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Class of Case: Let’s Get It Right!
Class of Case

By Julie Bell, CTR, Quality Data Coordinator

Did you know? If a patient is diagnosed at your facility and there is no treatment at your facility, the Class of Case could be a 00, 10 or 14.

Really? Yes, really!

Many registrars are confused about when to use a class 00 versus a class 10. The easiest way to explain it is: If you know what happened to the patient after they left your facility, then the Class of Case cannot be a 10.

Let’s look at the definitions to further clarify:

Class of Case 00: Initial diagnosis at the reporting facility AND all treatment or a decision not to treat was done elsewhere.

  • An example would be a patient with a benign brain tumor at your facility who has a consult after discharge with an outside physician, and that physician recommends active surveillance.

Class of Case 10: Initial diagnosis at the reporting facility and it is unknown if or where the patient was treated for their cancer. The key to Class of Case 10 is that you do not know anything about the patient’s treatment. If, or where, it was recommended.

  • This includes patients that leave your facility AMA, or patients that have a biopsy or a scan, which reveals a diagnosis of malignancy, and they go home before any recommendations are made at the reporting facility.

Class of Case 14: Initial diagnosis at the reporting facility AND all first course treatment or a decision not to treat at the reporting facility.

  • For example: A patient comes to your facility with back pain, a scan is positive for a mass in the kidney. Further studies reveal that this is a renal cell cancer. Due to the fact that the patient has several comorbidities and the tumor is small, the recommendation is for active surveillance. This would be a class 14. The patient is diagnosed at your facility and your facility made the decision not to treat at this time.

Some other points to remember when assigning a class 00, 10 and 14:

“Referred To” should be filled in for Class 00.

  • “Referred To” identifies the facility to which the patient was referred for further care after discharge from the reporting facility. Some common questions to ask include, “Where did the patient go for treatment after being diagnosed at your facility?” and “What facility made the treatment decisions?”

The “Date of Diagnosis” and the “Date of First Contact” should always be the same date for class 00, 10 and 14.

  • Date of first contact with the reporting facility for an analytic case is the date the case became analytic. For class 00, 10 and 14 the diagnosis date is the date the case became analytic.

So now you know: If a patient is diagnosed at your facility and receives no treatment at your facility, you have to investigate further to find out if any treatment was recommended and if so where before assigning the Class of Case.

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