FROM THE CANSWER FORUM:
NAACCR WEBINAR 2016-2017 SERIES: Collecting Cancer Data: Melanoma Part 3 – Treatment Coding
Melanoma Surgical Coding
A biopsy (incisional, shave, punch, elliptical, biopsy nos) with GROSS positive margins is coded to a diagnostic and staging procedure code of 02.
- If the biopsy removes all of the tumor it is coded to an excisional biopsy code of 27.
- If the biopsy removes all gross disease and there is only microscopic residual at the margin, code also to an excisional biopsy code of 27.
- If initial biopsy is done elsewhere and no information is available, assume it is excisional biopsy code of 27 (Anna Delev http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/fords/first-course-of-treatment/surgery/714-melanoma-surgery-codes)
The biopsy of the primary tumor is normally followed by a wide excision which removes a margin of healthy or normal tissue around the tumor.
Code the subsequent wide excision based on the surgical margin measurements: Use the margin measurement from the PATHOLOGY report.
- If the margin of tissue is less than or equal to 1 cm code to 30-33.
- If the margin of tissue is unknown or not stated use codes 30-33.
- Use code 30 if the initial biopsy is an excisional biopsy not stated to be shave or punch biopsy
- Use code 31 if the initial biopsy was a shave biopsy.
- Use code 32 if the initial biopsy was a punch biopsy.
- Use code 33 if the initial biopsy was incisional (diagnostic and staging procedure code of 02).
- If the margin of tissue is more than 1 cm and microscopically negative code to 45-47.
- Use code 45 if the margins are more than 1 cm but unknown if less than 2 cm.
- Use code 46 if the margins are more than 1 cm but less than 2 cm.
- Use code 47 if margins are more than 2 cm.
If the subsequent procedure is a Mohs, use codes 34-36. Mohs surgery is performed by a specially trained surgeon and a pathologist is present to review the cuts or thin layers of skin removed until the margins are negative.
- 1st Procedure Back lesion, skin punch biopsy of large lesion: Lentiginous malignant melanoma, Clarks level II, 1 mm depth of invasion, ulceration absent, mitoses not identified, peripheral margin positive.
- 2nd Procedure Wide Excision Residual melanoma. Margins negative by 1.2cm
- 1st procedure coded to 27 due to only peripheral margin positive.
- 2nd procedure 46 – margins stated to be negative between 1-2cm.
- 1st procedure – Skin right forearm shave biopsy: Superficial spreading malignant melanoma, Breslow depth 0.47 mm, no ulceration, invasive melanoma extends to peripheral edge, regression not present.
- 2nd procedure – Wide Excision of right forearm: Biopsy site changes with focal residual melanoma completely excised.
- 1st procedure is coded to 27 due to only peripheral margins positive
- 2nd procedure is coded to 31 (shave biopsy followed by a gross excision of a lesion). Pathology report does not provide the margin of tissue.