Internal Dosimetry Organ External Dosimetry Organ and IREP Model Selection by ICD Code - Technical Information Bulletins (TIBs) -- Alphabetical Listing

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ORAU TEAM Dose Reconstruction Project for NIOSH Oak Ridge Associated Universities I Dade Moeller & Associates I MJW Corporation Page 1 of 33 Document Title: Document Number: Revision: Effective Date: Type of Document: Supersedes: ORAUT-OTIB-0005 02 PC-1 02/10/2006 OTIB Revision 01 Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model Selection by ICD-9 Code Subject Expert: Scott R. Siebert Document Owner Approval: Signature on File Edward F. Maher, Task 5 Manager Approval Date: 11/10/2005 Concurrence: Signature on File Patricia C. Kimpan, Project Director Concurrence Date: 11/10/2005 Approval: Signature on File James W. Neton, Associate Director for Science Approval Date: 12/02/2005 New Total Rewrite Revision Page Change FOR DOCUMENTS MARKED AS A TOTAL REWRITE, REVISION, OR PAGE CHANGE, REPLACE THE PRIOR REVISION AND DISCARD / DESTROY ALL COPIES OF THE PRIOR REVISION. Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 2 of 33 PUBLICATION RECORD EFFECTIVE DATE 11/03/2003 01/23/2004 03/05/2004 REVISION NUMBER 00 01 01 PC-1 DESCRIPTION ORAU technical information bulletin to clarify IMBA organ and IREP model selection First approved issue. Initiated by Elizabeth M. Brackett. Incorporates applicable external dosimetry organ selection. Approved issue of Revision 01. Initiated by Elizabeth M. Brackett. IREP model correction for ICD-9 code 238.7 (added Bone model), remove IMBA/External/IREP model info from header rows for ICD-9 codes 194 and 205. Approved issue of page change 1. Initiated by Elizabeth M. Brackett. IMBA and External model correction for ICD-9 code 231.8 (changed to med review on page 15), IMBA model correction for ICD-9 codes 235.8 and 235.9 (changed to med review on page 16), External model correction for ICD-9 code 185 (changed to bladder on page 8). Approved issue of page change 2. Initiated by Elizabeth M. Brackett. IMBA model correction for ICD-9 code 189.2, 189.3, and 189.4 (changed to highest non-met organ/tissue on page 9), added footnote number 5 to Table 1 for ICD-9 code 232 on page 18. Changed DOL documentation to NIOSH Referral Summary Document (NRSD) on page 20. Approved issue of page change 3. Initiated by Scott R. Siebert. Adds information for ICD-9 codes 289.7 and 289.9, clarifies handling adenocarcinoma of the distal (lower third) esophagus, corrects external organ for ICD-9 codes 233.4 and 236.5, updates correct model selections for various cancers (to reflect guidance in OCAS TIB-012, except as directed by OCAS to mark many 200-204 organs as “Reserved”), adds likely primary cancer selection for secondary cancers. Changes references to “IMBA organ” to “Internal Dosimetry organ.” Approved issue of Revision 02. Training required: As determined by the Task Manager. Initiated by Scott R. Siebert. Approved page change revision. Updates Table 3-1 (pages 15 – 22) in Section 3.2 to reflect guidance in OCAS TIB-012 Rev 1 (internal and external organs for ICD-9 series 200 through 204 changed from “Reserved” to the specified organ) and changes OCAS-TIB-012 issue date and revision number in reference section (page 33). No sections were deleted. Training required: As determined by the Task Manager. Initiated by Scott R. Siebert. Approval: Signature on File Edward F. Maher, Task 5 Manager 05/07/2004 01 PC-2 10/29/2004 01 PC-3 12/02/2005 02 02/10/2006 02 PC-1 02/08/2006 Signature on File Kate Kimpan, Project Director 02/07/2006 Signature on File James W. Neton, Associate Director for Science 02/09/2006 Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 3 of 33 TABLE OF CONTENTS SECTION 1.0 2.0 3.0 TITLE PAGE Purpose.......................................................................................................................................4 Background.................................................................................................................................4 Guidance.....................................................................................................................................4 3.1 Selection of appropriate organ/model ............................................................................ 4 3.2 Secondary cancers with unknown primary cancer site .................................................. 4 Discussion.................................................................................................................................29 4.1 Highest Non-metabolic organ....................................................................................... 29 4.2 Medical review ............................................................................................................. 30 4.3 Thyroid/Remainder Selection for External Dose .......................................................... 30 4.4 Remainder Selection for External Dose ....................................................................... 30 4.5 Bladder......................................................................................................................... 30 4.6 Multiple IREP Models................................................................................................... 30 4.7 Adenocarcinoma of the distal (lower third) esophagus ................................................ 31 4.8 Secondary cancers - Likely primary cancer sites with multiple IMBA, external, and IREP organ model options ..................................................................... 31 4.9 Multiple secondary cancers with unknown primary cancer site or Multiple Primary and Secondary Cancers ................................................................................. 31 4.0 References ...........................................................................................................................................33 Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 4 of 33 1.0 PURPOSE Technical Information Bulletins (TIBs) are general working documents that provide guidance concerning the preparation of dose reconstructions at particular sites or categories of sites. They will be revised in the event additional relevant information is obtained. TIBs may be used to assist the National Institute for Occupational Safety and Health in the completion of individual dose reconstructions. This Technical Information Bulletin (TIB) provides guidance on selecting appropriate ICRP modeled organs/tissues to estimate the internal dose for specific ICD-9 codes, the appropriate organs/tissues to estimate external dose, and the appropriate model in the Interactive RadioEpidemiological Program (IREP). This TIB also provides information for selecting and assessing likely primary cancers for secondary cancers. 2.0 BACKGROUND Under EEOICPA, the organs/tissues for which doses must be estimated are those delineated by the specified ICD-9 code received from the Department of Labor (DOL). While many ICD-9 codes are clear in their intended organ/tissue, additional guidance is necessary to identify the appropriate internal dosimetry organ, organ/tissue for external dose estimate, and IREP model to use for the organ/tissue. This TIB designates the appropriate internal dosimetry organ/tissue selection for the various ICD-9 coded cancers, the appropriate organ/tissue to estimate external dose, and the appropriate IREP model to use as well. 3.0 3.1 GUIDANCE SELECTION OF APPROPRIATE ORGAN/MODEL Table 3-1 correlates ICD-9 codes to the appropriate organ/tissue selection for internal dose estimate, the appropriate organ/tissue selection for external dose estimate, and the appropriate IREP model. Organs/tissues labeled “Highest non-met org/tiss” indicate that dose to the highest non-metabolic organ is to be used to represent the dose to the ICD-9 Code designated organ/tissue. A discussion of this term is included in section 4.0 of this bulletin. The remaining regions are described by the term used in the Integrated Modules for Bioassay Analysis (IMBA) software program. 