ORAU Team

NIOSH Dose Reconstruction Project

Technical Information Bulletin: IMBA Organ, External 

Dosimetry Organ, and IREP Model Selection by ICD-9 Code

Document No.: 

ORAUT-OTIB-0005

Effective Date: 05/07/2004

Revision No.: 01 PC-2 

Controlled Copy No.: ________

Page 1 of 19

Subject Expert: Scott R. Siebert

Approval: Signature on File Date: 01/28/2004

James P. Griffin, Task 5 Manager 

Concurrence: Signature on File Date: 01/28/2004 Richard E. Toohey, Project Director

Approval: Signature on File Date: 01/30/2004

James W. Neton, NIOSH, OCAS Health Science Administrator

Supersedes: 

 

 Revision No.: 00
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 2 of 19

RECORD OF ISSUE/REVISIONS

ISSUE 

AUTHORIZATION 

DATE

EFFECTIVE 

DATE REV. NO. DESCRIPTION

Draft 10/15/2003 00-A ORAU technical information bulletin to clarify 

IMBA organ and IREP model selection. Initiated 

by Elizabeth Brackett. 

Draft 11/03/2003 00-B Incorporates comments from NIOSH and ORAU 

team members.

11/03/2003 11/03/2003 00 First approved issue. Initiated by Elizabeth 

Brackett.

Draft 01/15/2004 01-A Incorporates applicable external dosimetry organ 

selection. Initiated by Elizabeth Brackett.

Draft 01/23/2004 01-B Incorporates comments from NIOSH and ORAU 

team members. Initiated by Elizabeth Brackett.

01/23/2004 01/23/2004 01 Approved issue of Revision 01. Initiated by 

Elizabeth Brackett.

01/23/2004 03/05/2004 01-PC-1 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. 

Initiated by Elizabeth Brackett. 

Approval:

Signature on File 03/08/2004 

James P. Griffin, Task 5, Manager 

Richard E. Toohey, Project Director

Signature on File 03/08/2004

James W. Neton, OCAS Health Science 

Administrator

Signature on File 03/08/2004

01/23/2004 05/07/2004 01-PC-2 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. Initiated by Elizabeth Brackett. 

Approval:

Signature on File 05/07/2004 

Matt McFee, Task 5, Manager 

Richard E. Toohey, Project Director

Signature on File 05/04/2004

James W. Neton, OCAS Health Science 

Signature on File 05/07/2004
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 3 of 19

Administrator

1.0 Purpose

This Technical Information Bulletin provides guidance on selecting appropriate ICRP modeled 

organs/tissues in the Integrated Modules for Bioassay Analysis (IMBA) software program 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). 

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 IMBA 

model, organ/tissue for external dose estimate, and IREP model to use for the organ/tissue. This TIB 

designates the appropriate organ/tissue selection within IMBA to use 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 Guidance

The following table correlates ICD-9 codes to the appropriate organ/tissue selection in IMBA, 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 IMBA. 

Table 1

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

140 MALIGANT NEOPLASM LIP 

140.0 MALIG NEO UPPER VERMILION Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.1 MALIG NEO LOWER VERMILION Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.3 MALIG NEO UPPER LIP, INNER Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.4 MALIG NEO LOWER LIP, INNER Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.5 MALIG NEO LIP, INNER NOS Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.6 MALIG NEO LIP, COMMISSURE Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.8 MALIG NEO LIP NEC Highest non-met 

org/tiss

Skin Oral Cav and pharynx

140.9 MALIG NEO LIP/VERMIL NOS Highest non-met 

org/tiss

Skin Oral Cav and pharynx

141 MALIG NEO TONGUE 

141.0 MALIG NEO TONGUE BASE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.1 MALIG NEO DORSAL TONGUE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.2 MALIG NEO TIP/LAT TONGUE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.3 MALIG NEO VENTRAL TONGUE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.4 MALIG NEO ANT 2/3 TONGUE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.5 MALIG NEO TONGUE JUNCTION Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.6 MALIG NEO LINGUAL TONSIL LNET Thyroid/Remainder1 Oral Cav and pharynx
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 4 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

