Scoping it out: A change in sentinel lymph node surgery coding practice

Recently, a committee of clinicians noted that registry data regarding the Scope of Regional Lymph Node Surgery did not match the expected standards of clinical practice. Review of data from their own registries led them to the conclusion that much of the problem lay not in clinical practice or in registry coding, but in the coding instructions themselves. In particular, the existing instructions for this surgery did not make clear that coding should be based on the operative report rather than the pathology report. As a result, the instructions failed to give adequate guidance for distinguishing sentinel lymph node biopsies from regional lymph node dissections where multiple nodes were removed. In addition, somewhat separately from these issues, the problem of coding multiple surgeries to show the cumulative effect of the surgery contributed to the miscoding of Scope of Regional Lymph Node Surgery. This article describes the Commission on Cancer's (CoC) exploration of the problem through a field test, and provides background for the changes in coding instructions introduced for use beginning with cases diagnosed in 2012.