Q: How is the 1st and 2nd procedure coded in the following melanoma scenario?
- 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, all margins are grossly positive.
- 2nd Procedure: Wide Excision: Residual melanoma, the lesion is .9 cm from the nearest margin. completely excised.
A:
- 1st Procedure is coded to a diagnostic and staging procedure code of 02 due to gross positive margins.
- 2nd Procedure is coded to a code 32 (punch biopsy followed by a gross excision of a lesion) due to margins that are less than 1mm.
Q: What is the code for a patient diagnosed with a metastatic melanoma but no primary lesion is identified?
A: Code to Skin, NOS (C449) per FORDS 2013 page 7.