, 2004, any case diagnosed with benign brain or central nervous system tumors are also reportable. The reportable list below is based on the NPCR required data set.

For diagnosis years 2018 forward the authority for reportable histologies is the appropriate version of ICD-O-3.2.The ICD-O-3 Coding Updates for corresponding applicable diagnosis years is in the ICD-O-3 The North American Association of Central Cancer Registries (NAACCR) posts Implementation Guidelines on their website.

For 2022, the major changes apply to reportable terminology. The 2020 update includes: 12 new ICD-O codes/terms, two of which are non-reportable, three histologies have changed behavior with two remaining non-reportable and one becoming reportable, and 42 new preferred or related terms.

For 2023, the major changes apply to behavior code changes to a CNS neoplasm and reportable terminology. The 2023 update includes: 5 new ICD-O codes/terms, one histology changed behavior and is reportable, and 41 new preferred or related terms.

IMPORTANT FOR CASES Diagnosed 2023 FORWARD: Beginning 1/1/2023, all cases diagnosed with pilocytic astrocytoma/juvenile pilocytic astrocytoma and related terminology are to be reported with behavior /1. They will no longer be collected with malignant behavior (/3). ICD-O code 9421/3 will be valid for the diagnosis of high-grade astrocytoma with piloid features or HGAP only. Coding instructions are included in the remarks section for 9421/1 and 9421/3 in the 2023 ICD-O Update Tables 1 and 2.

Check the 2023 ICD-O-3 Update Table 1 or 2 to determine if the histology is listed. If the histology is not included in the update, then review ICD-O-3.2 and/or Hematopoietic and Lymphoid Database and/or Solid Tumor Rules (MP/H).

Many changes for 2024 are new related terms for existing codes, five new ICD-O codes, four reportable and one non-reportable, and one histology that has changed behaviors and is now reportable.

Please refer to the appropriate program manual for further guidance on reportable neoplasms. It is important to understand that cancer registry reportability rules based on behavior code still apply. Except for primary intracranial and central nervous system benign and borderline tumors, the addition of a /0 or /1 coded term to ICD-O-3 does not imply that it is now reportable. Some /2 behaviors may not be reportable or are reportable for a select site or sites. Again, please refer to your standard setter reporting requirements if you have questions.

Find the 2018-2024 ICD-O-3 Coding Guidelines and Coding tables in PDF or Excel format here .

Please refer to the 2023 and 2024 SEER Program Code Manual Appendix E for reportable and non-reportable examples.

For cases diagnosed prior to 2023, please use this link to access historical SEER Program Coding and Staging Manuals .

The hospital that receives a pathology specimen diagnostic of cancer from another hospital is not required to report the case. It is the responsibility of the hospital or outpatient facility that first collected or received the specimen to report the case. However, if a hospital receives a pathology specimen diagnostic of cancer from a physician's office, the hospital is required to report the case.

All providers of health care for cancer patients including, but not limited to, hospitals, outpatient surgical facilities, laboratories (hospital and free-standing), radiation therapy facilities which are independent and/or free-standing facilities, nursing homes, hospice facilities not owned or managed by a hospital, medical oncology facilities and Physicians that diagnose or treat cancer patients that include but not limited to Urologists, Dermatologists, and Hematologists.

The hospital that receives a pathology specimen diagnostic of cancer from another hospital is not required to report the case. It is the responsibility of the hospital or outpatient facility that first collected or received the specimen to report the case. However, if a hospital receives a pathology specimen diagnostic of cancer from a physician's office, the hospital is required to report the case.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) does not impact the status of cancer reporting procedures. HIPAA allows for the reporting of identifiable cancer data and other reportable conditions to public health entities. The GCR falls under the definition of a public health entity. HIPAA allows all facilities to continue reporting data to the GCR in compliance with state law.

For interpretations of HIPAA rules, refer to the Georgia Department of Public Health website .

More overview of legal authority for Georgia reporting of this manual.

For Public Laws, Cancer Registry Amendment Act, see CDC Cancer Control and Prevention, Cancer Registries Amendment Act

Report all required data elements as described in GCR Required Data Set and Instructions for Abstracting and Coding . See dataset details.

All facilities with an average annual case load of greater than or equal to 50 cases must submit the required data electronically using Abstract Plus software provided free of charge by GCR or using other available registry software. Facilities should utilize the monthly data upload feature on our secure web site for submitting electronic data. The facility will be notified by GCR when the data submission has been received.

All facilities with an average annual case load of less than 50 cases annually (Small Reporting Facility) may also submit the required data electronically. Alternatively, the preferred method for small facility reporting is through uploading scanned copies of medical records to the secured Labkey system on the GCCS website . You must be identified as a facility contact within the system to be authorized as a registered user. Please contact your [Regional Coordinator] for your contact information to be entered for your facility in the system.

Contact your Regional Coordinator for setup and instructions.