141.8 MALIG NEO TONGUE NEC Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

141.9 MALIG NEO TONGUE NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

142 MALIG NEO MAJOR SALIVARY 

142.0 MALIG NEO PAROTID Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

142.1 MALIG NEO SUBMANDIBULAR Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

142.2 MALIG NEO SUBLINGUAL Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

142.8 MALIG NEO MAJ SALIVARY NEC Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

142.9 MALIG NEO SALIVARY NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

143 MALIGNANT NEOPLASM GUM 

143.0 MALIG NEO UPPER GUM Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

143.1 MALIG NEO LOWER GUM Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

143.8 MALIG NEO GUM NEC Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

143.9 MALIG NEO GUM NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

144 MALIG NEO MOUTH FLOOR 

144.0 MALIG NEO ANT FLOOR MOUTH Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

144.1 MALIG NEO LAT FLOOR MOUTH Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

144.8 MALIG NEO MOUTH FLOOR NEC Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

144.9 MALIG NEO MOUTH FLOOR NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145 MALIG NEO MOUTH NEC/NOS 

145.0 MALIG NEO CHEEK MUCOSA Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.1 MALIG NEO MOUTH VESTIBULE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.2 MALIG NEO HARD PALATE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.3 MALIG NEO SOFT PALATE Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.4 MALIG NEO UVULA Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.5 MALIG NEO PALATE NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.6 MALIG NEO RETROMOLAR Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.8 MALIG NEO MOUTH NEC Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

145.9 MALIG NEO MOUTH NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Oral Cav and pharynx

146 MALIG NEO OROPHARYNX 

146.0 MALIG NEO TONSIL LNET Esophagus Oral Cav and pharynx

146.1 MALIG NEO TONSILLAR FOSSA LNET Esophagus Oral Cav and pharynx

146.2 MALIG NEO TONSIL PILLARS LNET Esophagus Oral Cav and pharynx

146.3 MALIG NEO VALLECULA ET2 Esophagus Oral Cav and pharynx

146.4 MALIG NEO ANT EPIGLOTTIS ET2 Esophagus Oral Cav and pharynx

146.5 MALIG NEO EPIGLOTTIS JUNCT ET2 Esophagus Oral Cav and pharynx

146.6 MALIG NEO LAT OROPHARYNX ET2 Esophagus Oral Cav and pharynx

146.7 MALIG NEO POST OROPHARYNX ET2 Esophagus Oral Cav and pharynx

146.8 MALIG NEO OROPHARYNX NEC ET2 Esophagus Oral Cav and pharynx

146.9 MALIG NEO OROPHARYNX NOS ET2 Esophagus Oral Cav and pharynx

147 MALIG NEO NASOPHARYNX 

147.0 MALIG NEO SUPER NASOPHARYN ET2 Esophagus Oral Cav and pharynx

147.1 MALIG NEO POST NASOPHARYNX ET2 Esophagus Oral Cav and pharynx

147.2 MALIG NEO LAT NASOPHARYNX ET2 Esophagus Oral Cav and pharynx

147.3 MALIG NEO ANT NASOPHARYNX ET2 Esophagus Oral Cav and pharynx

147.8 MALIG NEO NASOPHARYNX NEC ET2 Esophagus Oral Cav and pharynx

147.9 MALIG NEO NASOPHARYNX NOS ET2 Esophagus Oral Cav and pharynx
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 5 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

