TN 20 (12-18)

DI 23022.270 Peritoneal Mesothelioma

COMPASSIONATE ALLOWANCE INFORMATION

PERITONEAL MESOTHELIOMA

ALTERNATE NAMES

Malignant Mesothelioma of the Peritoneum

DESCRIPTION

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.

DIAGNOSTIC TESTING, PHYSCIAL FINDINGS, AND ICD-9-CM CODING

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 CT scan and MRI suggests a diagnosis, but definitive diagnosis is via tissue sampling by CT-directed biopsy or peritoneoscopy.

Physical findings: Symptoms of Peritoneal Mesothelioma include:

  • Weight loss;

  • Abdominal pain and swelling due to a buildup of fluid in the abdomen,

  • Bowel obstruction,

  • Blood clotting abnormalities;

  • Anemia; and

  • Fever.

ICD-9: 158.8, 159, 159.8, 501, 789.51

PROGRESSION

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.

TREATMENT

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.

SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
  • CT-directed biopsy or peritoneoscopy.

  • Pathology report confirming diagnosis of Peritoneal Mesothelioma.

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets
Equals 13.15 A Peritoneal Mesothelioma may equal this listing based on diagnosis confirmed by biopsy.
* 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.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022270
DI 23022.270 - Peritoneal Mesothelioma - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018