3.2 SECONDARY CANCERS WITH UNKNOWN PRIMARY CANCER SITE Another situation that needs to be assessed is the diagnosis of a secondary cancer with an unknown primary cancer location. It is accepted in medicine that cancer-causing agents such as ionizing radiation produce primary cancers. This means, in a case in which the primary site of cancer is unknown, the primary site must be established by inference to establish probability of causation. For each secondary cancer, the set of primary cancers producing approximately 75% of that secondary cancer among the U.S. population was identified (males and females were considered separately). Therefore, for secondary cancers with unknown primary site, Table 3-2 will be consulted to select likely primary sites, which will then be evaluated using IREP (reproduced from Table 7 in the IREP technical documentation). Since each secondary cancer in Table 3-2 has more than one likely primary cancer site, each likely primary site must be evaluated using IREP to determine a probability of causation. If any one of the likely primary cancer sites yields a probability of causation greater than or equal to 50%, this site will be assumed to be the originating site for the secondary cancer and shall be submitted as such. Table 3-1. ICD-9 Code 140 140.0 140.1 140.3 140.4 140.5 140.6 140.8 140.9 141 141.0 141.1 141.2 141.3 141.4 141.5 141.6 141.8 141.9 142 142.0 142.1 142.2 142.8 142.9 143 143.0 143.1 143.8 143.9 144 144.0 144.1 144.8 144.9 145 145.0 145.1 Cancer code explanation MALIGANT NEOPLASM LIP MALIG NEO UPPER VERMILION MALIG NEO LOWER VERMILION MALIG NEO UPPER LIP, INNER MALIG NEO LOWER LIP, INNER MALIG NEO LIP, INNER NOS MALIG NEO LIP, COMMISSURE MALIG NEO LIP NEC MALIG NEO LIP/VERMIL NOS MALIG NEO TONGUE MALIG NEO TONGUE BASE MALIG NEO DORSAL TONGUE MALIG NEO TIP/LAT TONGUE MALIG NEO VENTRAL TONGUE MALIG NEO ANT 2/3 TONGUE MALIG NEO TONGUE JUNCTION MALIG NEO LINGUAL TONSIL MALIG NEO TONGUE NEC MALIG NEO TONGUE NOS MALIG NEO MAJOR SALIVARY MALIG NEO PAROTID MALIG NEO SUBMANDIBULAR MALIG NEO SUBLINGUAL MALIG NEO MAJ SALIVARY NEC MALIG NEO SALIVARY NOS MALIGNANT NEOPLASM GUM MALIG NEO UPPER GUM MALIG NEO LOWER GUM MALIG NEO GUM NEC MALIG NEO GUM NOS MALIG NEO MOUTH FLOOR MALIG NEO ANT FLOOR MOUTH MALIG NEO LAT FLOOR MOUTH MALIG NEO MOUTH FLOOR NEC MALIG NEO MOUTH FLOOR NOS MALIG NEO MOUTH NEC/NOS MALIG NEO CHEEK MUCOSA MALIG NEO MOUTH VESTIBULE Internal Organ Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss LNET Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss External organ Skin Skin Skin Skin Skin Skin Skin Skin Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 IREP model Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 5 of 33 Highest non-met org/tiss Thyroid/Remainder1 Oral Cav and pharynx Highest non-met org/tiss Thyroid/Remainder1 Oral Cav and pharynx Table 3-1 (Continued). ICD-9 Code 145.2 145.3 145.4 145.5 145.6 145.8 145.9 146 146.0 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 147 147.0 147.1 147.2 147.3 147.8 147.9 148 148.0 148.1 148.2 148.3 148.8 148.9 149 149.0 149.1 149.8 149.9 150 Cancer code explanation MALIG NEO HARD PALATE MALIG NEO SOFT PALATE MALIG NEO UVULA MALIG NEO PALATE NOS MALIG NEO RETROMOLAR MALIG NEO MOUTH NEC MALIG NEO MOUTH NOS MALIG NEO OROPHARYNX MALIG NEO TONSIL MALIG NEO TONSILLAR FOSSA MALIG NEO TONSIL PILLARS MALIG NEO VALLECULA MALIG NEO ANT EPIGLOTTIS MALIG NEO EPIGLOTTIS JUNCT MALIG NEO LAT OROPHARYNX MALIG NEO POST OROPHARYNX MALIG NEO OROPHARYNX NEC MALIG NEO OROPHARYNX NOS MALIG NEO NASOPHARYNX MALIG NEO SUPER NASOPHARYN MALIG NEO POST NASOPHARYNX MALIG NEO LAT NASOPHARYNX MALIG NEO ANT NASOPHARYNX MALIG NEO NASOPHARYNX NEC MALIG NEO NASOPHARYNX NOS MALIG NEO HYPOPHARYNX MALIG NEO POSTCRICOID MALIG NEO PYRIFORM SINUS MALIG NEO ARYEPIGLOTT FOLD MALIG NEO POST HYPOPHARYNX MALIG NEO HYPOPHARYNX NEC MALIG NEO HYPOPHARYNX NOS OTHER MALIG OROPHARYNX MALIG NEO PHARYNX NOS MALIG NEO WALDEYER’S RING MALIG NEO ORAL/PHARYNX NEC MALIG NEO OROPHRYN ILL-DEF MALIG NEO ESOPHAGUS Internal Organ Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss LNET LNET LNET ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 ET2 LNET ET2 ET2 External organ Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus IREP model Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Oral Cav and pharynx Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 6 of 33 Table 3-1 (Continued). ICD-9 Code 150.0 150.1 150.2 150.3 150.4 150.5 150.8 150.9 151 151.0 151.1 151.2 151.3 151.4 151.5 151.6 151.8 151.9 152 152.0 152.1 152.2 152.3 152.8 152.9 153 153.0 153.1 153.2 153.3 153.4 153.5 153.6 Cancer code explanation MALIG NEO CERVICAL ESOPHAG MALIG NEO THORACIC ESOPHAG MALIG NEO ABDOMIN ESOPHAG MALIG NEO UPPER 3RD ESOPH MALIG NEO MIDDLE 3RD ESOPH MALIG NEO LOWER 3RD ESOPH MALIG NEO ESOPHAGUS NEC MALIG NEO ESOPHAGUS NOS MALIGNANT NEO STOMACH MALIG NEO STOMACH CARDIA MALIG NEO PYLORUS MALIG NEO PYLORIC ANTRUM MALIG NEO STOMACH FUNDUS MALIG NEO STOMACH BODY MALIG NEO STOM LESSER CURV MALIG NEO STOM GREAT CURV MALIG NEO STOMACH NEC MALIG NEO STOMACH NOS MALIG NEO SMALL BOWEL MALIG NEO DUODENUM MALIG NEO JEJUNUM MALIG NEO ILEUM MALIG NEO MECKEL’S DIVERT MALIG NEO SMALL BOWEL NEC MALIG NEO SMALL BOWEL NOS MALIGNANT NEOPLASM COLON MALIG NEO HEPATIC FLEXURE MALIG NEO TRANSVERSE COLON MALIG NEO DESCEND COLON MALIG NEO SIGMOID COLON MALIG NEO CECUM MALIG NEO APPENDIX MALIG NEO ASCEND COLON Internal Organ Esophagus Esophagus/stomach6 Esophagus/stomach 6 Document No. ORAUT-OTIB-0005 6 External organ IREP model Esophagus Esophagus Esophagus/stomach Esophagus/stomach6 Esophagus/stomach Esophagus/stomach6 6 Esophagus Esophagus Esophagus/stomach6 Esophagus/stomach 6 Esophagus Esophagus Esophagus Esophagus Esophagus/stomach Esophagus/stomach6 6 6 Esophagus/stomach Esophagus/stomach6 Esophagus/stomach Esophagus/stomach6 Esophagus/stomach6 Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach SI SI SI SI SI SI ULI ULI LLI LLI ULI ULI ULI 6 Revision No. 02 Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Colon Colon Colon Colon Colon Colon Colon Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach Stomach All digestive All digestive All digestive All digestive All digestive All digestive Colon Colon Colon Colon Colon Colon Colon Effective Date: 12/02/2005 Page 7 of 33 Table 3-1 (Continued). ICD-9 Code 153.7 153.8 153.9 154 154.0 154.1 154.2 154.3 154.8 155 155.0 155.1 155.2 156 156.0 156.1 156.2 156.8 156.9 157 157.0 157.1 157.2 157.3 157.4 157.8 157.9 158 158.0 158.8 158.9 159 159.0 159.1 159.8 159.9 160 160.0 Cancer code explanation MALIG NEO SPLENIC FLEXURE MALIG NEO COLON NEC MALIG NEO COLON NOS MALIG NEO RECTUM/ANUS MALIG NEO RECTOSIGMOID JCT MALIG NEO RECTUM MALIG NEO ANAL CANAL MALIG NEO ANUS NOS MALIG NEO RECTUM/ANUS NEC MALIGNANT NEOPLASM LIVER MALIG NEO LIVER, PRIMARY MALIG NEO INTRAHEPAT DUCTS MALIG NEO LIVER NOS MALIG NEO GB/EXTRAHEPATIC MALIG NEO GALLBLADDER MALIG NEO EXTRAHEPAT DUCTS MALIG NEO AMPULLA VATER MALIG NEO BILIARY NEC MALIG NEO BILIARY NOS MALIGNANT NEO PANCREAS MALIG NEO PANCREAS HEAD MALIG NEO PANCREAS BODY MALIG NEO PANCREAS TAIL MALIG NEO PANCREATIC DUCT MALIG NEO ISLET LANGERHANS MALIG NEO PANCREAS NEC MALIG NEO PANCREAS NOS MALIG NEO PERITONEUM MALIG NEO RETROPERITONEUM MALIG NEO PERITONEUM NEC MALIG NEO PERITONEUM NOS OTHER MALIG NEO GI/PERITON MALIG NEO INTESTINE NOS MALIG NEO SPLEEN NEC MALIG NEO GI/INTRA-ABD NEC MALIG NEO GI TRACT ILL-DEF MALIG NEO NASAL CAV/SINUS MALIG NEO NASAL CAVITIES Internal Organ LLI Colon Colon LLI LLI LLI LLI LLI Liver Gallbladder Liver Gallbladder Gallbladder Gallbladder Gallbladder Gallbladder Pancreas Pancreas Pancreas Pancreas Pancreas Pancreas Pancreas External organ Colon Colon Colon Colon Colon Colon Colon Colon Liver Bladder Liver Bladder Bladder Bladder Bladder Bladder Stomach Stomach Stomach Stomach Stomach Stomach Stomach IREP model Colon Colon Colon Rectum Rectum Rectum Rectum Rectum Liver Gallbladder Liver Gallbladder Gallbladder Gallbladder Gallbladder Gallbladder Pancreas Pancreas Pancreas Pancreas Pancreas Pancreas Pancreas All digestive All digestive All digestive All digestive All digestive All digestive All digestive Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Highest