CoRe Cancer Treatment Files

Overview

Separate FFS and MA Condensed Resource (CoRe) Cancer Treatment Files are created for systemic therapy, radiation therapy, and cancer-directed surgery, as described in more detail below.

The Treatment Files are restricted to persons who are included in the ABFFS, MA, and/or Part D cohorts and summarize receipt of cancer treatment from 4 months prior to the cancer diagnosis until cohort exit (e.g., change in enrollment status, subsequent cancer diagnosis, end of data, or death). Treatment assessments begin prior to cancer diagnosis to acknowledge that there may be some discrepancies in diagnosis date and because only month and year of diagnosis are known in the data.

Receipt of cancer treatment is determined based on procedure codes (ICD, CPT/HCPCS, NDC) listed in the Medicare BASE Utilization Files; experts at NCI generated treatment-specific code lists, detailed below. If a claim or encounter includes a listed procedure code then information from that claim or encounter is summarized in the respective FFS or MA CoRe treatment file.

Information from one BASE utilization record may be represented across multiple CoRe treatment records (e.g., if one BASE claim has more than one NCH/Carrier or DME line record or Outpatient revenue center record indicating receipt of cancer treatment, each of these line/revenue center records will be represented as a separate CoRe treatment record). For CoRe file uniformity, if there was more than one procedure code on a MedPAR claim or Inpatient encounter indicating cancer treatment, each procedure will also be included as a separate CoRe treatment record. Procedures listed on the line records (NCH/Carrier/DME) or revenue center records (Outpatient) are given priority over similar information on the header/base records because the coding system used on the line/revenue center records tends to be more granular. Claim/record id and source file (i.e., NCH, Carrier, DME, MedPAR, Inpatient, Outpatient) are listed on each CoRe treatment record to allow referencing back to the BASE utilization record (e.g., the full claim/encounter data as included in the files from CMS).

The main diagnoses (e.g., admitting, principal, reason for visit, and line diagnoses) listed on the BASE record are included in the CoRe Treatment Files. All diagnosis variables listed on the record are also searched for cancer diagnosis information, see the identification and classification of cancer diagnosis (PDF, 158 KB) codes considered; codes for up to three unique primary cancer diagnoses and up to three unique secondary cancer diagnoses are included on each CoRe treatment record. Diagnosis codes can help determine the reason for treatment, assess agreement with type of cancer diagnosed in the registry data and/or gain insights into secondary tumor diagnoses.

Note: caution should be taken because the reporting of secondary cancer diagnoses is not usually required for reimbursement. Therefore, secondary cancer diagnoses are likely under-reported in the Medicare BASE data.

Note: treatments listed on NCH and DME denied claims (Carrier Claim Payment Denial Code =“denied” (whole claim denied) and Line Processing Indicator Code not “allowed” (line item denied)) are retained in the CoRe treatment files. The denied indicator variable can be used to easily identify these records.

There are several types of CoRe Cancer Treatment Files

CoRe Cancer Treatment Systemic Files

• Systemic ABFFS File identifies systemic therapy covered by Medicare Parts A and B, and as such, combines information across multiple BASE FFS Claims files: in-patient hospital (MedPAR), out-patient hospital (Outpatient), individual providers (NCH) and durable medical equipment (DME). This file is restricted to persons included in the ABFFS cohort.
• Systemic MA File identifies systemic therapy covered by Medicare Advantage (Part C), and as such, combines information across multiple BASE MA encounter files: in-patient hospital (Inpatient), out-patient hospital (Outpatient), individual providers (Carrier) and durable medical equipment (DME). This file is restricted to persons included in the MA cohort.
• Systemic Part D File identifies systemic therapy covered by Medicare Parts D and is based on information from the Part D Drug Event File. This file is restricted to persons included in the Part D cohort.

All identified BASE utilization records (claims and encounters assess separately) that have at least one International Classification of Disease (ICD) diagnosis or procedure code, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code, or National Drug Code (NDC) associated with systemic therapy were identified based on the Cancer Medications Enquiry Database (CanMED), administrative codes (HCPCS: 96400-96549, Q0083-Q0085) and demonstrative codes (HCPCS: G0355-G0363). Specific drugs were categorized based on the CanMED classification: hormonal therapy, chemotherapy, immunotherapy, and radiopharmaceutical. Ancillary therapies per CanMED are not included in the CoRe files. Systemic therapies were also classified based on the HemOnc ontology.

CoRe Cancer Treatment- Radiation Files

These files, created separately for persons include in the ABFFS and MA cohorts, combines information across multiple BASE utilization files: ABFFS cohort- inpatient hospital (MedPAR), out-patient hospital (Outpatient), and individual providers (NCH); and MA cohort - in-patient hospital (Inpatient), out-patient hospital (Outpatient), and individual providers (Carrier). These files are restricted to persons included in the ABFFS or MA cohorts, respectively.

All identified BASE utilization records (claims and encounters, separately) that have at least one International Classification of Disease (ICD) diagnosis or procedure code, or Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) code associated with radiation therapy were identified. The complete list of codes used to identify radiation therapy is available below.

CoRe Cancer Treatment- Surgery Files

These files, created separately for persons include in the ABFFS and MA cohorts, combine information across multiple BASE utilization files: ABFFS cohort- inpatient hospital (MedPAR), out-patient hospital (Outpatient), and individual providers (NCH); and MA cohort - in-patient hospital (Inpatient), out-patient hospital (Outpatient), and individual providers (Carrier).These files are restricted to persons included in the ABFFS or MA cohorts, respectively.

All identified BASE utilization records (claims and encounters, separately) were included that have at least one International Classification of Disease (ICD) diagnosis or procedure code, or Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) code associated with surgery.

CoRe Summary Treatment Files

These files, created separately for persons include in the ABFFS and MA cohorts, include further summarized information from the CoRe Cancer Systemic and Radiation files. The files include indicator variables to summarize the receipt of each treatment type during pre-specified time periods (e.g., during the 1^st year, 2^nd year, or more than 2 years after diagnosis) and months from diagnosis to treatment if received during a “more than” time window, among persons included in the ABFFS or MA cohorts, respectively. Dates of treatment are not included in the file. These are the same variables that are available in the SEER-Medicare SEER-Stat Specialized databases. For more information see the Condensed Resource (CoRe) data dictionary (XLSX, 67 KB)