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Malignant Neoplasm of the Anus and Anal Canal B027
Current RMA Instruments:
|Reasonable Hypothesis SOP||51 of 2013|
|Balance of Probabilities SOP||52 of 2013|
Changes from Previous Instruments:
- ICD-9-CM Codes: 154.2, 154.3, 154.8, 230.5, 230.6
- ICD-10-AM Codes: C21.0, C21.1, C21.2, D01.3
Is specific diagnostic evidence required to apply the SOP? – Yes.
This is a histological diagnosis based on biopsy or operative specimen. The relevant medical specialist is a general surgeon, oncologist or gastroenterologist.
Are there sub-factors that require specific information? – No.
Additional diagnoses covered by SOP
- Adenocarcinoma of the anus / anal canal
- Squamous cell carcinoma of the anus / anal canal
- Carcinoma in situ of the anus / anal canal
Conditions not covered by SOP
- Hodgkin’s lymphoma of the anus / anal canal, use ICD code 201.9
- Malignant melanoma of the anus / anal canal
- Malignant neoplasm of anal margin, ICD-9 code 173.5
- Malignant neoplasm of perianal skin, ICD-9 code 173.5
- Malignant neoplasm of the rectum, ICD-9 code 154.1
- Non-Hodgkin’s lymphoma of the anus / anal canal, use ICD code 202.8
- Soft tissue sarcoma of the anus / anal canal, use ICD code 171.8
If, after considering the above information you are unable to apply the SOP, you should then:
- seek medical officer advice about further investigation, or;
- re-encode the condition, if appropriate.
The following investigations may be useful in establishing the diagnosis.
- report from a gastroenterologist
- upper GI endoscopy report