Program Operations Manual System (POMS)
TN 60 (10-23)
DI 23022.325 Small Intestine Cancer - with Distant Metastases or Inoperable or Recurrent
COMPASSIONATE ALLOWANCES INFORMATION
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SMALL INTESTINE
CANCER - WITH DISTANT
METASTASES OR INOPERABLE OR RECURRENT
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ALTERNATE NAMES |
Small Intestine Adenocarcinoma; Small Intestine Sarcoma; Small Intestine Gastrointestinal
Stromal Tumor; Small Intestine Carcinoid; Small Intestine Carcinoma
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DESCRIPTION
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Small Intestine Cancer forms in tissues of the small intestine. The most common type is adenocarcinoma. Most
of these tumors occur in the part of the small intestine near the stomach. They may
grow and block the intestine.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: The following may be used to diagnose the disease:
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Physical exam and history;
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Fecal occult blood test (FOBT);
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Physical findings: Physical findings for small intestine cancer may include:
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Blood in the stool (feces);
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Pain or cramps in the abdomen;
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Unexplained weight loss; and
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Episodes of abdominal pain that may be accompanied by severe nausea or vomiting.
ICD-9: 152
ICD-10: C78.4
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PROGRESSION |
The overall 5-year survival rate for resectable adenocarcinoma is only 20%. |
TREATMENT
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Treatment may include surgery, radiation, biologic therapy, and/or chemotherapy.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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A physician's opinion that indicates the cancer is inoperable or unresectable based
on described objective findings.
“Inoperable” refers to a physician's opinion that surgery would not be beneficial
based on a review of imaging studies, laboratory results, and physical examination
findings.
“Unresectable” cancer is established when the operative report indicates that the
cancer is not completely removed or the pathology report notes that the surgical specimen
has positive margins.
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Suggested Listings for
Evaluation: |
DETERMINATION |
LISTING
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REMARKS |
Meets |
13.17 |
Small Intestine Cancer that is inoperable, unresectable, recurrent, or with distant
metastases meets the criteria in listing 13.17.
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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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To Link to this section - Use this URL: http://policy.ssa.gov/poms.nsf/lnx/0423022325
| DI 23022.325 - Small Intestine Cancer - with Distant Metastases or Inoperable or Recurrent - 10/05/2023
Batch run: 10/05/2023
Rev:10/05/2023 |