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Report Produced: 12/19/2025 14:33 PM

Report Question ID Question Discussion Answer Year
20230049

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.

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.

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.

 2023
20230034

Update to Current Manual/Surgery of Primary Site 2023--Melanoma:  Considering the 2023 melanoma surgery codes for punch biopsy NOS (B220) and shave biopsy NOS (B230), how is Date of First Surgical Procedure coded when the punch or shave biopsy is not excisional? See 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?

Example: On 01/01/2023, patient has a frontal scalp shave biopsy showing melanoma, margins involved. On 02/01/2023, frontal scalp excision shows residual melanoma. Surgery code is assigned B520 (shave followed by wide excision). How is Date of First Surgical Procedure coded now that there is an additional surgery code for the shave biopsy?

Code the Date of First Surgical Procedure as 01/01/2023 in the example provided where the shave biopsy is followed by wide excision. Beginning in 2023, significant changes were made in that shave, punch, and elliptical biopsies are coded as surgical procedure regardless of margin status. Appendix C Skin Surgery Codes state that an incisional biopsy would be a needle or core biopsy of the primary tumor.

Please see Appendix M: Case Studies for Coding Melanoma in STORE v23, Case study 2: Shave Biopsy followed by WLE (page 412), for an explicit example of how to code your example case.

We will clarify this in the upcoming release of the SEER manual,

 2023
20051036 Date of Diagnosis--Sarcoma: Should the date of diagnosis be coded to the date of biopsy or the date of birth for an infant biopsied at 3 days of age and stated to have a diagnosis of congenital alveolar rhabdomyosarcoma, widely metastatic?

Code the date of the biopsy as the date of diagnosis. This is the date the cancer was first identified by a medical practitioner.

Note: SEER collects the Month and Year of diagnosis. The "day" of diagnosis is not collected by SEER.

 2005
20061046 First Course Treatment--Hematopoietic, NOS: How are Decadron and Zometa coded when used in the treatment of multiple myeloma? See Discussion. The 2004 SEER Program Manual instructions for coding hormone therapy do not provide any specific instructions for coding adrenocorticotrophic agents. Per Abstracting and Coding Guide for the Hematopoietic Diseases pg. 3, prednisone and decadron are coded as hormonal therapy (when given as part of a chemotherapy regimen). Does this mean that Decadron without chemo agents is not coded as treatment? In paging through the hematopoietic disease manual, one sees this instruction for other sites as well. Yet, for other diseases (e.g., Waldenstroms macroglobulinemia on page 18), prednisone is coded as hormone therapy (not necessarily as part of chemo regimen).

Code the decadron as hormonal treatment. Do not code the zometa--it is an ancillary agent.

In the August 2006 update of SEER*Rx, a note was added to decadron and other hormonal agents that they can be used to control white cell proliferation in lymphoma and multiple myeloma.

In general, decadron is used more commonly for supportive care and as an antiemetic than as hormone therapy.

 2006
20071054 Date of Diagnosis: Can the phrase "suspicious for a primary lung tumor" from a CT be used to code date of diagnosis? See Discussion. Thorax CT on 4/18/05 states 'enlarged RUL nodular opacity suspicious for a primary lung tumor.' Biopsy confirmation was not done until 8/4/05 because patient declined further work-up until then. Would date of diagnoses be 4/18/05 or 8/4/05?

Code the diagnosis date 08/04/2005 based on the biopsy.

The statement "suspicious for a primary tumor" is not a clinical diagnosis of cancer or malignancy.

 2007
20150027

Date of diagnosis--Diagnostic confirmation: How are the diagnosis date and diagnostic confirmation coded when the pathology (needle biopsy followed by resection) reports GIST, NOS and the physician subsequently states this is a malignant GIST and treats the patient for a malignancy? See Discussion.

Pathologists rarely diagnose a GIST as a malignant tumor. Per the AJCC, GISTs encompass a continuum in terms of biologic potential, with larger more mitotically active tumors landing on the "histologically sarcomatous" or malignant end of the spectrum. Because the pathologists generally do not categorize these tumors as benign or malignant, the judgement is typically made by the clinician in light of all the clinical and pathologic findings. Unless there are obvious distant metastases, the clinician usually decides whether a GIST is malignant and treats the patient as such.

In the case above, the patient underwent a gastric biopsy on 04/10/2014 that showed GIST. The subsequent resection on 04/12/2014 showed a 4.5 cm GIST, spindle cell type with 6 mitoses/5 square mm. The resection pathology report does not indicate the GIST is malignant, but does identify a large tumor with mitotic activity. After reviewing the evidence in this case, the clinician calls this a malignant GIST on 04/29/2014 and starts the patient on Gleevec.

