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DI 23022.735: Glioma - Grade III and IV

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  • Effective Dates: 08/10/2012 - Present
  • Effective Dates: 11/16/2017 - Present
  • TN 7 (08-12)
  • DI 23022.735 Glioma - Grade III and IV
  • COMPASSIONATE ALLOWANCE INFORMATION
  • GLIOMA – GRADE III and IV
  • ALTERNATE NAMES
  • High Grade Malignant Glioma; Malignant Glioma Grade III; Malignant Glioma Grade IV; Glioblastoma; Anaplastic Astrocytoma; Undifferentiated Glioma; Anaplastic Glioma
  • DESCRIPTION
  • Glioma is a broad category of brain and spinal cord tumors that come from glial cells, the main brain cells that can develop into cancer. Approximately 80 percent of malignant brain tumors are gliomas. These gliomas are categorized as ependymomas, astrocytomas or oligodendrogliomas. The exact cause of malignant gliomas is unknown.
  • DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
  • Diagnostic testing: Malignant gliomas are diagnosed by a CT scan, MRI scan and biopsy. MRI is the preferred diagnostic tool.
  • ICD9: 191.0-9
  • ONSET AND PROGRESSION
  • Malignant gliomas can develop at any age. They tend to grow and become more malignant over time. The peak incidence generally occurs in the fifth and sixth decade of life. Prognosis is often poor for individuals with grades III and IV tumors with the average survival time approximately 12 months. Few individuals survive beyond three years with conventional treatment.
  • TREATMENT
  • Treatment depends on the location of the tumor and its progression. These tumors tend to grow or infiltrate into the normal brain tissue. Standard treatment is surgery followed by radiation therapy. If surgery is not an option, radiation therapy is given. Chemotherapy is sometimes given during or after radiation therapy.
  • SUGGESTED PROGRAMMATIC ASSESSMENT*
  • Suggested MER for evaluation:
  • * Pathology report documenting type and stage of tumor
  • * Operative reports
  • * MRI or CT scans
  • Suggested Listings for Evaluation:
  • DETERMINATION
  • LISTING
  • REMARKS
  • Meets Listing
  • 13.13A1
  • 13.13A1&2
  • 113.13
  • 113.13A&B
  • Grade III and IV gliomas meet listings 13.13A1 and 113.13 upon confirmed diagnosis, regardless of effectiveness of treatment. Recurrent malignant gliomas meet 13.13A2 upon confirmed diagnosis, regardless of grade and effectiveness of treatment.
  • Grade III and IV gliomas meet listings 13.13A1&2 and 113.13A&B upon confirmed diagnosis, regardless of effectiveness of treatment. Recurrent malignant gliomas meet 13.13A3 upon confirmed diagnosis, regardless of grade and effectiveness of treatment.
  • Medical Equals
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  • * Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.
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