148 MALIG NEO HYPOPHARYNX 

148.0 MALIG NEO POSTCRICOID ET2 Esophagus Oral Cav and pharynx

148.1 MALIG NEO PYRIFORM SINUS ET2 Esophagus Oral Cav and pharynx

148.2 MALIG NEO ARYEPIGLOTT FOLD ET2 Esophagus Oral Cav and pharynx

148.3 MALIG NEO POST HYPOPHARYNX ET2 Esophagus Oral Cav and pharynx

148.8 MALIG NEO HYPOPHARYNX NEC ET2 Esophagus Oral Cav and pharynx

148.9 MALIG NEO HYPOPHARYNX NOS ET2 Esophagus Oral Cav and pharynx

149 OTHER MALIG OROPHARYNX 

149.0 MALIG NEO PHARYNX NOS ET2 Esophagus Oral Cav and pharynx

149.1 MALIG NEO WALDEYER'S RING LNET Esophagus Oral Cav and pharynx

149.8 MALIG NEO ORAL/PHARYNX NEC ET2 Esophagus Oral Cav and pharynx

149.9 MALIG NEO OROPHRYN ILL-DEF ET2 Esophagus Oral Cav and pharynx

150 MALIG NEO ESOPHAGUS 

150.0 MALIG NEO CERVICAL ESOPHAG Esophagus Esophagus Esophagus

150.1 MALIG NEO THORACIC ESOPHAG Esophagus Esophagus Esophagus

150.2 MALIG NEO ABDOMIN ESOPHAG Esophagus Esophagus Esophagus

150.3 MALIG NEO UPPER 3RD ESOPH Esophagus Esophagus Esophagus

150.4 MALIG NEO MIDDLE 3RD ESOPH Esophagus Esophagus Esophagus

150.5 MALIG NEO LOWER 3RD ESOPH Esophagus Esophagus Esophagus

150.8 MALIG NEO ESOPHAGUS NEC Esophagus Esophagus Esophagus

150.9 MALIG NEO ESOPHAGUS NOS Esophagus Esophagus Esophagus

151 MALIGNANT NEO STOMACH 

151.0 MALIG NEO STOMACH CARDIA Stomach Stomach Stomach

151.1 MALIG NEO PYLORUS Stomach Stomach Stomach

151.2 MALIG NEO PYLORIC ANTRUM Stomach Stomach Stomach

151.3 MALIG NEO STOMACH FUNDUS Stomach Stomach Stomach

151.4 MALIG NEO STOMACH BODY Stomach Stomach Stomach

151.5 MALIG NEO STOM LESSER CURV Stomach Stomach Stomach

151.6 MALIG NEO STOM GREAT CURV Stomach Stomach Stomach

151.8 MALIG NEO STOMACH NEC Stomach Stomach Stomach

151.9 MALIG NEO STOMACH NOS Stomach Stomach Stomach

152 MALIG NEO SMALL BOWEL 

152.0 MALIG NEO DUODENUM SI Stomach All digestive

152.1 MALIG NEO JEJUNUM SI Stomach All digestive

152.2 MALIG NEO ILEUM SI Stomach All digestive

152.3 MALIG NEO MECKEL'S DIVERT SI Stomach All digestive

152.8 MALIG NEO SMALL BOWEL NEC SI Stomach All digestive

152.9 MALIG NEO SMALL BOWEL NOS SI Stomach All digestive

153 MALIGNANT NEOPLASM COLON 

153.0 MALIG NEO HEPATIC FLEXURE ULI Colon Colon

153.1 MALIG NEO TRANSVERSE COLON ULI Colon Colon

153.2 MALIG NEO DESCEND COLON LLI Colon Colon

153.3 MALIG NEO SIGMOID COLON LLI Colon Colon

153.4 MALIG NEO CECUM ULI Colon Colon

153.5 MALIG NEO APPENDIX ULI Colon Colon

153.6 MALIG NEO ASCEND COLON ULI Colon Colon

153.7 MALIG NEO SPLENIC FLEXURE LLI Colon Colon

153.8 MALIG NEO COLON NEC Colon Colon Colon

153.9 MALIG NEO COLON NOS Colon Colon Colon

154 MALIG NEO RECTUM/ANUS 

154.0 MALIG NEO RECTOSIGMOID JCT LLI Colon Rectum

154.1 MALIG NEO RECTUM LLI Colon Rectum

154.2 MALIG NEO ANAL CANAL LLI Colon Rectum

154.3 MALIG NEO ANUS NOS LLI Colon Rectum

154.8 MALIG NEO RECTUM/ANUS NEC LLI Colon Rectum

155 MALIGNANT NEOPLASM LIVER 

155.0 MALIG NEO LIVER, PRIMARY Liver Liver Liver

155.1 MALIG NEO INTRAHEPAT DUCTS Gallbladder Bladder Gallbladder

155.2 MALIG NEO LIVER NOS Liver Liver Liver

156 MALIG NEO GB/EXTRAHEPATIC 

156.0 MALIG NEO GALLBLADDER Gallbladder Bladder Gallbladder

156.1 MALIG NEO EXTRAHEPAT DUCTS Gallbladder Bladder Gallbladder

156.2 MALIG NEO AMPULLA VATER Gallbladder Bladder Gallbladder

156.8 MALIG NEO BILIARY NEC Gallbladder Bladder Gallbladder

156.9 MALIG NEO BILIARY NOS Gallbladder Bladder Gallbladder

157 MALIGNANT NEO PANCREAS 

157.0 MALIG NEO PANCREAS HEAD Pancreas Stomach Pancreas

157.1 MALIG NEO PANCREAS BODY Pancreas Stomach Pancreas

157.2 MALIG NEO PANCREAS TAIL Pancreas Stomach Pancreas
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 6 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