non-met org/tiss Stomach Highest non-met org/tiss Stomach Highest non-met org/tiss Stomach Colon Spleen Highest non-met org/tiss Highest non-met org/tiss ET1 Stomach Stomach Stomach Stomach Page 8 of 33 Thyroid/Remainder1 Other respiratory Table 3-1 (Continued). ICD-9 Code 160.1 160.2 160.3 160.4 160.5 160.8 160.9 161 161.0 161.1 161.2 161.3 161.8 161.9 162 162.0 162.2 162.3 162.4 162.5 162.8 162.9 163 163.0 163.1 163.8 163.9 164 164.0 164.1 164.2 164.3 164.8 164.9 165 165.0 165.8 165.9 Cancer code explanation MALIG NEO MIDDLE EAR MALIG NEO MAXILLARY SINUS MALIG NEO ETHMOIDAL SINUS MALIG NEO FRONTAL SINUS MALIG NEO SPHENOID SINUS MALIG NEO ACCESS SINUS NEC MALIG NEO ACCESS SINUS NOS MALIGNANT NEO LARYNX MALIG NEO GLOTTIS MALIG NEO SUPRAGLOTTIS MALIG NEO SUBGLOTTIS MALIG NEO CARTILAGE LARYNX MALIG NEO LARYNX NEC MALIG NEO LARYNX NOS MALIG NEO TRACHEA/LUNG MALIG NEO TRACHEA MALIG NEO MAIN BRONCHUS MALIG NEO UPPER LOBE LUNG MALIG NEO MIDDLE LOBE LUNG MALIG NEO LOWER LOBE LUNG MALIG NEO BRONCH/LUNG NEC MALIG NEO BRONCH/LUNG NOS MALIGNANT NEOPL PLEURA MALIG NEO PARIETAL PLEURA MALIG NEO VISCERAL PLEURA MALIG NEO PLEURA NEC MALIG NEO PLEURA NOS MALIG NEO THYMUS/MEDIASTIN MALIG NEO THYMUS MALIG NEO HEART MALIG NEO ANT MEDIASTINUM MALIG NEO POST MEDIASTINUM MALIG NEO MEDIASTINUM NEC MALIG NEO MEDIASTINUM NOS OTH/ILL-DEF MAL NEO RESP MALIG NEO UPPER RESP NOS MALIG NEO THORAX/RESP NEC MALIG NEO RESP SYSTEM NOS Internal Organ Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss ET2 ET2 ET2 ET2 ET2 ET2 Lung Lung Lung Lung Lung Lung Lung Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Thymus Heart Wall Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Lung Lung Lung External organ Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Esophagus Esophagus Esophagus Esophagus Esophagus Esophagus Lung Lung Lung Lung Lung Lung Lung Lung Lung Lung Lung Thymus Thymus Thymus Thymus Thymus Thymus Lung Lung Lung IREP model Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Lung Lung Lung Lung Lung Lung Lung Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Other respiratory Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 9 of 33 Table 3-1 (Continued). ICD-9 Code 170 170.0 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 171 171.0 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 172 172.0 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 173 173.0 173.1 Cancer code explanation MALIG NEO BONE/ARTIC CART MALIG NEO SKULL/FACE BONE MALIG NEO MANDIBLE MALIG NEO VERTEBRAE MALIG NEO RIBS/STERN/CLAV MALIG NEO LONG BONES ARM MALIG NEO BONES WRIST/HAND MALIG NEO PELVIC GIRDLE MALIG NEO LONG BONES LEG MALIG NEO BONES ANKLE/FOOT MALIG NEO BONE NOS MALIG NEO SOFT TISSUE MALIG NEO SOFT TISSUE HEAD MALIG NEO SOFT TISSUE ARM MALIG NEO SOFT TISSUE LEG MALIG NEO SOFT TIS THORAX MALIG NEO SOFT TIS ABDOMEN MALIG NEO SOFT TIS PELVIS MALIG NEO TRUNK NOS MALIG NEO SOFT TISSUE NEC MALIG NEO SOFT TISSUE NOS MALIGNANT MELANOMA SKIN MALIG MELANOMA LIP MALIG MELANOMA EYELID MALIG MELANOMA EAR MALIG MELANOMA FACE NEC/NOS MALIG MELANOMA SCALP/NECK MALIG MELANOMA TRUNK MALIG MELANOMA ARM MALIG MELANOMA LEG MALIG MELANOMA SKIN NEC MALIG MELANOMA SKIN NOS OTHER MALIG NEOPL SKIN MALIG NEO SKIN LIP MALIG NEO SKIN EYELID Internal Organ Bone surface Bone surface Bone surface Medical review Bone surface Bone surface Medical review Medical review Bone surface Medical review Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin External organ Bone Surface Bone Surface Bone Surface Bone Surface Bone Surface Bone Surface Bone Surface Bone Surface Bone Surface Bone Surface Thyroid/Remainder1 Remainder2 Remainder2 Remainder2 Remainder2 Remainder2 Remainder2 Remainder2 Remainder2 Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Bone Bone Bone Bone Bone Bone Bone Bone Bone Bone Connective Tissue Connective Tissue Connective Tissue Connective Tissue Connective Tissue Connective Tissue Connective Tissue Connective Tissue Connective Tissue Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Malignant melanoma Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell IREP model Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 10 of 33 Table 3-1 (Continued). ICD-9 Code 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 174 174.0 174.1 174.2 174.3 174.4 174.5 174.6 174.8 174.9 175 175.0 175.9 176 176.0 176.1 176.2 176.3 Cancer code explanation MALIG NEO SKIN EAR MALIG NEO SKIN FACE NEC MALIG NEO SCALP/SKIN NECK MALIG NEO SKIN TRUNK MALIG NEO SKIN ARM MALIG NEO SKIN LEG MALIG NEO SKIN NEC MALIG NEO SKIN NOS MALIG NEO FEMALE BREAST MALIG NEO NIPPLE MALIG NEO BREAST-CENTRAL MALIG NEO BREAST UP-INNER MALIG NEO BREAST LOW-INNER MALIG NEO BREAST UP-OUTER MALIG NEO BREAST LOW-OUTER MALIG NEO BREAST-AXILLARY MALIG NEO BREAST NEC MALIG NEO BREAST NOS MALIG NEO MALE BREAST MALIG NEO MALE NIPPLE MALIG NEO MALE BREAST NEC KAPOSI'S SARCOMA SKIN-KAPOSI'S SARCOMA SOFT TISSUE-KAPOSI'S SARCOMA PALATE-KAPOSI'S SARCOMA GI SITES-KAPOSI'S SARCOMA Internal Organ Skin Skin Skin Skin Skin Skin Skin Skin Breast Breast Breast Breast Breast Breast Breast Breast Breast Breast Breast Skin External organ Skin Skin Skin Skin Skin Skin Skin Skin Breast Breast Breast Breast Breast Breast Breast Breast Breast Breast Breast Skin IREP model Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell Breast Breast Breast Breast Breast Breast Breast Breast Breast Breast Breast Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Connective tissue AND Non-melanoma skin-Squamous cell Highest non-met org/tiss Remainder2 Connective tissue AND Non-melanoma skin-Squamous cell Highest non-met org/tiss Thyroid/Remainder1 Connective tissue AND Non-melanoma skin-Squamous cell Colon Stomach/Colon Connective tissue AND (location dependant) Non-melanoma skin-Squamous cell Page 11 of 33 Table 3-1 (Continued). ICD-9 Code 176.4 176.5 176.8 176.9 179 180 180.0 180.1 180.8 180.9 181 182 182.0 182.1 182.8 183 183.0 183.2 183.3 183.4 183.5 183.8 183.9 184 184.0 184.1 184.2 184.3 184.4 184.8 184.9 185 186 186.0 Cancer code explanation LUNG-KAPOSI'S SARCOMA LYMPH NODES-KAPOSI'S SARCOMA SPF STS-KAPOSI'S SARCOMA KAPOSI'S SARCOMA NOS MALIG NEO UTERUS NOS MALIG NEO CERVIX UTERI MALIG NEO ENDOCERVIX MALIG NEO EXOCERVIX MALIG NEO CERVIX NEC MALIG NEO CERVIX UTERI NOS MALIG NEO PLACENTA MALIG NEO UTERUS BODY MALIG NEO CORPUS UTERI MALIG NEO UTERINE ISTHMUS MALIG NEO BODY UTERUS NEC MALIG NEO UTERINE ADNEXA MALIG NEO OVARY MALIG NEO FALLOPIAN TUBE MALIG NEO BROAD LIGAMENT MALIG NEO PARAMETRIUM MALIG NEO ROUND LIGAMENT MALIG NEO ADNEXA NEC MALIG NEO ADNEXA NOS MALIG NEO FEM GEN NEC/NOS MALIG NEO VAGINA MALIG NEO LABIA MAJORA MALIG NEO LABIA MINORA MALIG NEO CLITORIS MALIG NEO VULVA NOS MALIG NEO FEMALE GENIT NEC MALIG NEO FEMALE GENIT NOS MALIG NEO PROSTATE MALIG NEO TESTIS MALIG NEO UNDESCEND TESTIS Internal Organ Lung External organ Lung IREP model Connective tissue AND Non-melanoma skin-Squamous cell Connective tissue AND Non-melanoma skin-Squamous cell Connective tissue AND Non-melanoma skin-Squamous cell Connective tissue AND Non-melanoma skin-Squamous cell Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Ovary Ovary Ovary Ovary Ovary Ovary Ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary All male genitalia All male genitalia Document No. ORAUT-OTIB-0005 Highest non-met org/tiss Remainder2 Highest non-met org/tiss Remainder2 Highest non-met org/tiss Remainder2 Uterus Uterus Uterus Uterus Uterus Uterus Uterus Uterus Uterus Ovaries Ovaries Ovaries Uterus Uterus Ovaries Ovaries Muscle Skin Skin Skin Skin Uterus Uterus Highest non-met org/tiss Testes Uterus Uterus Uterus Uterus Uterus Uterus Uterus Uterus Uterus Ovaries Ovaries Ovaries Ovaries Ovaries Ovaries Ovaries Uterus Uterus Uterus Uterus Uterus Uterus Uterus Bladder Testes Revision No. 02 Effective Date: 12/02/2005 Page 12 of 33 Table 3-1 (Continued). ICD-9 Code 186.9 187 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 188 188.0 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 189 189.0 189.1 189.2 189.3 189.4 189.8 189.9 190 190.0 190.1 190.2 190.3 190.4 190.5 190.6 Cancer code explanation MALIG NEO TESTIS NEC MALIG NEO MALE