GLIOMA – GRADE III and IV
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ALTERNATE NAMES
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High Grade Malignant Glioma; Malignant Glioma Grade III; Malignant Glioma Grade IV;
Glioblastoma; Anaplastic Astrocytoma; Undifferentiated Glioma; Anaplastic Glioma;
Anaplastic Oligodendroglioma; Anaplastic Oligoastrocytoma; Giant Cell Glioblastoma;
Gliosarcoma; Epithelioid Glioblastoma; Diffuse Midline Glioma
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DESCRIPTION
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Glioma is a broad category of brain and spinal cord tumors that come from glial cells, the
main brain cells that can develop into cancer. Approximately 80% of malignant brain
tumors are gliomas. These gliomas are categorized as ependymomas, astrocytomas or
oligodendrogliomas. The exact cause of malignant gliomas is unknown.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: MRI is the preferred diagnostic tool, however malignant gliomas are also diagnosed
by CT scan and biopsy. Biopsy is often needed to establish the grade of the glioma.
Physical findings: Common signs and symptoms of malignant gliomas include:
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Confusion or a decline in brain function;
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Personality changes or irritability;
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Vision problems, such as blurred vision, double vision or loss of peripheral vision;
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Seizures, especially in someone without a history of seizures.
ICD-9:
191.0-9
ICD-10: C71.9
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PROGRESSION
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Malignant gliomas can develop at any age. They tend to grow and become more malignant
over time. The peak incidence generally occurs in the fifth and sixth decade of life.
Prognosis is often poor for individuals with grades III and IV tumors with the average
survival time approximately 12 months. Few individuals survive beyond three years
with conventional treatment.
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TREATMENT
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Treatment depends on the location of the tumor and its progression. These tumors tend
to grow or infiltrate into the normal brain tissue. Standard treatment is surgery
followed by radiation therapy. If surgery is not an option, radiation therapy is given.
Chemotherapy is sometimes given during or after radiation therapy.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Pathology report documenting type and stage of tumor;
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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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13.13 A 1 & 2
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Grade III and IV gliomas meet the criteria in listing 13.13 A 1 & 2 upon confirmed
diagnosis, regardless of effectiveness of treatment. Recurrent malignant gliomas meet
13.13 A 3 upon confirmed diagnosis, regardless of grade and effectiveness of treatment.
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113.13 A & B
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Grade III and IV gliomas meet the criteria in listing 113.13 A & B upon confirmed
diagnosis, regardless of effectiveness of treatment.
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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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