TN 22 (12-18)

DI 23022.975 Peritoneal Mucinous Carcinomatosis

COMPASSIONATE ALLOWANCE INFORMATION

PERITONEAL MUCINOUS CARCINOMATOSIS

ALTERNATE NAMES

Primary Peritoneal Surface Malignancy; Invasive Peritoneal Mucinous Carcinomatosis

DESCRIPTION

Peritoneal Mucinous Carcinomatosis is a rare type of cancer that affects the lining of the abdominal cavity called the peritoneum. It occurs when cancer cells from other parts of the body, such as the appendix, colon, gall bladder, liver, rectum, or pancreas, metastasize and implant into the lining of the peritoneum. It is a common feature of abdominal cancers that are in the terminal stage.

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

Diagnostic testing: CT scan showing thickening of the peritoneum and ascites.

Physical findings: Clinical features of this disease include:

• Ascites;

• Abdominal swelling;

• Constipation;

• Gastrointestinal disorders;

• Nausea;

• Vomiting;

• Anorexia; and

• Unexplained weight loss.

ICD-9: 197.6

PROGRESSION

The prognosis for people with this disease is poor because spread of multiple cancerous nodules from other organs to the peritoneum occurs in the late stages of the disease.

TREATMENT

Peritoneal mucinous carcinomatosis is an advanced form of cancer that is treated aggressively to prevent the cancer from spreading further. Treatment typically includes surgical debulking followed by chemotherapy.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Imaging such as X-ray, CT or MRI scan reports of the peritoneum;

  • Biopsy report of the peritoneum; and

  • Tumor marker tests of blood indicating the presence of peritoneal cancer.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.16 B

Any affected primary abdominal cancer listing requiring metastases beyond the regional lymph nodes meets the criteria in listing 13.16 B. Listing level severity must be documented.

13.17

Any affected primary abdominal cancer listing requiring metastases beyond the regional lymph nodes meets the criteria in listing 13.17. Listing level severity must be documented.

13.18

Any affected primary abdominal cancer listing requiring metastases beyond the regional lymph nodes meets the criteria in listing 13.18. Listing level severity must be documented.

13.27

Any affected primary abdominal cancer listing requiring metastases beyond the regional lymph nodes meets the criteria in listing 13.27. Listing level severity must be documented.

Equals

13.15 B

 

Any affected listing for sites other than primary abdominal cancers involved by primary peritoneal carcinoma, including 13.15 B for men.

13.23 E 1

Any affected listing for sites other than primary abdominal cancers involved by primary peritoneal carcinoma, including 13.23 E 1 for women.

* 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/0423022975
DI 23022.975 - Peritoneal Mucinous Carcinomatosis - 12/28/2018
Batch run: 12/28/2018
Rev:12/28/2018