157.3 MALIG NEO PANCREATIC DUCT Pancreas Stomach Pancreas

157.4 MALIG NEO ISLET LANGERHANS Pancreas Stomach Pancreas

157.8 MALIG NEO PANCREAS NEC Pancreas Stomach Pancreas

157.9 MALIG NEO PANCREAS NOS Pancreas Stomach Pancreas

158 MALIG NEO PERITONEUM 

158.0 MALIG NEO RETROPERITONEUM Highest non-met 

org/tiss

Stomach All digestive

158.8 MALIG NEO PERITONEUM NEC Highest non-met 

org/tiss

Stomach All digestive

158.9 MALIG NEO PERITONEUM NOS Highest non-met 

org/tiss

Stomach All digestive

159 OTHER MALIG NEO GI/PERITON 

159.0 MALIG NEO INTESTINE NOS Colon Stomach All digestive

159.1 MALIG NEO SPLEEN NEC Spleen Stomach All digestive

159.8 MALIG NEO GI/INTRA-ABD NEC Highest non-met 

org/tiss

Stomach All digestive

159.9 MALIG NEO GI TRACT ILL-DEF Highest non-met 

org/tiss

Stomach All digestive

160 MALIG NEO NASAL CAV/SINUS 

160.0 MALIG NEO NASAL CAVITIES ET1 Thyroid/Remainder1 Other respiratory

160.1 MALIG NEO MIDDLE EAR Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

160.2 MALIG NEO MAXILLARY SINUS Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

160.3 MALIG NEO ETHMOIDAL SINUS Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

160.4 MALIG NEO FRONTAL SINUS Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

160.5 MALIG NEO SPHENOID SINUS Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

160.8 MALIG NEO ACCESS SINUS NEC Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

160.9 MALIG NEO ACCESS SINUS NOS Highest non-met 

org/tiss

Thyroid/Remainder1 Other respiratory

161 MALIGNANT NEO LARYNX 

161.0 MALIG NEO GLOTTIS ET2 Esophagus Other respiratory

161.1 MALIG NEO SUPRAGLOTTIS ET2 Esophagus Other respiratory

161.2 MALIG NEO SUBGLOTTIS ET2 Esophagus Other respiratory

161.3 MALIG NEO CARTILAGE LARYNX ET2 Esophagus Other respiratory

161.8 MALIG NEO LARYNX NEC ET2 Esophagus Other respiratory

161.9 MALIG NEO LARYNX NOS ET2 Esophagus Other respiratory

162 MALIG NEO TRACHEA/LUNG 

162.0 MALIG NEO TRACHEA Lung Lung Lung

162.2 MALIG NEO MAIN BRONCHUS Lung Lung Lung

162.3 MALIG NEO UPPER LOBE LUNG Lung Lung Lung

162.4 MALIG NEO MIDDLE LOBE LUNG Lung Lung Lung

162.5 MALIG NEO LOWER LOBE LUNG Lung Lung Lung

162.8 MALIG NEO BRONCH/LUNG NEC Lung Lung Lung

162.9 MALIG NEO BRONCH/LUNG NOS Lung Lung Lung

163 MALIGNANT NEOPL PLEURA 

163.0 MALIG NEO PARIETAL PLEURA Highest non-met 

org/tiss

Lung Other respiratory

163.1 MALIG NEO VISCERAL PLEURA Highest non-met 

org/tiss

Lung Other respiratory

163.8 MALIG NEO PLEURA NEC Highest non-met 

org/tiss

Lung Other respiratory

163.9 MALIG NEO PLEURA NOS Highest non-met 

org/tiss

Lung Other respiratory

164 MALIG NEO THYMUS/MEDIASTIN 

