Program Operations Manual System (POMS)
TN 33 (08-20)
COMPASSIONATE ALLOWANCES INFORMATION
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PANCREATIC CANCER
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ALTERNATE NAMES
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Exocrine Cancer; Pancreatic Adenocarcinoma; Pancreatic Carcinoma
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DESCRIPTION
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Pancreatic Cancer occurs when cells of the pancreas grow abnormally to form a tumor. The malignant
(cancer) cells form in the tissues of the pancreas. Most pancreatic cancers begin
in the ducts that carry pancreatic juices. The digestive juices are produced by exocrine
pancreas cells and the hormones are produced by endocrine pancreas cells. About 95%
of pancreatic cancers begin in exocrine cells.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: To determine extent of disease the following may be done:
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Lab tests including blood, urine, and stool samples to check for bilirubin and other
substances,;
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Ultrasonography: transabdominal ultrasound or endoscopic ultrasound (EUS), endoscopic
retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography
(PTC), and laparoscopy.
Diagnosis is made on pathological review of a biopsy specimen.
Physical findings:
Symptoms of this disease may include:
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Pain in the upper abdomen or upper back;
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Yellow skin and eyes, and dark urine from jaundice;
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ICD-9: 157.3, V18.11, V84.81
ICD-10: C78.89
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PROGRESSION
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Although rare, Pancreatic Cancer can be cured only when it is found at an early stage,
before it has spread. However, other treatments may be able to control the disease
and help patients live longer and feel better.
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TREATMENT
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Pancreatic Cancer may have several treatment options. Depending on the type and stage,
before it has spread. However, other treatments may be able to control the disease
and help patients and their doctors choose palliative therapy.
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SUGGESTED
PROGRAMMATIC ASSESSMENT* |
Suggested MER for
Evaluation: A pathology report showing the presence of a non-islet cell adenocarcinoma in the
pancreas is the only test that can definitively make the diagnosis.
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Suggested Listings for
Evaluation: |
DETERMINATION |
LISTING
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REMARKS |
Meets |
13.20 A & B |
Only pathology report is needed for adjudication. |
Equals |
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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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