Small facilities should submit their yearly disease index in excel format in January following the year of diagnosis or date of first contact for cancer.

Small facilities are encouraged to provide electronic access of their medical record to their Regional Coordinator to facilitate/assist in screening for reportability to the GCR. Alternatively, all medical records with a cancer code on the disease index may be submitted.

Medical record submission for small facilities should be submitted with their disease index no later than March following the year of diagnosis or date of first contact for known cancer.

The following reports from the medical record should be submitted: Face sheet, History & Physical, pathology report, relevant labs and tumor markers, operative report, discharge summary, X-Rays, scans, scopes, and other diagnostic reports.

The facility will receive a notification by e-mail from gccs@sph.emory.edu that the data submission has been received. If you do not receive the notification by e-mail within a week after sending your submission, you should email confirmation at gccs@sph.emory.edu .

Data Editing

GCR requires all submitted data to be edited by the GA edit software. GCR recommends an edit report be attached to or included with each submitted data file. To obtain the GA edit software please contact your Regional Coordinator. The GA edit software is free of charge and available to all hospitals.

File Naming Conventions for Data Sent to the Georgia Cancer Registry

Small Facilities (less than 50 cases a month) should contact their Regional Coordinator for methods for securing their data during transmission to the GCR via Labkey .

GCR should comply with the established goals and standards set by the National Program for Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC) for timeliness of data collection. The established standard for timeliness is to have each cancer reported to the central registry within six months from the date of diagnosis of the cancer.

Large facilities should report monthly by electronic submission. Facilities should utilize the monthly data upload feature on our secure web site for submitting electronic data. Facilities will be notified by GCR when the data submission has been received.

A large facility will be considered delinquent for the monthly submission if data has not been received at GCR by the end of the business day of the last day of the month. For example: January submissions should be received on or before 5:00 pm, January 31st to be considered timely. If it is not possible for a facility to submit data during a given month, a notice should be submitted by email to gccs@sph.emory.edu prior to the end of the month stating both the reason for not submitting data and when the hospital plans to report. If an acceptable reason is provided the facility will not be considered delinquent. Acceptable reasons for not reporting include but are not limited to 1) recent personnel losses, 2) recent computer problems (software/hardware), 3) natural disasters, and 4) no data to report.

Timeliness will be monitored by GCR staff. The facility will receive communication from the GCR Regional Coordinator if a data submission is overdue.

How to Submit:

• Upload to Labkey
• Labkey Instructions
• Contact your Regional Coordinator if assistance is needed.

Each electronic data monthly submission will receive an electronic data receipt including a summary of cases submitted, rejected, and duplicated. Detailed reports may be retrieved from Labkey for each facility. It is up to the contractor to obtain any reports containing rejected or edit error data and to resubmit any pending resubmissions in a timely manner.

Rejected data must be resubmitted to the GCR within 30 days of the date stated on the email receipt your facility receives. Re-submitted files due to records rejected during a prior submission should follow the format stated in Edits and Naming Conventions for data sent to the GCR. Only rejected abstracts should be electronically resubmitted. Do not resubmit the entire original submission.

Modification/correction files are required to be submitted to GCR Monthly.

Facilities using registry software that is capable of identifying abstracts containing modifications/corrections made since the abstract was transmitted to the central registry, will be able to send a separate file of these corrections. Modification/correction abstracts are identified by the NAACCR data item number 10 – Record Type as ‘M’. You DO NOT need to run edits on this submission.

Please note the following:

• This submission file is not counted as your regular monthly submission and should be submitted as a separate file
• Use ‘MOD’ file extension for the name of the file i.e. 380000Jul19_1MOD.xml
• Be sure you compact/compress the file prior to uploading
• File can be uploaded using the Monthly Data submission link in Labkey .

How to Submit:

• Upload to Labkey
• Labkey Instructions
• Contact your Regional Coordinator if assistance is needed

Each year, GCR may require that facilities offload all reportable cancer cases diagnosed within a particular year to assure that all cases from each facility are being reported. Please refer to Edits and Naming Conventions for these files. The extract should be based on diagnosis year for the specified year. Do not use the date of first contact or accession number to extract the file.

Facilities converting software from one vendor to a different vendor must ensure that data is not compromised, and all data is converted accurately. An accounting of all complete, suspense and incomplete abstracts should be made prior to conversion, as well as identifying abstracts that have not been transmitted to the state versus those previously transmitted. The facility must confirm that abstracts are not flagged erroneously as transmitted. At the request of the facility, GCR will provide a list of all abstracts submitted by the facility to the state prior to the conversion for comparison.

