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Tumor Tip of the Week-Stereotactic Biopsy Brain-Path Grade

Scenario:  01-24-2020 Stereotactic biopsy Parietal Brain: Glioblastoma, IDH-Wild Type, WHO Grade IV

Per SEER Appendix C Seer Program Coding & Staging Manual 2018 Surgery Codes Brain [SEER Note: Assign code 20 for stereotactic biopsy of brain tumor] 20= Local excision of tumor, lesion, or mass, excisional biopsy https://seer.cancer.gov/manuals/2018/AppendixC/Surgery_Codes_Brain_2018.pdf

Grade Clinical would be Grade 4 [SSDI Grade Manual page 112 Note 2: Assign the highest grade from the primary tumor assessed during the clinical time frame.]

Question:  How would the Grade Pathological be recorded?

    • 4 WHO Grade IV
    • 9 Grade cannot be assessed (GX); Unknown

Answer:  9 Grade cannot be assessed (GX); Unknown

Rationale: SSDI Grade Manual page 113 Note 5: Code 9 when No resection of the primary site.

The entire tumor was not resected, just a stereotactic biopsy performed. CAnswer Forum Post per Jennifer Ruhl, “The primary tumor must be resected to code a pathological grade. Resections are generally 30 or above, so your surgery code would not qualify for a resection. Path grade would be 9.http://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/100047-stereotactic-brain-bx-path-grade

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