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Coding Alert

Prepare for a Recode in Oropharynx Cases - Pharyngeal Tonsils Not Located in Oropharynx

The AJCC is providing early notice to help registrars prepare for a recode that will happen with the 2026 registry software updates. Documenting this information (in text) now while you abstract 2025 oropharynx cases will save you time and help you prepare for the recode guidance that will be included in 2026 registry software.

Starting with 2025 diagnosed cases and going forward, all cases coded to C11.1 will be considered nasopharynx. This will affect a small number of cases, estimated to be 5-6 cases per facility.

Pharyngeal tonsils are located in the nasopharynx and will not be abstracted as an oropharynx primary site. There is currently a schema discriminator question that registrars answer to allocate C11.1 cases to either nasopharynx or oropharynx.  

  • Posterior wall goes to nasopharynx
  • Adenoid and pharyngeal tonsil currently go to oropharynx

Starting in 2026, all of these sites will go to nasopharynx and the schema discriminator will disappear.  

All 2025 diagnosed cases with Schema Discriminator 1 coded ‘2’ will need to be manually reviewed and the AJCC stage reassigned using nasopharynx. You can document in text now what should be coded for nasopharynx. 

The following fields, if collected, will have to be reviewed:

  • AJCC TNM Clin T, N, M, and Stage Group [1001, 1002, 1003, 1004]
  • AJCC TNM Path T, N, M, and Stage Group [1011, 1012, 1013, 1014]
  • AJCC TNM Post Therapy Clin T, N, M, and Stage Group [1062, 1064, 1066, 1067]
  • AJCC TNM Post Therapy Path T, N, M, and Stage Group [121, 1022, 1023, 1024]
  • There is no grading system for nasopharynx - Grade Clinical [3843], Grade Pathological [3844], Grade Post Therapy Clin [1068], Grade Post Therapy Path [3845]
  • Summary Stage 2018 [764]
  • EOD 2018 Primary tumor [772], EOD 2018 regional nodes [774], EOD 2018 mets [776]

For (2025+) cases where this recode will apply, registrars should begin to document details within the abstract now. For additional information or questions regarding AJCC staging, please post questions in CAnswer Forum.