Although neither the biopsy nor the resection call this a malignant tumor, should the date the GIST was first diagnosed (biopsy on 04/10/2014) be used to code the diagnosis date, since this is the date the tumor (ultimately felt to be malignant) was diagnosed? If the diagnosis date is coded as the date malignant GIST was first mentioned (04/29/2014), this would exclude surgery as treatment for this tumor.

Would this be a histologic diagnosis because the tumor was histologically confirmed to be GIST? Or must this be a clinical diagnosis because the diagnosis of malignancy was only made clinically (by the clinician's review of the clinical and pathologic findings)?

Code the diagnosis date for this case as 04/10/2014. Code the diagnostic confirmation as histologically confirmed. The clinician is using all of the information available to determine the diagnosis, including the biopsy and resection.

2015
20130047 Date of diagnosis--Heme & Lymphoid Neoplasms: What is the diagnosis date for a patient with a mild thrombocytosis diagnosed in 2008, that was subsequently treated with Anagrelide in 11/2010 following an increase in platelet count, and later in 3/2011 was found to have positive JAK2 study physician refers to as essential thrombocythemia? See Discussion. In 2008, patient diagnosed with mild thrombocytosis. The patient opted to be followed clinically with observation. In November 2010, a CBC showed an increased platelet count to 600,000. Anagrelide was started. The patient would never agree to a bone marrow biopsy. However, in 3/2011 a JAK2 study was performed and read as positive. Following the positive Jak2 study, physician stated the diagnosis was essential thrombocytosis and started the patient on a different drug.

Code the diagnosis date to 3/2011. It wasn't until 3/2011 that the physician documented a reportable diagnosis of essential thrombocytosis [9962/3].

Mild thrombocytosis is not reportable. Therefore, the case was not reportable in 2008. Although the patient was treated in 2010, there was no documentation of a reportable diagnosis.

2013
20000512 EOD-Extension/EOD-Lymph Nodes--Kaposi Sarcoma: What code is used to represent this field for a Kaposi sarcoma with no skin lesions but positive lymph node and bone marrow biopsies?

Code the EOD-Extension field to 13 [Visceral (e.g., pulmonary, gastrointestinal tract, spleen, other)], because of the positive bone marrow. Code the EOD-Lymph Nodes field to 3 [Both clinically enlarged palpable lymph nodes (adenopathy) and pathologically positive lymph nodes], for the pathologically positive node.

Note: Potential revision of the extension scheme will be referred to SEER Medical Advisory Group (SMAG).

 2000
20000486 EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined/Surgical Procedure of Other Site--Kaposi Sarcoma: How do you code these fields for a groin mass excision containing 4 lymph nodes for a Kaposi sarcoma case that presented with multiple skin lesions?

Code the EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined fields to 99 99 for Kaposi cases that present systemically and for those that present in more than one site (which includes cases with more than one skin subsite involved at diagnosis). There are no "regional" lymph nodes for such cases. This represents a majority of currently diagnosed Kaposi cases. However, for localized Kaposi cases, you can count the number of regional lymph nodes positive and examined if the primary site selected has a regional lymph node chain(s) associated with it (e.g., soft palate, hard palate, or a skin subsite).

For cases diagnosed 1/1/2003 and after: Code the groin mass excision in the Surgical Procedure of Other Site field to 1 [Non-primary surgical procedure performed; Non-primary surgical resection to other site(s), unknown if whether the site(s) is regional or distant].

 2000
20021204 EOD-Size of Primary Tumor--Cervix: When both a depth and diameter of the tumor are provided and the description of the diameter is provided in a range, how do you code the size of the primary tumor? See discussion.

Path states "microscopic focus of endocervical glands considered invasive adenoca...maximum depth of that focus measures approximately 2 mm. Maximum diameter of that focus measures 3-4 mm."

What size would be coded for this case: 999, 002, 003, or 004?

Code the EOD-Size of Primary Tumor field to 004 [4 mm]. Code the diameter dimension in the EOD-Size of Primary Tumor field and the depth dimension iin the EOD-Extension field. Code the largest number associated if a range is provided for the diameter of the invasive tumor.

If the size of the diameter had not been mentioned, the EOD-Size of Primary Tumor field would have been coded to 001 [microscopic focus or foci only], which ignores the size associated with the depth dimension of the tumor.

 2002