**Note 1:** Clinical grade must not be blank.
**Note 2:** Assign the highest grade from the primary tumor assessed during the clinical time frame.
**Note 3:** Priority order for codes
- Urothelial cancers: use codes L, H and 9
+ If only G1-G3 are documented, code 9
- Adenocarcinomas and Squamous Cell Carcinomas: use codes 1-3, 9
+ If only L or H are documented, code 9
**Note 4:** G3 includes undifferentiated and anaplastic.
**Note 5:** For bladder, a TURB qualifies for a clinical grade only.
**Note 6:** Code 9 when
* Grade from primary site is not documented
* Clinical workup is not done (for example, cancer is an incidental finding during surgery for another condition)
* Grade checked "not applicable" on CAP Protocol (if available) and no other grade information is available
**Note 7:** If there is only one grade available and it cannot be determined if it is clinical or pathological, assume it is a clinical grade and code appropriately per clinical grade categories for that site, and then code unknown (9) for pathological grade, and blank for post therapy grade.