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Malignant Neoplasm of the Liver B032
In this section
Current RMA Instruments:
|Reasonable Hypothesis SOP||21 of 2011|
|Balance of Probabilities SOP||22 of 2011|
Changes from Previous Instruments:
- ICD-9-CM Codes: 155.0
- ICD-10-AM Codes: C22.0
Is specific diagnostic evidence required to apply the SOP? – Yes.
Information on the histological type is required. Note the excluded conditions, listed below. The liver is a common site for secondary/metastatic cancer. Ensure the claimed condition is a primary liver cancer before applying this SOP.
Are there sub-factors that require specific information? – No.
Diagnoses covered by SOP
- hepatocellular carcinoma
- liver cell carcinoma
- malignant hepatoma
- malignant teratoma of the liver
Conditions excluded from SOP
- carcinoma of an intrahepatic bile duct, ICD code 155.1
- cholangiocarcinoma of the liver, ICD code 155.1
- Hodgkin’s lymphoma of the liver, ICD code 201.9
- non-Hodgkin’s lymphoma of the liver, ICD code 202.8
- soft tissue sarcoma of the liver, ICD code 171.8
- Secondary/metastatic cancer/carcinoma involving the liver (code to primary cancer site)
If, after applying the above information, you are unable to confirm the diagnosis, you should then:
- seek medical officer advice about further investigation, or;
- generate a diagnostic report, or;
- re-encode the condition, if appropriate.
The following may be useful in establishing the diagnosis:
- A report from a treating specialist;
- A histopathology report.