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SEER Inquiry System - Report
Produced: 11/07/2024 1:29 AM
Question 20230049
Inquiry Details
References:
2023 SEER Manual, 169-171. Surgery of Primary Site 2023; Appendix C Coding Guidelines
Question:
Update to Current Manual/Surgery of Primary Site 2023--Skin: Regarding the 2023 skin surgery codes for punch biopsy NOS (B220) and shave biopsy NOS (B230), how is Date of First Surgical Procedure coded for cutaneous lymphoma and Kaposi sarcoma when the punch or shave biopsy is not excisional? See Discussion.
Discussion:
Now that there are specific surgery codes for shave and punch biopsies, are these biopsies always the Date of First Surgical Procedure (NAACCR Item #1200)? Or should we still be applying the Surgery of Primary Site 2023 instruction in the SEER Manual that states shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed?
We are aware of the instruction for melanoma cases outlined in SINQ 20230034; however, it is unclear if this should also apply to cutaneous lymphomas and Kaposi sarcomas, or if the intent of the procedure is used for these specific types of skin cases that typically present with multifocal involvement.
Example 1: Patient is diagnosed March 2023 with primary cutaneous T-cell lymphoma presenting as pink, tan patches on the trunk. Punch biopsy diagnosed CTCL and treatment was given via narrow band UVB phototherapy.
Example 2: Patient is diagnosed February 2023 with Kaposi sarcoma presenting as widespread violaceous macules, papules, plaques on the torso, bilateral extremities, and abdomen. Punch biopsy diagnosed Kaposi sarcoma.
Answer:
Code the Date of First Surgical Procedure (NAACCR Item #1200) as the date the shave, punch, or elliptical biopsy was performed. This instruction applies to cutaneous lymphoma and Kaposi sarcoma as well. Beginning with cases diagnosed 2023 and after, shave, punch, or elliptical biopsies are coded as a surgical procedure regardless of margin status.
The instruction in the 2023 SEER Manual that states "shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed" has been deleted from the 2024 SEER Manual. Refer also to the Appendix C Coding Guidelines for Kaposi Sarcoma of All Sites and Lymphoma for coding primary site.
