Program Operations Manual System (POMS)
TN 31 (08-20)
DI 23022.921 Adult Non-Hodgkin Lymphoma
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COMPASSIONATE ALLOWANCES INFORMATION
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ADULT NON-HODGKIN LYMPHOMA
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ALTERNATE NAMES
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Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic
lymphoma; Cancer - non-Hodgkin's lymphoma; Diffuse Large B-Cell Lymphoma; DLBCL
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DESCRIPTION
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Adult Non-Hodgkin Lymphoma (NHL) is a type of cancer that starts in the lymphatic system, which in turn allows spread
to other organs and tissues in the body. Adult NHL is categorized into three grades:
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Low grade or indolent, which are slow growing lymphomas;
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Intermediate grade or aggressive and faster growing lymphomas; and
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High-grade or highly aggressive and very fast growing lymphomas.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing:
Diagnostic testing for Adult NHL includes:
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Bone marrow aspiration and biopsy.
Physical findings: Adult NHL may cause different signs and symptoms, depending on the location of the
tumor. These signs may include:
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Swollen lymph nodes in the neck, armpit or groin;
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Discomfort or feeling of fullness in the abdomen;
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Unexplained fever, night sweats, or weight loss.
ICD-9: 200.2; 200.5; 200.6; 200.7; 202.0; 202.7; 202.8
ICD-10:
C85.90
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PROGRESSION
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NHL can occur at any age, with the risk of increasing with age. Most people are diagnosed
in their 60’s. The prognosis for Adult NHL is dependent on the type and characteristics
of the malignant tumor, the growth and location of the tumor, and the spread (metastasis)
at the time of diagnosis.
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TREATMENT
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Adult NHL is mainly treated with chemotherapy, with radiation therapy, or antibody
or biological therapy added depending on response to treatment.
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| SUGGESTED PROGRAMMATIC
ASSESSMENT* |
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Suggested MER for Evaluation:
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Clinical history and examination that describes diagnostic features of the impairment;
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Pertinent treatment records; and
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Up-to-date progress notes.
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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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13.05 A
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Listing level aggressive adult Non-Hodgkin Lymphoma requires that the cancer be recurrent
after initial anti-neoplastic treatment. Listing level indolent adult non-Hodgkin
lymphoma requires initiation of more than one antineoplastic treatment regimen within
a consecutive 12-month period.
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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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