GENITAL NEC MALIG NEO PREPUCE MALIG NEO GLANS PENIS MALIG NEO PENIS BODY MALIG NEO PENIS NOS MALIG NEO EPIDIDYMIS MALIG NEO SPERMATIC CORD MALIG NEO SCROTUM MALIG NEO MALE GENITAL NEC MALIG NEO MALE GENITAL NOS MALIG NEO BLADDER MALIG NEO BLADDER-TRIGONE MALIG NEO BLADDER-DOME MALIG NEO BLADDER-LATERAL MALIG NEO BLADDER-ANTERIOR MALIG NEO BLADDER-POST MALIG NEO BLADDER NECK MALIG NEO URETERIC ORIFICE MALIG NEO URACHUS MALIG NEO BLADDER NEC MALIG NEO BLADDER NOS MALIG NEO URINARY NEC/NOS MALIG NEO KIDNEY MALIG NEO RENAL PELVIS MALIG NEO URETER MALIG NEO URETHRA MALIG NEO PARAURETHRAL MALIG NEO URINARY NEC MALIG NEO URINARY NOS MALIGANT NEOPLASM EYE MALIG NEO EYEBALL MALIG NEO ORBIT MALIG NEO LACRIMAL GLAND MALIG NEO CONJUNCTIVA MALIG NEO CORNEA MALIG NEO RETINA MALIG NEO CHOROID Internal Organ Testes Skin Skin Testes Testes Testes Testes Testes Testes Testes Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Kidney Kidney Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Bladder Medical review Brain Brain Skin Skin Skin Brain Brain External organ Testes Testes Testes Testes Testes Testes Testes Testes Testes Testes Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Liver Liver Liver Liver Liver Liver Liver Eye Lens Eye Lens Eye Lens Eye Lens Eye Lens Eye Lens Eye Lens IREP model All male genitalia All male genitalia All male genitalia All male genitalia All male genitalia All male genitalia All male genitalia All male genitalia All male genitalia All male genitalia Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Eye Eye Eye Eye Eye Eye Eye Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 13 of 33 Table 3-1 (Continued). ICD-9 Code 190.7 190.8 190.9 191 191.0 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 192 192.0 192.1 192.2 192.3 192.8 192.9 193 194 194.0 194.1 194.3 194.4 194.5 194.6 194.8 194.9 195 195.0 195.1 195.2 195.3 195.4 195.5 Cancer code explanation MALIG NEO LACRIMAL DUCT MALIG NEO EYE NEC MALIG NEO EYE NOS MALIG NEOASM BRAIN MALIG NEO CEREBRUM MALIG NEO FRONTAL LOBE MALIG NEO TEMPORAL LOBE MALIG NEO PARIETAL LOBE MALIG NEO OCCIPITAL LOBE MALIG NEO CEREB VENTRICLE MALIG NEO CEREBELLUM NOS MALIG NEO BRAIN STEM MALIG NEO BRAIN NEC MALIG NEO BRAIN NOS MALIG NEO NERVE NEC/NOS MALIG NEO CRANIAL NERVES MALIG NEO CEREBRAL MENING MALIG NEO SPINAL CORD MALIG NEO SPINAL MENINGES MALIG NEO NERVOUS SYST NEC MALIG NEO NERVOUS SYST NOS MALIG NEO THYROID MALIG NEO OTHER ENDOCRINE MALIG NEO ADRENAL MALIG NEO PARATHYROID MALIG NEO PITUITARY MALIG NEO PINEAL GLAND MALIG NEO CAROTID BODY MALIG NEO PARAGANGLIA NEC MALIG NEO ENDOCRINE NEC MALIG NEO ENDOCRINE NOS MALIG NEO OTH/ILL-DEF SITE MALIG NEO HEAD/FACE/NECK MALIG NEO THORAX MALIG NEO ABDOMEN MALIG NEO PELVIS MALIG NEO ARM MALIG NEO LEG Internal Organ Skin Skin Skin Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Thyroid Adrenals Thyroid Brain Brain Brain Brain Medical review Medical review Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss Highest non-met org/tiss External organ Eye Lens Eye Lens Eye Lens Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Thyroid/Remainder1 Remainder2 Remainder2 Thyroid/Remainder1 Remainder2 Remainder2 Remainder2 Remainder2 Remainder2 IREP model Eye Eye Eye Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Thyroid Other endocrine glands Other endocrine glands Other endocrine glands Other endocrine glands Other endocrine glands Other endocrine glands Other endocrine glands Other endocrine glands Other and ill-defined sites Other and ill-defined sites Other and ill-defined sites Other and ill-defined sites Other and ill-defined sites Other and ill-defined sites Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 14 of 33 Table 3-1 (Continued). ICD-9 Code 195.8 196 196.0 196.1 196.2 196.3 196.5 196.6 196.8 196.9 197 197.0 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 198 198.0 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.81 198.82 198.89 199 199.0 199.1 200 200.0 Cancer code explanation MALIG NEO SITE NEC MALIG NEO LYMPH NODES MALIG NEO LYMPH-HEAD/NECK MALIG NEO LYMPH-INTRATHOR MALIG NEO LYMPH-INTRA-ABD MALIG NEO LYMPH-AXILLA/ARM MALIG NEO LYMPH-INGUIN/LEG MALIG NEO LYMPH-INTRAPELV MALIG NEO LYMPH-MULT MALIG NEO LYMPH NOS SEC MALIG NEO GI/RESP SEC MALIG NEO LUNG SEC MALIG NEO MEDIASTINUM SEC MALIG NEO PLEURA SEC MALIG NEO RESP NEC SEC MALIG NEO SM BOWEL SEC MALIG NEO LG BOWEL SEC MALIG NEO PERITONEUM SEC MALIG NEO LIVER SEC MALIG NEO GI NEC SEC MALIG NEO OTHER SITES SEC MALIG NEO KIDNEY SEC MALIG NEO URIN NEC SEC MALIG NEO SKIN SEC MALIG NEO BRAIN/SPINE SEC MALIG NEO NERVE NEC SEC MALIG NEO BONE SEC MALIG NEO OVARY SEC MALIG NEO ADRENAL OTHER SECONDARY MALIG NEO SEC MALIG NEO BREAST SEC MALIG NEO GENITAL SEC MALIG NEO NEC MALIG NEOPLASM NOS MALIG NEO DISSEMINATED MALIG NEO NOS LYMPHOSARC/RETICULOSARC RETICULOSARCOMA Internal Organ External organ Highest non-met org/tiss Remainder2 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 Highest non-met org/tiss Highest non-met org/tiss LN(TH) LN(TH) NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 Remainder2 Remainder2 Thyroid Thyroid IREP model Other and ill-defined sites NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 NA3 Other and ill-defined sites Other and ill-defined sites Lymphoma and multiple myeloma Lymphoma and multiple myeloma Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 15 of 33 Table 3-1 (Continued). ICD-9 Code 200.00 200.01 200.02 200.03 200.04 200.05 200.06 200.07 200.08 200.1 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.2 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.8 200.80 200.81 200.82 200.83 200.84 200.85 200.86 200.87 Cancer code explanation RETCLSRC UNSPEC EXT ORG RETICULOSARCOMA HEAD RETICULOSARCOMA THORAX RETICULOSARCOMA ABDOM RETICULOSARCOMA AXILLA RETICULOSARCOMA INGUIN RETICULOSARCOMA PELVIC RETICULOSARCOMA SPLEEN RETICULOSARCOMA MULT LYMPHOSARCOMA LYMPHSRC UNSPEC EXT ORG LYMPHOSARCOMA HEAD LYMPHOSARCOMA THORAX LYMPHOSARCOMA ABDOM LYMPHOSARCOMA AXILLA LYMPHOSARCOMA INGUIN LYMPHOSARCOMA PELVIC LYMPHOSARCOMA SPLEEN LYMPHOSARCOMA MULT BURKITT'S TUMOR/LYMPHOMA BURKITT'S TUMOR UNSPEC EXT ORG BURKITT'S TUMOR HEAD BURKITT'S TUMOR THORAX BURKITT'S TUMOR ABDOM BURKITT'S TUMOR AXILLA BURKITT'S TUMOR INGUIN BURKITT'S TUMOR PELVIC BURKITT'S TUMOR SPLEEN BURKITT'S TUMOR MULT MIXED LYMPHOSARCOMA OTHER VARN UNSPEC EXT ORG MIXED LYMPHOSARC HEAD MIXED LYMPHOSARC THORAX MIXED LYMPHOSARC ABDOM MIXED LYMPHOSARC AXILLA MIXED LYMPHOSARC INGUIN MIXED LYMPHOSARC PELVIC MIXED LYMPHOSARC SPLEEN Internal Organ LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen External organ Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Lung Lung Lung Lung Lung Lung Lung Lung Lung Lung Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach IREP model Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 16 of 33 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 200.88 MIXED LYMPHOSARC MULT 201 HODGKIN'S DISEASE 201.0 HODGKIN'S PARAGRANULOMA 201.00 HODGKINS PARAGRANULOMA UNSPEC EXT ORG 201.01 HODGKINS PARAGRAN HEAD 201.02 HODGKINS PARAGRAN THORAX 201.03 HODGKINS PARAGRAN ABDOM 201.04 HODGKINS PARAGRAN AXILLA 201.05 HODGKINS PARAGRAN INGUIN 201.06 HODGKINS PARAGRAN PELVIC 201.07 HODGKINS PARAGRAN SPLEEN 201.08 HODGKINS PARAGRAN MULT 201.1 HODGKIN'S GRANULOMA 201.10 HODGKINS GRANULOM UNSPEC EXT ORG 201.11 HODGKINS GRANULOM HEAD 201.12 HODGKINS GRANULOM THORAX 201.13 HODGKINS GRANULOM ABDOM 201.14 HODGKINS GRANULOM AXILLA 201.15 HODGKINS GRANULOM INGUIN 201.16 HODGKINS GRANULOM PELVIC 201.17 HODGKINS GRANULOM SPLEEN 201.18 HODGKINS GRANULOM MULT 201.2 HODGKIN'S SARCOMA 201.20 HODGKINS SRC UNSPEC EXT ORG 201.21 HODGKINS SARCOMA HEAD 201.22 HODGKINS SARCOMA THORAX 201.23 HODGKINS SARCOMA ABDOM 201.24 HODGKINS SARCOMA AXILLA 201.25 HODGKINS SARCOMA INGUIN 201.26 HODGKINS SARCOMA PELVIC 201.27 HODGKINS SARCOMA SPLEEN 201.28 HODGKINS SARCOMA MULT 201.4 HODGKINS LYMPH-HISTIOCYT 201.40 LYM-HST UNSPEC EXT ORGN 201.41 HODGKINS LYMPH-HISTIO HEAD 201.42 HODGKINS LYMPH-HISTIO THORAX Internal Organ LN(TH) LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) External organ Thyroid Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung IREP model Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 17 of 33 Table 3-1 (Continued). ICD-9 Code 201.43 201.44 201.45 201.46 201.47 201.48 201.5 201.50 201.51 201.52 201.53 201.54 201.55 201.56 201.57 201.58 201.6 201.60 201.61 201.62 201.63 201.64 201.65 201.66 201.67 201.68 201.7 201.70 201.71 201.72 201.73 201.74 201.75 201.76 201.77 201.78 201.9 201.90 Cancer code explanation HODGKINS LYMPH-HISTIO ABDOM HODGKINS LYMPH-HISTIO AXILLA HODGKINS LYMPH-HISTIO INGUIN HODGKINS LYMPH-HISTIO PELVIC HODGKINS LYMPH-HISTIO SPLEEN HODGKINS LYMPH-HISTIO MULT HODGKINS NODULAR SCLEROS NODULAR SCLEROS UNSPEC EXT ORG HODGKINS NODUL SCLERO HEAD HODGKINS NODUL SCLERO THORAX HODGKINS NODUL SCLERO ABDOM HODGKINS NODUL SCLERO AXILLA HODGKINS NODUL SCLERO INGUIN HODGKINS NODUL SCLERO PELVIC HODGKINS NODUL SCLERO SPLEEN HODGKINS NODUL SCLERO MULT HODGKINS MIX CELLULARITY MXD CELR UNSPEC EXT ORG HODGKINS MIX CELL HEAD HODGKINS MIX CELL THORAX HODGKINS MIX CELL ABDOM HODGKINS MIX CELL AXILLA HODGKINS MIX CELL INGUIN HODGKINS MIX CELL PELVIC HODGKINS MIX CELL SPLEEN HODGKINS MIX CELL MULT HODG LYMPHOCYTIC DEPLET LYM DPLT UNSPEC EXT ORG HODGKINS LYMPH DEPLET HEAD HODGKINS LYMPH DEPLET THORAX HODGKINS LYMPH DEPLET ABDOM HODGKINS LYMPH DEPLET AXILLA HODGKINS LYMPH DEPLET INGUIN HODGKINS LYMPH DEPLET PELVIC HODGKINS LYMPH DEPLET SPLEEN HODGKINS LYMPH DEPLET MULT HODGKINS DISEASE NOS HDGK DISEASE UNSPEC EXT ORG Internal Organ Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) Highest non-met org/tiss LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) External organ Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thyroid Thyroid IREP model Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 18 of 33 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 201.91 HODGKINS DISEASE NOS HEAD 201.92 HODGKINS DISEASE NOS THORAX 201.93 HODGKINS DISEASE NOS ABDOM 201.94 HODGKINS DISEASE NOS AXILLA 201.95 HODGKINS DISEASE NOS INGUIN 201.96 HODGKINS DISEASE NOS PELVIC 201.97 HODGKINS DISEASE NOS SPLEEN 201.98 HODGKINS DISEASE NOS MULT 202 OTHER MALIG NEO LYMPH/HISTIO 202.0 NODULAR LYMPHOMA 202.00 NDLR LYM UNSPEC EXT ORG 202.01 NODULAR LYMPHOMA HEAD 202.02 NODULAR LYMPHOMA THORAX 202.03 NODULAR LYMPHOMA ABDOM 202.04 NODULAR LYMPHOMA AXILLA 202.05 NODULAR LYMPHOMA INGUIN 202.06 NODULAR LYMPHOMA PELVIC 202.07 NODULAR LYMPHOMA SPLEEN 202.08 NODULAR LYMPHOMA MULT 202.1 MYCOSIS FUNGOIDES 202.10 MYCS FNG UNSPEC EXT ORG 202.11 MYCOSIS FUNGOIDES HEAD 202.12 MYCOSIS FUNGOIDES THORAX 202.13 MYCOSIS FUNGOIDES ABDOM 202.14 MYCOSIS FUNGOIDES AXILLA 202.15 MYCOSIS FUNGOIDES INGUIN 202.16 MYCOSIS FUNGOIDES PELVIC 202.17 MYCOSIS FUNGOIDES SPLEEN 202.18 MYCOSIS FUNGOIDES MULT 202.2 SEZARY'S DISEASE 202.20 SZRY DISEASE UNSPEC EXT ORG 202.21 SEZARY'S DISEASE HEAD 202.22 SEZARY'S DISEASE THORAX 202.23 SEZARY'S DISEASE ABDOM 202.24 SEZARY'S DISEASE AXILLA 202.25 SEZARY'S DISEASE INGUIN 202.26 SEZARY'S DISEASE PELVIC 202.27 SEZARY'S DISEASE SPLEEN Internal Organ LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin External organ Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin IREP model Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 19 of 33 Table 3-1 (Continued). ICD-9 Code 202.28 202.3 202.30 202.31 202.32 202.33 202.34 202.35 202.36 202.37 202.38 202.4 202.40 202.41 202.42 202.43 202.44 202.45 202.46 202.47 202.48 202.5 202.50 202.51 202.52 202.53 202.54 202.55 202.56 202.57 202.58 202.6 202.60 202.61 202.62 202.63 202.64 202.65 Cancer code explanation SEZARY'S DISEASE MULT MALIG HISTIOCYTOSIS MLG HIST UNSPEC EXT ORG MALIG HISTIOCYTOSIS HEAD MALIG HISTIOCYTOSIS THORAX MALIG HISTIOCYTOSIS ABDOM MALIG HISTIOCYTOSIS AXILLA MALIG HISTIOCYTOSIS INGUIN MALIG HISTIOCYTOSIS PELVIC MALIG HISTIOCYTOSIS SPLEEN MALIG HISTIOCYTOSIS MULT LEUKEM RETICULOENDOTHEL LK RTCTL UNSPEC EXT ORG HAIRY-CELL LEUKEM HEAD HAIRY-CELL LEUKEM THORAX HAIRY-CELL LEUKEM ABDOM HAIRY-CELL LEUKEM AXILLA HAIRY-CELL LEUKEM INGUIN HAIRY-CELL LEUKEM PELVIC HAIRY-CELL LEUKEM SPLEEN HAIRY-CELL LEUKEM MULT LETTERER-SIWE DISEASE LTR-SIWE UNSPEC EXT ORG LETTERER-SIWE DISEASE HEAD LETTERER-SIWE DISEASE THORAX LETTERER-SIWE DISEASE ABDOM LETTERER-SIWE DISEASE AXILLA LETTERER-SIWE DISEASE INGUIN LETTERER-SIWE DISEASE PELVIC LETTERER-SIWE DISEASE SPLEEN LETTERER-SIWE DISEASE MULT MALIG MAST CELL TUMORS MALIG MAST UNSPEC EXT ORG MALIG MASTOCYTOSIS HEAD MALIG MASTOCYTOSIS THORAX MALIG MASTOCYTOSIS ABDOM MALIG MASTOCYTOSIS AXILLA MALIG MASTOCYTOSIS INGUIN Internal Organ Skin LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss Highest non-met org/tiss Spleen LN(TH) Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(ET) LN(TH) Highest non-met org/tiss LN(TH) Highest non-met org/tiss External organ Skin Thyroid Thyroid Thyroid Lung Stomach Lung Bladder Bladder Stomach Thyroid Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Thyroid Thyroid Thyroid Lung Stomach Lung Bladder IREP model Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 20 of 33 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 202.66 MALIG MASTOCYTOSIS PELVIC 202.67 MALIG MASTOCYTOSIS SPLEEN 202.68 MALIG MASTOCYTOSIS MULT 202.8 LYMPHOMAS NEC 202.80 OTHER LYMP UNSPEC EXT ORG 202.81 LYMPHOMAS NEC HEAD 202.82 LYMPHOMAS NEC THORAX 202.83 LYMPHOMAS NEC ABDOM 202.84 LYMPHOMAS NEC AXILLA 202.85 LYMPHOMAS NEC INGUIN 202.86 LYMPHOMAS NEC PELVIC 202.87 LYMPHOMAS NEC SPLEEN 202.88 LYMPHOMAS NEC MULT 202.9 MALIG NEO LYM/HIST TIS NEC 202.90 UNSPEC LYM UNSPEC EXT ORG 202.91 LYMPHOID MALIG NEC HEAD 202.92 LYMPHOID MALIG NEC THORAX 202.93 LYMPHOID MALIG NEC ABDOM 202.94 LYMPHOID MALIG NEC AXILLA 202.95 LYMPHOID MALIG NEC INGUIN 202.96 LYMPHOID MALIG NEC PELVIC 202.97 LYMPHOID MALIG NEC SPLEEN 202.98 LYMPHOID MALIG NEC MULT 203 MULTIPLE MYELOMA ET AL 203.0 MULTIPLE MYELOMA 203.00 MULT MYELM W/O REMISSION 203.01 MULT MYELM W/REMISSION 203.1 PLASMA CELL LEUKEMIA 203.10 PLSM CELL LEUK W/O REMISSON 203.11 PLSM CELL LEUK W/REMISS 203.8 IMMUNOPROLIFERAT NEOPLASM NEC 203.80 OTHER IMNPRFL NPL W/O REMISS 203.81 OTHER IMNPRFL NPL W/REMISS 204 LYMPHOID LEUKEMIA 204.0 ACUTE LYMPHOID LEUKEMIA 204.00 ACT LYM LEUK W/O REMISS 204.01 ACT LYM LEUK W/REMISS 204.1 CHRONIC LYMPHOID LEUKEMIA Internal Organ Highest non-met org/tiss Spleen LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) LN(TH) Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow NA External organ Bladder Stomach Thyroid Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Thymus/Lung7 Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow NA IREP model Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Lymphoma and multiple myeloma Acute lymphoid leukemia Acute lymphoid leukemia Acute lymphoid leukemia Acute lymphoid leukemia NA4 Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 21 of 33 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 204.10 CHRONIC LYM LEUK W/O REMISS 204.11 CHRONIC LYM LEUK W/REMISS 204.2 SUBACUTE LYMPHOID LEUKEMIA 204.20 SBAC LYM LEUK W/O REMISS 204.21 SBAC LYM LEUK W/REMISS 204.8 LYMPHOID LEUKEMIA NEC 204.80 OTHER LYM LEUK W/O REMISS 204.81 OTHER LYM LEUK W/REMISS 204.9 LYMPHOID LEUKEMIA NOS 204.90 UNS LYM LEUK W/O REMISS 204.91 UNS LYM LEUK W/REMISS 205 MYELOID LEUKEMIA 205.0 205.00 205.01 205.1 205.10 205.11 205.2 205.20 205.21 205.3 205.30 205.31 205.8 205.80 205.81 205.9 205.90 ACUTE MYELOID LEUKEMIA ACT MYL LEUK W/O REMISS ACT MYL LEUK W/REMISS CHRONIC MYELOID LEUKEMIA CHRONIC MYL LEUK W/O REMISS CHRONIC MYL LEUK W/REMISS SUBACUT MYELOID LEUKEMIA SBAC MYL LEUK W/O REMISS SBAC MYL LEUK W/REMISS MYELOID SARCOMA MYL SRCOMA W/O REMISS MYL SRCOMA W/REMISS MYELOID LEUKEMIA NEC OTHER MYL LEUK W/O REMISS OTHER MYL LEUK W/REMISS MYELOID LEUKEMIA NOS UNS MYL LEUK W/O REMISS Internal Organ NA NA Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow External organ NA NA Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow IREP model NA4 NA4 Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Acute lymphoid leukemia Acute lymphoid leukemia Acute lymphoid leukemia Leukemia, less CLL AND Acute myeloid leukemia Leukemia, less CLL AND Acute myeloid leukemia Leukemia, less CLL AND Acute myeloid leukemia Leukemia, less CLL AND Acute myeloid leukemia Leukemia, less CLL AND