The value set for clinical staging includes only one code which has the description "pathologist evaluation." However our understanding is that clinical staging is an evaluation that incorporates findings from many sources (e.g., physical exam, imaging, diagnostic biopsies, etc). The staging is not performed by the pathologist, but rather by the surgeon or oncologist on the basis of all of the available evidence. Our client, a large oncology center, tells us that in some instances clinical staging may even occur without biopsy/cytology. We think the value set needs to be expanded or corrected to include SNOMED codes that represent clinical staging as opposed to the pathologist's contribution. In the interim, 1) should patients who had staging performed without biopsy be excluded from the measure and 2) should the time when pathologist's results are available be the point in time used for calculations; even if the actual staging occurred later.