**Note 1:** Grade Clinical must not be blank.
**Note 2:** Assign the highest grade from the primary tumor assessed during the clinical time frame.
**Note 3:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade.
**Note 4:** Priority order for codes
* Urothelial cancers (WHO/ISUP grade): 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 5:** G3 includes undifferentiated and anaplastic.
**Note 6:** For bladder, a TURB qualifies for a clinical grade only.
**Note 7:** Code 9 (unknown) 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 8:** If there is only one grade available and it cannot be determined if it is clinical or pathological, assume it is a Grade Clinical and code appropriately per Grade Clinical categories for that site, and then code unknown (9) for Grade Pathological, and blank for Grade Post Therapy Clin (yc) and Grade Post Therapy Path (yp).