Chronic myeloid leukemia Leukemia, less CLL AND Chronic myeloid leukemia Leukemia, less CLL AND Chronic myeloid leukemia Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL AND Acute myeloid leukemia Leukemia, less CLL AND Acute myeloid leukemia Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 22 of 33 Table 3-1 (Continued). ICD-9 Code 205.91 206 206.0 206.00 206.01 206.1 206.10 206.11 206.2 206.20 206.21 206.8 206.80 206.81 206.9 206.90 206.91 207 207.0 207.00 207.01 207.1 207.10 207.11 207.2 207.20 207.21 207.8 207.80 207.81 208 208.0 208.00 Cancer code explanation UNS MYL LEUK W/REMISS MONOCYTIC LEUKEMIA ACUTE MONOCYTIC LEUKEMIA ACT MONO LEUK W/O REMISS ACT MONO LEUK W/REMISS CHRONIC MONOCYTIC LEUKEMIA CHRONIC MONO LEUK W/O REMISS CHRONIC MONO LEUK W/REMISS SUBAC MONOCYTIC LEUKEMIA SBACUTE MONO LEUK W/O REMISS SBACUTE MONO LEUK W/REMISS MONOCYTIC LEUKEMIA NEC OTHER MONO LEUK W/O REMISS OTHER MONO LEUK W/REMISS MONOCYTIC LEUKEMIA NOS UNS MONO LEUK W/O REMISS UNS MONO LEUK W/REMISS OTHER SPECIFIED LEUKEMIA ACUTE ERYTHREMIA ACT ERTH/ERYLK W/O REMISS ACT ERTH/ERYLK W/REMISS CHRONIC ERYTHREMIA CHRONIC ERYTHRM W/O REMISION CHRONIC ERYTHRM W/REMISION MEGAKARYOCYTIC LEUKEMIA MGKRYCYT LEUK W/O REMISS MGKRYCYT LEUK W/REMISS SPECIFIED LEUKEMIA NEC OTHER SPF LEUK W/O REMISS OTHER SPF LEUK W/REMSION LEUKEMIA-UNSPECIF CELL ACT LEUK UNS CL W/O REMISS ACT LEUK UNS CL W/O REMISS Internal Organ Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow External organ Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow IREP model Leukemia, less CLL AND Acute myeloid leukemia Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL AND Acute lymphoid leukemia AND Acute myeloid leukemia Leukemia, less CLL AND Acute lymphoid leukemia AND Acute myeloid leukemia Leukemia, less CLL AND Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 23 of 33 Acute lymphoid leukemia AND Acute myeloid leukemia Document No. ORAUT-OTIB-0005 Table 3-1 (Continued). ICD-9 Code 208.01 208.1 208.10 208.11 208.2 208.20 208.21 208.8 208.80 208.81 208.9 Cancer code explanation ACT LEUK UNS CL W/REMISS CHRONIC LEUKEMIA NOS CHRONIC LEUK UNS CL W/O REMISS CHRONIC LEUK UNS CL W/REMISS SUBACUTE LEUKEMIA NOS SUBACUTE LEUKEMIA UNS CL W/O REMISSION SUBACUTE LEUKEMIA UNS CL W/REMISSION LEUKEMIA-UNSPEC CELL NEC OTHER LEUK UNS CL W/O REMISSION OTHER LEUK UNS CL W/REMISSION LEUKEMIA-UNSPEC CELL NOS Internal Organ Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow External organ Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow IREP model Leukemia, less CLL AND Acute lymphoid leukemia AND Acute myeloid leukemia Leukemia, less CLL AND Chronic myeloid leukemia Leukemia, less CLL AND Chronic myeloid leukemia Leukemia, less CLL AND Chronic myeloid leukemia Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL Leukemia, less CLL AND Acute lymphoid leukemia AND Acute myeloid leukemia AND Chronic myeloid leukemia Leukemia, less CLL AND Acute lymphoid leukemia AND Acute myeloid leukemia AND Chronic myeloid leukemia Leukemia, less CLL AND Acute lymphoid leukemia AND Acute myeloid leukemia AND Chronic myeloid leukemia Oral cav. and pharynx Esophagus Stomach Colon Rectum Rectum Rectum Revision No. 02 Effective Date: 12/02/2005 208.90 OTHER LEUK NOS W/O REMISSION Red Bone Marrow Red Bone Marrow 208.91 OTHER LEUK NOS W/REMISSION Red Bone Marrow Red Bone Marrow 230 230.0 230.1 230.2 230.3 230.4 230.5 230.6 CA IN SITU DIGESTIVE ORG CA IN SITU ORAL CAV/PHAR CA IN SITU ESOPHAGUS CA IN SITU STOMACH CA IN SITU COLON CA IN SITU RECTUM CA IN SITU ANAL CANAL CA IN SITU ANUS NOS Highest non-met org/tiss Esophagus Stomach Colon LLI LLI LLI Thyroid Esophagus Stomach Colon Colon Colon Colon Page 24 of 33 230.7 CA IN SITU BOWEL NEC/NOS Colon Colon All digestive Document No. ORAUT-OTIB-0005 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 230.8 CA IN SITU LIVER/BILIARY 230.9 CA IN SITU GI NEC/NOS 231 CA IN SITU RESPIRATORY 231.0 CA IN SITU LARYNX 231.1 CA IN SITU TRACHEA 231.2 CA IN SITU BRONCHUS/LUNG 231.8 CA IN SITU RESP SYS NEC 231.9 CA IN SITU RESP SYS NOS 232 CARCINOMA IN SITU SKIN 232.0 CA IN SITU SKIN LIP 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 233 233.0 233.1 233.2 233.3 233.4 233.5 CA IN SITU EYELID CA IN SITU SKIN EAR CA IN SITU SKIN FACE NEC CA IN SITU SCALP CA IN SITU SKIN TRUNK CA IN SITU SKIN ARM CA IN SITU SKIN LEG CA IN SITU SKIN NEC CA IN SITU SKIN NOS CA IN SITU BREAST/GU CA IN SITU BREAST CA IN SITU CERVIX UTERI CA IN SITU UTERUS NEC CA IN SITU FEM GEN NEC CA IN SITU PROSTATE CA IN SITU PENIS Internal Organ External organ Liver Liver Highest non-met org/tiss Remainder2 ET2 BB Lung Medical review Lung Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Breast Uterus Uterus Uterus Esophagus Thyroid Lung Medical review Lung Skin Skin Skin Skin Skin Skin Skin Skin Skin Skin Breast Uterus Uterus Uterus IREP model Liver All digestive Other respiratory Lung Lung Other respiratory Other respiratory Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Malignant melanoma AND Non-melanoma skin-Squamous cell5 Breast Female genitalia less ovary Female genitalia less ovary Female genitalia less ovary AND Ovary All male genitalia All male genitalia Revision No. 02 Effective Date: 12/02/2005 Page 25 of 33 Highest non-met org/tiss Bladder Testes Testes 233.6 CA IN SITU MALE GEN NEC Testes Testes All male genitalia Document No. ORAUT-OTIB-0005 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 233.7 CA IN SITU BLADDER 233.9 CA IN SITU URINARY NEC 234 CA IN SITU NEC/NOS 234.0 CA IN SITU EYE 234.8 CA IN SITU NEC 234.9 CA IN SITU NOS 235 UNCERT BEHAV NEOPLASM GI/RESP 235.0 UNCERT BEHAV NEOPLASM SALIVARY 235.1 UNCERT BEHAV NEOPLASM ORAL/PHAR 235.2 UNCERT BEHAV NEOPLASM INTESTINE (stomach) 235.2 UNCERT BEHAV NEOPLASM INTESTINE (colon) 235.2 UNCERT BEHAV NEOPLASM INTESTINE (rectum) 235.3 UNCERT BEHAV NEOPLASM LIVER 235.4 UNCERT BEHAV NEOPLASM PERITONEUM 235.5 UNCERT BEHAV NEOPLASM GI NEC 235.6 UNCERT BEHAV NEOPLASM LARYNX 235.7 UNCERT BEHAV NEOPLASM LUNG 235.8 UNCERT BEHAV NEOPLASM PLEURA 235.9 UNCERT BEHAV NEOPLASM RESP NEC 236 UNCERT BEHAV NEOPLASM GU 236.0 UNCERT BEHAV NEOPLASM UTERUS 236.1 UNCERT BEHAV NEOPLASM PLACENTA 236.2 UNCERT BEHAV NEOPLASM OVARY 236.3 UNCERT BEHAV NEOPLASM FEMALE NEC 236.4 UNCERT BEHAV NEOPLASM TESTIS 236.5 UNCERT BEHAV NEOPLASM PROSTATE 236.6 UNCERT BEHAV NEOPLASM MALE NEC 236.7 UNCERT BEHAV NEOPLASM BLADDER 236.9 UNCERT BEHAV NEOPLASM OTHER URINAR 236.90 UNCERT BEHAV NEOPLASM URINAR NOS 236.91 UNCERT BEHAV NEOPLASM KIDNEY 236.99 UNCERT BEHAV NEOPLASM URINAR NEC 237 UNCER NEOPLASM ENDOCRINE/NERV Internal Organ Bladder Medical review External organ Bladder Liver IREP model Bladder Urinary organs less bladder Eye Other and ill-defined sites Other and ill-defined sites Brain Eye Lens Highest non-met org/tiss Remainder2 Highest non-met org/tiss Remainder2 Highest non-met org/tiss Thyroid/Remainder1 Oral cav. and pharynx Highest non-met org/tiss Thyroid/Remainder1 Oral cav. and pharynx Stomach Stomach Stomach Colon LLI Liver Highest non-met org/tiss Colon ET2 Lung Medical review Medical review Uterus Uterus Ovaries Medical review Testes Highest non-met org/tiss Testes Bladder Medical review Medical review Medical review Medical review Colon Colon Liver Colon Colon Esophagus Lung Lung Lung Uterus Uterus Ovaries Uterus Testes Bladder Testes Bladder Liver Liver Liver Liver Colon Rectum Liver All digestive All digestive Other respiratory Lung Other respiratory Other respiratory Female genitalia, less ovary Female genitalia, less ovary Ovary Female genitalia, less ovary All male genitalia All male genitalia All male genitalia Bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Urinary organs less bladder Revision No. 02 Effective Date: 12/02/2005 Page 26 of 33 237.0 UNCERT BEHAV NEOPLASM PITUITARY Brain Thyroid/Remainder1 Thyroid Document No. ORAUT-OTIB-0005 Table 3-1 (Continued). ICD-9 Code Cancer code explanation 237.1 UNCERT BEHAV NEOPLASM PINEAL 237.2 UNCERT BEHAV NEOPLASM ADRENAL 237.3 UNCERT BEHAV NEOPLASM PARAGANG 237.4 UNCER NEOPLASM ENDOCRINE NEC 237.5 UNCERT BEH NEOPLASM BRAIN/SPINAL 237.6 UNCERT BEHAV NEOPLASM MENINGES 237.7 NEUROFIBROMATOSIS 237.70 