81.23—Guidelines for cancers for which primary site is unknown.
(a)
In claims for which the primary cancer site cannot be determined, but a site of metastasis is known, DOL will calculate probability of causation estimates for various likely primary sites. Table 1, below, indicates the primary cancer site(s) DOL will use in NIOSH-IREP when the primary cancer site is unknown.
Primary cancers (ICD-9 codes 3) for which probability of causation is to be calculated, if only a secondary cancer site is known. “M” indicates cancer site should be used for males only, and “F” indicates the cancer site should be used for females only. A glossary of cancer descriptions for each ICD-9 code is provided in appendix A to this part.
Code of Federal Regulations
Footnote(s): 3 The International Classification of Diseases Clinical Modification (9th Revision) Volume I&II. [1991] Department of Health and Human Services Publication No. (PHS) 91-1260, U.S. Government Printing Office, Washington D.C.
| Secondary cancer (ICD-9 code) | ICD-9 code of likely primary cancers |
|---|---|
| Lymph nodes of head, face and neck (196.0) | 141, 142 (M), 146 (M), 149 (F), 161 (M), 162, 172, 173, 174 (F), 193 (F). |
| Intrathoracic lymph nodes (196.1) | 150 (M), 162, 174 (F). |
| Intra-abdominal lymph nodes (196.2) | 150 (M), 151 (M), 153, 157 (F), 162, 174 (F), 180 (F), 185 (M), 189, 202 (F). |
| Lymph nodes of axilla and upper limb (196.3) | 162, 172, 174 (F). |
| Inguinal and lower limb lymph nodes (196.5) | 154 (M), 162, 172, 173 (F), 187 (M). |
| Intrapelvic lymph nodes (196.6) | 153 (M), 154 (F), 162 (M), 180 (F), 182 (F), 185 (M), 188. |
| Lymph nodes of multiple sites (196.8) | 150 (M), 151 (M), 153 (M), 162, 174 (F). |
| Lymph nodes, site unspecified (196.9) | 150 (M), 151, 153, 162, 172, 174 (F), 185 (M). |
| Lung (197.0) | 153, 162, 172 (M), 174 (F), 185 (M), 188 (M), 189. |
| Mediastinum (197.1) | 150 (M), 162, 174 (F). |
| Pleura (197.2) | 150 (M), 153 (M), 162, 174 (F), 183 (F), 185 (M), 189 (M). |
| Other respiratory organs (197.3) | 150, 153 (M), 161, 162, 173 (M), 174 (F), 185 (M), 193 (F). |
| Small intestine, including duodenum (197.4) | 152, 153, 157, 162, 171, 172 (M), 174 (F), 183 (F), 189 (M). |
| Large intestine and rectum (197.5) | 153, 154, 162, 174 (F), 183 (F), 185 (M). |
| Retroperitoneum and peritoneum (197.6) | 151, 153, 154 (M), 157, 162 (M), 171, 174 (F), 182 (F), 183 (F). |
| Liver, specified as secondary (197.7) | 151 (M), 153, 154 (M), 157, 162, 174 (F). |
| Other digestive organs (197.8) | 150 (M), 151, 153, 157, 162, 174 (F), 185 (M). |
| Kidney (198.0) | 153, 162, 174 (F), 180 (F), 185 (M), 188, 189, 202 (F). |
| Other urinary organs (198.1) | 153, 174 (F), 180 (F), 183 (F), 185 (M), 188, 189 (F). |
| Skin (198.2) | 153, 162, 171 (M), 172, 173 (M), 174 (F), 189 (M). |
| Brain and spinal cord (198.3) | 162, 172 (M), 174 (F). |
| Other parts of nervous system (198.4) | 162, 172 (M), 174 (F), 185 (M), 202. |
| Bone and bone marrow (198.5) | 162, 174 (F), 185 (M). |
| Ovary (198.6) | 153 (F), 174 (F), 183 (F). |
| Suprarenal gland (198.7) | 153 (F), 162, 174 (F). |
| Other specified sites (198.8) | 153, 162, 172 (M), 174 (F), 183 (F), 185 (M), 188 (M). |
(b)
DOL will select the site producing the highest estimate for probability of causation to adjudicate the claim.