• https://seer.cancer.gov/tools/staging/
• ICD-O-3
• SEER Appendix E – Reportable and Non-reportable Examples
• ICD-O-3 is not to be used for coding hematopoietic or lymphoid neoplasms after 1/1/2010. Use the Hematopoietic and Lymphoid Neoplasm Database and Manual for coding histology and determining multiple primaries for diagnosis years 2010 forward.
  https://seer.cancer.gov/tools/heme/
• 2023 & 2024 SEER Program Code and Staging Manual
• Extent of Disease 2018 General Instructions
• Summary Stage 2018 Manual
• SEER*RSA
• Site – Specific Data Items (SSDI) Manual, SSDI Appendix A & SSDI Appendix B
• Grade Manual
• SEER Solid Tumor Rules
• Hematopoietic Database

The stand-alone version of the Hematopoietic database is no longer provided. The web-based tool is the most up-to-date information.

In April 2011, GCR required Nursing Home and Hospice facilities to report their diagnosed cancer patients. Facilities are required to complete a reporting form in its entirety by its designee when the patient is admitted to its service.

• Each cancer needs to be reported by the facility only once. It is of note that all the fields on the form are important, with special emphasis on the diagnosis date of the patient’s cancer, be it an exact date or estimation.
• Please contact your Regional Coordinator for the form and relevant instructions. Regional Coordinators will follow back to facilities for any clarifications or questions.
• The information reported is entered into a tracking database to allow the GCR to contact the diagnosing facility or physician if the patient has not been reported to GCR by the end of the diagnosed year. The requirement to report will facilitate complete cancer incidence reporting in Georgia and reduce the number of death certificate only cases.

Facilities reporting to the GCR with an annual caseload of less than 50 cancer cases per year will be required to submit a disease index on a yearly basis to the GCR.

The disease index should be in electronic format (ex: Excel, CSV). A template provided by your Regional Coordinator that contains the minimum required fields that must be used for reporting your disease index. Additional fields may be submitted if available from your electronic medical record system. Pathology reports may be in an electronic or pdf format. If you or your IT representative needs assistance in this format, please contact your Regional Coordinator.

Facilities reporting to the GCR with an annual caseload of less than 50 cancer cases per year:

• May submit abstracts electronically using Abstract Plus (free software from GCR) or other registry software.
• May submit medical records to the GCR to be abstracted.

If a facility has NO reportable cases for a month, an email to gccs@sph.emory.edu or gccs@gccs.gadirect.net should be submitted stating so. If it is not possible for a facility to submit during a given month, a notice must be submitted by email stating the reason and when the hospital plans to report. The facility will not be considered delinquent if notice is received by the last day of the non-reporting month. Acceptable reasons for not reporting include 1) recent personnel losses, 2) recent computer problems (software/hardware), and 3) natural disasters.

Confirmation of Submission

The facility will receive an email notification from GCR notifying the facility that the data submission has been received. If you do not receive this notification within a week after sending your submission, you should contact GCR for confirmation. You should maintain a copy of your confirmations for future reference

How to Submit:

• Upload to Labkey
• Labkey Instructions
• Contact your Regional Coordinator if assistance is needed

Cover Sheet

A cover sheet should indicate the following:

1. Reporting facility
2. Date of submission
3. Number of cases being sent

Individual Records

Individual records must include the following:

• Demographic or Face Sheet
• Discharge Summary
• History and Physical, Consult, and Progress Reports
• Pertinent x-ray reports, scans. Do not send routine laboratory reports unless specific for the cancer
• Operative report
• Pathology Report
• Cytology Report
• Cancer Treatment Information

A facility will be considered delinquent for the monthly submission if data has not been received by GCR by the last day of the month except for Small Facilities. Small facilities should submit an entire year disease index for the prior year in January of the year following diagnosis or admission for cancer. Medical records should be submitted between January and March of the following year of diagnosis or admission for cancer.

If a facility has NO reportable cases for a month, an email to gccs@sph.emory.edu or gccs@gccs.gadirect.net should be submitted stating so. If it is not possible for a facility to submit during a given month, a notice must be submitted by email stating the reason and when the hospital plans to report. The facility will not be considered delinquent if notice is received by the last day of the non-reporting month. Acceptable reasons for not reporting include 1) recent personnel losses, 2) recent computer problems (software/hardware), and 3) natural disasters.

How to Submit:

• Upload to Labkey
• Labkey Instructions
• Contact your Regional Coordinator if assistance is needed

Confirmation of Submission

The facility will receive an email notification from GCR notifying the facility that the data submission has been received. If you do not receive this notification within a week after sending your submission, you should email gccs@sph.emory.edu for confirmation . You should maintain a copy of your confirmations for future reference.

Abstract Plus is an abstracting tool used to summarize the medical record into an electronic report of cancer diagnosis and treatment. This software was developed by the Centers for Disease Control and Prevention (CDC) in support of CDC's National Program of Cancer Registries (NPCR).

A customized version of Abstract Plus for Georgia state reporting and accompanying help documents are available in the Abstract Plus section of the Georgia Center for Cancer Statistics (GCCS) web site at the Application Download link under Cancer Reporting .

New users of Abstract Plus should contact their Regional Coordinator or GCR for assistance with installation and use.