NEUROFIBROMATOSIS NOS 237.71 NEUROFIBROMATOSIS TYPE I 237.72 NEUROFIBROMATOSIS TYP II 237.9 UNCERT BEH NEOPLASM NERV SYS NEC 238 UNCERT BEHAV NEOPLASM NEC/NOS 238.0 UNCERT BEHAV NEOPLASM BONE 238.1 UNCERT BEHAV NEOPLASM SOFT TISSU 238.2 UNCERT BEHAV NEOPLASM SKIN 238.3 238.4 238.5 238.6 238.7 238.8 238.9 239 239.0 239.1 239.2 239.2 239.3 239.4 239.5 239.5 UNCERT BEHAV NEOPLASM BREAST POLYCYTHEMIA MASTOCYTOMA NOS PLASMACYTOMA NOS LYMPHOPROLIFERAT DISEASE NOS UNCERT BEHAVIOR NEOPLASM NEC UNCERT BEHAVIOR NEOPLASM NOS UNSPECIFIED NEOPLASM DIGESTIVE NEOPLASM NOS RESPIRATORY NEOPLASM NOS BONE/SKIN NEOPLASM NOS (Bone) BONE/SKIN NEOPLASM NOS (Skin) BREAST NEOPLASM NOS BLADDER NEOPLASM NOS OTHER GU NEOPLASM NOS (Female) OTHER GU NEOPLASM NOS (Male) Internal Organ Brain Adrenal Brain Medical review Brain Brain Medical review Medical review Medical review Medical review Medical review Medical review Medical review Medical review Medical review Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Medical review Medical review Medical review Medical review Medical review Medical review Breast Bladder Medical review Medical review External organ Thyroid/Remainder1 Liver Thyroid/Remainder1 Remainder2 Thyroid/Remainder1 Thyroid/Remainder1 Remainder2 Remainder2 Remainder2 Remainder2 Remainder2 Red Bone Marrow Remainder2 Skin Breast Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow Remainder2 Remainder2 Stomach Lung Red Bone Marrow skin Breast Bladder Bladder Testes IREP model Thyroid Urinary organs less bladder Nervous system Thyroid Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Nervous system Bone Connective Tissue Malignant melanoma AND non-melanoma skin-Basal cell Breast Bone Lymphoma and multiple myeloma Lymphoma and multiple myeloma Bone AND Lymphoma and multiple myeloma Other and ill-defined sites Other and ill-defined sites All digestive Lung AND Other respiratory Bone Non-melanoma skin-Basal cell Breast Bladder Female genitalia less ovary AND Ovary AND All urinary organs All male genitalia AND All urinary organs Revision No. 02 Effective Date: 12/02/2005 Page 27 of 33 239.6 ICD-9 Code 239.7 239.7 239.8 239.9 273 273.3 289 289.7 289.8 289.9 1. 2. 3. 4. 5. 6. 7. BRAIN NEOPLASM NOS Brain Thyroid/Remainder1 Nervous system Document No. ORAUT-OTIB-0005 Table 3-1 (Continued). Cancer code explanation BRAIN/NERV NEOPLASM NOS ENDOCRINE NOS NEOPLASM NOS, SITE NEC NEOPLASM NOS DISORDERS OF PLASMA PROTEIN METABOLISM WALDENSTROM'S MACROGLOBULINEMIA OTHER SPECIFIED BLOOD DISORDER ESSENTIAL THROMBOCYTOSIS OTHER SPECIFIED DISEASES OF BLOOD AND BLOOD-FORMING ORGANS ESSENTIAL THROMBOCYTHEMIA Internal Organ Medical review Medical review Medical review Medical review Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow External organ Remainder2 Remainder2 Remainder2 Remainder2 Red Bone Marrow Red Bone Marrow Red Bone Marrow Red Bone Marrow IREP model Nervous system Thyroid AND Other endocrine glands Other and ill-defined sites Other and ill-defined sites Lymphoma and multiple myeloma Bone Bone Bone Revision No. 02 1 - See discussion in Section 4.3 2 - See discussion in Section 4.4 3 – For secondary cancers, doses are assessed for the likely primary cancer site(s), which are selected using guidance in Table 3-2. 4 - 42 CFR 81.30 states this cancer is non-radiogenic for the purposes of EEOICPA and assigns zero probability of causation. 5 – For ICD-9 code 232, if the type of cancer is specified by DOL (Malignant melanoma or Non-melanoma skin-Squamous cell) use only the specified IREP model (note that Bowden’s disease is another name for Squamous Cell Carcinoma in situ). If the cancer is not specified, run both IREP models as discussed in Section 4.6. 6 – See discussion in Section 4.7 7 - The external target organ should be lung if the lymphoma is known to be a B-cell variety, or thymus if the lymphoma is known to be a T-cell variety or if the variety is unknown. Effective Date: 12/02/2005 Page 28 of 33 Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 29 of 33 Table 3-2. Secondary cancer 196.0 Lymph nodes of head, face, and neck 196.1 Intrathoracic lymph nodes 196.2 Intra-abdominal lymph nodes 196.3 196.5 196.6 196.8 196.9 197.0 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 198.0 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 Lymph nodes of axilla and upper limb Inguinal and lower limb lymph nodes Intrapelvic lymph nodes Lymph nodes of multiple sites Lymph nodes, site unspecified Lung Mediastinum Pleura Other respiratory organs Small intestine, including duodenum Large intestine and rectum Retroperitoneum and peritoneum Liver, specified as secondary Other digestive organs Kidney Other urinary organs Skin Brain and spinal cord Other parts of nervous system Bone and bone marrow Ovary Suprarenal gland Other specified sites ICD-9 code of likely primary cancers1,2,3 141, 142(M), 146(M), 149(F), 161(M), 162, 172, 173, 174(F), 193(F) 150(M), 162, 174(F) 150(M), 151(M), 153, 157(F), 162, 174(F), 180(F), 185(M), 189, 202(F) 162, 172, 174(F) 154(M), 162, 172, 173(F), 187(M) 153(M), 154(F), 162(M), 180(F), 182(F), 185(M), 188 150(M), 151(M), 153(M), 162, 174(F) 150(M), 151, 153, 162, 172, 174(F), 185(M) 153, 162, 172(M), 174(F), 185(M), 188(M), 189 150(M), 162, 174(F) 150(M), 153(M), 162, 174(F), 183(F), 185(M), 189(M) 150, 153(M), 161, 162, 173(M), 174(F), 185(M), 193(F) 152, 153, 157, 162, 171, 172(M), 174(F), 183(F), 189(M) 153, 154, 162, 174(F), 183(F), 185(M) 151, 153, 154(M), 157, 162(M), 171, 174(F), 182(F), 183(F) 151(M), 153, 154(M), 157, 162, 174(F) 150(M), 151, 153, 157, 162, 174(F), 185(M) 153, 162, 174(F), 180(F), 185(M), 188, 189, 202(F) 153, 174(F), 180(F), 183(F), 185(M), 188, 189(F) 153, 162, 171(M), 172, 173(M), 174(F), 189(M) 162, 172(M), 174(F) 162, 172(M), 174(F), 185(M), 202 162, 174(F), 185(M) 153(F), 174(F), 183(F) 153(F), 162, 174(F) 153, 162, 172(M), 174(F), 183(F), 185(M), 188(M) 1 – “M” indicates cancer site should be used for males only, and “F” indicates cancer site should be used for females only. 2 – For likely primary cancer sites that have multiple possible IMBA or external organs, see Section 4.8. 3 – Whenever “173” is indicated as a likely primary cancer, the “non-melanoma skin-basal cell (BCC)” model should be used. If none of the likely primary cancer sites yield a probability of causation greater than or equal to 50%, the supporting documentation for all of them shall be submitted, demonstrating that all of them were less than 50%. 4.0 4.1 DISCUSSION HIGHEST NON-METABOLIC ORGAN The dose estimate for a number of tissues is based on the highest non-metabolic organ dose, designated as “Highest non-met org/tiss” in the table. Metabolic organs are those that are specifically modeled by the ICRP for a particular element. The biokinetic models are based on the behavior of the particular element in the body, so the metabolic organs vary with the element of interest. The metabolic organs also include the gastrointestinal tract (ICRP 30) and, in the case of inhalation, the respiratory tract (ICRP 66). For radionuclides that primarily emit alpha or beta radiation, the soft tissue compartment becomes the primary recipient of dose. This compartment contains all the organs not specifically accounted for in the metabolic model. This compartment accounts for the dose delivered by material actually deposited in that tissue. An additional source of exposure to the tissue is known as photon crossirradiation. This cross-irradiation is the exposure to a tissue from photons originating in other tissues. Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 30 of 33 When the energy emitted by a radionuclide is primarily alpha or beta radiation, the soft tissue compartment becomes the primary source of dose. Under this scenario most of the non-metabolic organs receive the same dose. For radionuclides where photon emissions are a major source of energy emitted, the non-metabolic organ doses can vary due to their relative proximity to the metabolic organs in which the radionuclides concentrate. IMBA calculates the dose from both means of irradiation and sums them. For many radionuclides (predominately alpha and beta emitters) this will cause only minor differences in doses to non-metabolic organs, so choosing the highest is a realistic assumption with only minor (if any) overestimation. It is conceivable that a situation could arise where a photon emitting radionuclide causes a large difference in doses delivered to non-metabolic organs. In accordance with the Internal Dose Reconstruction Implementation Guideline, it is acceptable in these situations to base the dose on an organ that is not the highest non-metabolic organ. The choice in these cases should be based on the proximity of the model organ to the actual organ of interest. 