Melanoma skin cancer may not be as commonly discussed as basal cell carcinoma and squamous cell carcinoma, but it exhibits a higher level of aggressiveness and the potential to grow and spread, rendering it the deadliest form of skin cancer. Melanoma is caused when a person’s melanocytes begin to grow and get out of control. When this happens, cancer is formed and if not caught early enough will spread to other parts of the body causing it to metastasize and become even more deadly. Due to the serious nature of this disease, cancer registrars are required to report malignant melanoma cases to central registries but are not required to report basal cell and squamous cell carcinoma cases.
“Beginning with diagnosis year 2023, CoC will require all accredited programs to collect melanoma/skin surgery codes under the data items, Rx Hosp-Surg 2023 field for the procedure performed at the reporting hospital and Rx Summ-Sug 2023, for the procedure performed at all reporting facilities.” There are many medical coding changes for melanoma cases diagnosed in 2023. One of the major changes is to the surgical codes. Previously, an abstractor would enter a two-digit numeric code. In 2023, all surgery codes for skin melanoma cases now start with the letter B, while all other melanoma cases will start with the letter A. These changes “were made to align procedure codes with the Synoptic Operative Reports.”
Along with these code changes come changes concerning the margins. In previous years, determining a surgery code was based on margins. This is no longer true for 2023 cases. Therefore, the focus is now to code the actual procedure and not the results of the procedure. Even when there are no residual positive margins, an abstractor must still code the procedure. All shave, elliptical, and punch biopsies are coded to the surgery field, while smaller specimen biopsies such as needle and core biopsies will be coded to as a Diagnostic and Staging procedure.
Examples of New Surgery Code Changes
For biopsy only cases use:
- Old code 27—excisional biopsy
New codes:
- B200 Local tumor excision, NOS; Excisional biopsy, NOS
- B220 Shave biopsy, NOS B230 Punch biopsy, NOS
- B240 Elliptical biopsy (aka fusiform)
For biopsies followed by excision:
- Old codes 30-33
New codes:
- B500 Biopsy (NOS) of primary tumor followed by wide excision of the lesion; Wide
- Excision NOS, Re-excision
- B510 Incisional biopsy followed by wide excision
- B520 Shave biopsy followed by wide excision
- B530 Punch biopsy followed by wide excision B540 Elliptical biopsy (aka fusiform) followed by wide excision
How margins are reported have also changed for cases in 2023. Clinical melanoma margins are now captured in the Site-Specific Date Item (SSDI) “Clinical Margin Width” field. Clinical surgical margins are no longer coded from the pathology report but rather the physician’s operative report or other physician’s documentation. If margins cannot be found within these reports, then the next step would be to review the notes in the pathology report-description of the actual surgical procedure. The last resort would be to record the margins from the pathology report if unable to obtain them elsewhere.
When reporting margins in the SSDI field, it is important to follow the proper SSDI guidelines. If multiple procedures are performed, then record the largest peripheral margin which is the radial margin. Never code the deep margin. Only record margins from wide local excisions. If multiple wide local excisions are done, then code the clinical margin width from the procedure with the largest margin. Also remember to never add the margins together. When recording the margin, record the centimeters in the report and remember to include the decimal point.
A great reference to help become more familiar with these new changes and how to code these fields properly, is the Appendix M section of the 2023 STORE manual. In this section, several case studies are demonstrated to show how to properly code different scenarios. As with all cancer sites, the more you become familiar with the new information and changes, the better-quality data you will present to the state when abstracting your cases.
Next Steps
Take the time to review all medical coding changes for melanoma cases diagnosed in 2023. Staying informed with these changes can ultimately pave the way for improved patient care and help in maintaining the highest standards of data accuracy and integrity. With our support, you can be confident in providing quality cancer data, even in the face of evolving guidelines and changes. Contact us today to learn more about MRA’s cancer registry services.
References:
Clinical Margin Width | SSDI Data | (naaccr.org); store-manual-2023.pdf (facs.org); 8823.00.pdf (cancer.org)
