Program Operations Manual System (POMS)
TN 60 (10-23)
DI 23022.900 Spinal Nerve Root Cancer – Metastatic or Recurrent
COMPASSIONATE ALLOWANCES INFORMATION
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SPINAL NERVE ROOT
CANCER - METASTATIC OR
RECURRENT
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ALTERNATE NAMES
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Tumor- Spinal cord; Spinal Root Neoplasm; Spinal Cord Tumor
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DESCRIPTION
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Spinal Nerve Root Cancer is the growth of cancerous cells arising from the nerve roots rather than the spinal
cord (part of the CNS) and usually occurs in the lumbar spine. Spinal Nerve Root
Cancer that is metastatic or recurrent occurs when the malignant cancer cells have spread from the nerve roots to other
parts of the body, and has come back after treatment. Symptoms of spinal nerve root
cancer are related to compression of the nerve tissue or ceramic structures and may
include non-mechanical back pain in the middle or lower back, loss of sensation or
muscle weakness, difficulty walking, loss of bowel or bladder function, erectile dysfunction,
varying degrees of paralysis, and scoliosis of other spinal deformity.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: Diagnostic testing used to confirm the diagnosis of spinal nerve root cancer includes:
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CT scan or CT myelogram of the lumbar spine;
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Cerebrospinal fluid (CSF) examination;
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A biopsy is used to help determine the grade of the cancer. A neurological examination
may help to identify the location of the tumor.
Physical findings: A physical examination may show evidence of:
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Loss of pain and temperature sensation;
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ICD-9: 171.9
ICD-10: C47
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PROGRESSION
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The outcome of spinal nerve root cancer varies depending on the location, size, and
extent (including metastases) of the cancer. Early diagnosis and treatment usually
leads to a better outcome. Nerve damage often continues after surgery often leading
to neurologic dysfunction. Although some amount of permanent dysfunction is likely,
treatment may delay death.
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TREATMENT
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The goal of treatment is to reduce or prevent nerve damage from pressure (compression
of) on the spinal cord. Corticosteroids are prescribed to reduce inflammation and
swelling around the spinal cord. Surgery is used to remove as much of the tumor as
possible and to relieve pressure on the spinal cord. Radiation including radiosurgery
(SRS) therapy is used with, or instead, of surgery. Chemotherapy may be used in some
cases, but it has not been proven effective against most spinal tumors.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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If a pathology report is unavailable, a report or radiological studies such as MRI
and CT scans may provide the required information.
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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 B
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Requires documented metastases or recurrence.
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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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