4.2 MEDICAL REVIEW Due to the complexity of determining the appropriate organ/tissue for some ICD-9 code cancers, a medical review by an ORAU team physician is required to determine the organ/tissue to use in IMBA for those cancers. These cancers have been designated in the table as “Medical review.” The ORAU team physician will recommend to the dose reconstructor the appropriate organ/tissue for dose estimation purposes. 4.3 THYROID/REMAINDER SELECTION FOR EXTERNAL DOSE For cancer sites where “Thyroid/Remainder” is listed for the external organ selection, there is no external dose model for the organ of interest and the organ is located in close proximity to the thyroid.. The thyroid has higher organ dose conversion factors than the remainder selection, thereby maximizing the dose. If a more realistic dose assessment is required rather than a maximizing dose assessment, then the remainder organ should be selected to calculate dose. 4.4 REMAINDER SELECTION FOR EXTERNAL DOSE When there are cancers of multiple organs or the cancer site is unknown, the remainder organ should be selected as the model to apply dose. However, if the organ location can be determined through the medical records or a medical review, then an organ in close physical proximity should be selected. The remainder selection provides a claimant favorable estimate of dose. 4.5 BLADDER When the term “Bladder” is used in the table with no modifier, this represents the urinary bladder. When the organ of interest is the gallbladder, “Gallbladder” is specified clearly in the table above. 4.6 MULTIPLE IREP MODELS When multiple IREP models are listed for a given cancer type, the IREP model(s) to be run is determined based upon the use of the words “OR” and “AND” in the IREP Model column. For multiple IREP models listed that are connected by the word “OR”, only the model that best fits the actual cancer type should be selected and run in IREP. For example, ICD-9 code 173.0 has listed “Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell” in the IREP Model column. Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 31 of 33 The appropriate IREP model would be selected and run based on the type of skin cancer (Basal cell or Squamous cell) listed in the claim’s NIOSH Referral Summary Document (NRSD). For multiple IREP models listed that are connected by the word “AND”, separate IREP runs are made for each of the listed models, and compensability is determined based on the claimant favorable model resulting in the highest probability of causation. For example, ICD-9 code 233.3 has listed “Female genitalia less ovary AND Ovary “ in the IREP Model column. Separate IREP runs would be made using each model and compensability would be based upon the model that resulted in the highest probability of causation. 4.7 ADENOCARCINOMA OF THE DISTAL (LOWER THIRD) ESOPHAGUS If adenocarcinoma is indicated in the distal esophagus (also known as the lower third, abdominal, lower thoracic esophagus, gastro-esophageal, cardio-esophageal junction, or esophageal cardia), the appropriate IMBA, external, and IREP organ model is the stomach. In order to use the stomach, both conditions MUST be met (adenocarcinoma AND correct location). If either condition is not met, the use of the esophagus for the IMBA, external, and IREP organ model is appropriate. 4.8 SECONDARY CANCERS - LIKELY PRIMARY CANCER SITES WITH MULTIPLE IMBA, EXTERNAL, AND IREP ORGAN MODEL OPTIONS For secondary cancers with unknown primary cancers sites, the likely primary cancer sites are listed in Table 3-2. Since the likely primary cancer sites are listed only by ICD-9 code (three digit code with no extensions), it is possible for a single likely primary cancer site to have multiple options for IMBA, external, and IREP organ model selection. In this case, each possible option must be assessed and the option that yields the largest probability of causation shall be submitted. For example, secondary cancer code 196.2 has a likely primary cancer site of ICD-9 code 153. ICD-9 code 153 has an Internal Dosimetry Organ selection of ULI, LLI, and colon, depending on the extension of the ICD-9 code. Since it is an unknown location, each of these organs must be run for internal dose purposes and the one yielding the largest dose over the exposure period would be selected for use in the IREP run. 4.9 MULTIPLE SECONDARY CANCERS WITH UNKNOWN PRIMARY CANCER SITE OR MULTIPLE PRIMARY AND SECONDARY CANCERS In some claims, multiple secondary cancers with unknown primary cancer location may be indicated. In such cases, unless the DOL specifically states differently, each likely primary cancer site from each secondary cancer is to be treated separately, with individual IREP probability of causation determinations and combined as separate primary cancers. For example, consider a claim has indicated separate secondary cancers of 196.0 (Lymph nodes of head, face, and neck) and 197.7 (Liver, specified as secondary), with no indication of the cancers being metastasized from a single unknown primary cancer site. When each of the likely primary cancer sites are assessed, ICD-9 code 162 (Lung) yields the largest probability of causation for each of 38.00% (for this example only). Since it is possible that each secondary cancer came from a separate likely primary lung cancer, the probability of causation results for each likely primary lung cancer would be combined to yield a final probability of causation of 61.56% (per multiple cancer calculation in IREP). The same type of situation may occur when primary and secondary cancers are both indicated by DOL. The same logic applies that, unless specifically directed otherwise by DOL, each cancer will be Document No. ORAUT-OTIB-0005 Revision No. 02 Effective Date: 12/02/2005 Page 32 of 33 treated as a totally separate cancer for the determination of Probability of Causation and for combining them for the final Probability of Causation. It should not be assumed by the Dose Reconstructor that any listed secondary cancer has metastasized from another listed primary cancer. Document No. ORAUT-OTIB-0005 Revision No. 02 PC-1 Effective Date: 02/10/2006 Page 33 of 33 REFERENCES 42 CFR § 81, Guidelines for Determining the Probability of Causation Under the Energy Employees Occupational Illness Compensation Program Act of 2000; Final Rule, Federal Register/Vol.67, No. 85/Thursday, May 2, 2002, p 22296 NIOSH, (2002) Internal Dose Reconstruction Implementation Guideline, Rev 0, OCAS-IG-002, National Institute for Occupational Safety and Health, Office of Compensation Analysis and Support, Cincinnati, Ohio, August 2002 NIOSH, (2002) External Dose Reconstruction Implementation Guideline, Rev 1, OCAS-IG-001, National Institute for Occupational Safety and Health, Office of Compensation Analysis and Support, Cincinnati, Ohio, August 2002 ACJ & Associates and the UK National Radiological Protection Board, Integrated Modules for Bioassay Analysis, (IMBA), Software produced for NIOSH-OCAS as part of the EEOICPA Program, UK, July 2003 NIOSH, NIOSH-Interactive RadioEpidemiological Program (NIOSH-IREP), Technical Documentation, Office of Compensation Analysis and Support, Cincinnati, Ohio, June 2002 Office of Compensation Analysis and Support, OCAS-TIB-012, Rev 1, Selection of internal and external dosimetry target organs for lymphatic/hematopoietic cancers, February 10, 2006. Energy Employees Occupational Illness Compensation Program Act of 2000, EEOICPA Bulletin No. 03-32, Clarification by NCI of Certain Primary Cancers, August 27, 2003.