Program Operations Manual System (POMS)
TN 85 (09-25)
COMPASSIONATE ALLOWANCES INFORMATION
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PERITONEAL MESOTHELIOMA
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ALTERNATE NAMES
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Malignant Mesothelioma of the Peritoneum
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DESCRIPTION
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Peritoneal
mesothelioma is a rare cancer of the abdominal lining with about 600 cases per year in the United
States. It is usually associated with asbestos exposure and regarded as universally
fatal. Exposure to asbestos fibers can cause mesothelioma even years later. Working
with asbestos or living with someone who works with asbestos is the major risk factor
for mesothelioma.
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DIAGNOSTIC TESTING, PHYSCIAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING
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Diagnostic
testing: Diagnosing peritoneal mesothelioma is often difficult because the symptoms are often
associated with other conditions. Diagnostic testing includes a review of the patient's
medical history and a complete physical examination, including x-rays of the abdomen.
Diagnostic imaging by computed tomography (CT) scan and magnetic resonance imaging
(MRI) suggests a diagnosis, but definitive diagnosis is via tissue sampling by CT-directed
biopsy or peritoneoscopy.
Physical findings: Symptoms of peritoneal mesothelioma include:
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Abdominal pain and swelling due to a buildup of fluid in the abdomen;
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Blood clotting abnormalities;
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ICD-9: 158.8; 159; 159.8; 501; 789.51
ICD-10: C45.1
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PROGRESSION
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Delayed diagnosis of mesothelioma worsens its prognosis. In general, the prognosis
of mesothelioma is poor and most studies report median survival of less than a year.
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TREATMENT
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Standard treatment for all but localized mesothelioma is generally not curative. However,
radical resection is associated with a better prognosis and should be attempted when
possible. Chemotherapy can be administered systemically or directly into the abdomen
and is helpful as palliative treatment.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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CT-directed biopsy or peritoneoscopy; and
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Pathology report confirming diagnosis of peritoneal mesothelioma.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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Equals
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13.15 A
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Peritoneal mesothelioma may equal listing 13.15 A based on diagnosis confirmed by
biopsy.
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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