164.0 MALIG NEO THYMUS Thymus Thymus Other respiratory

164.1 MALIG NEO HEART Heart Wall Thymus Other respiratory

164.2 MALIG NEO ANT MEDIASTINUM Highest non-met 

org/tiss

Thymus Other respiratory

164.3 MALIG NEO POST MEDIASTINUM Highest non-met 

org/tiss

Thymus Other respiratory

164.8 MALIG NEO MEDIASTINUM NEC Highest non-met 

org/tiss

Thymus Other respiratory

164.9 MALIG NEO MEDIASTINUM NOS Highest non-met 

org/tiss

Thymus Other respiratory

165 OTH/ILL-DEF MAL NEO RESP 
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 7 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

165.0 MALIG NEO UPPER RESP NOS Lung Lung Other respiratory

165.8 MALIG NEO THORAX/RESP NEC Lung Lung Other respiratory

165.9 MALIG NEO RESP SYSTEM NOS Lung Lung Other respiratory

170 MALIG NEO BONE/ARTIC CART 

170.0 MALIG NEO SKULL/FACE BONE Bone surface Bone Surface Bone

170.1 MALIG NEO MANDIBLE Bone surface Bone Surface Bone

170.2 MALIG NEO VERTEBRAE Bone surface Bone Surface Bone

170.3 MALIG NEO RIBS/STERN/CLAV Medical review Bone Surface Bone

170.4 MALIG NEO LONG BONES ARM Bone surface Bone Surface Bone

170.5 MALIG NEO BONES WRIST/HAND Bone surface Bone Surface Bone

170.6 MALIG NEO PELVIC GIRDLE Medical review Bone Surface Bone

170.7 MALIG NEO LONG BONES LEG Medical review Bone Surface Bone

170.8 MALIG NEO BONES ANKLE/FOOT Bone surface Bone Surface Bone

170.9 MALIG NEO BONE NOS Medical review Bone Surface Bone

171 MALIG NEO SOFT TISSUE 

171.0 MALIG NEO SOFT TISSUE HEAD Highest non-met 

org/tiss

Thyroid/Remainder1 Connective Tissue

171.2 MALIG NEO SOFT TISSUE ARM Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.3 MALIG NEO SOFT TISSUE LEG Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.4 MALIG NEO SOFT TIS THORAX Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.5 MALIG NEO SOFT TIS ABDOMEN Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.6 MALIG NEO SOFT TIS PELVIS Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.7 MALIG NEO TRUNK NOS Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.8 MALIG NEO SOFT TISSUE NEC Highest non-met 

org/tiss

Remainder2 Connective Tissue

171.9 MALIG NEO SOFT TISSUE NOS Highest non-met 

org/tiss

Remainder2 Connective Tissue

172 MALIGNANT MELANOMA SKIN 

172.0 MALIG MELANOMA LIP Skin Skin Malignant melanoma

172.1 MALIG MELANOMA EYELID Skin Skin Malignant melanoma

172.2 MALIG MELANOMA EAR Skin Skin Malignant melanoma

172.3 MALIG MELANOMA FACE NEC/NOS Skin Skin Malignant melanoma

172.4 MALIG MELANOMA SCALP/NECK Skin Skin Malignant melanoma

172.5 MALIG MELANOMA TRUNK Skin Skin Malignant melanoma

172.6 MALIG MELANOMA ARM Skin Skin Malignant melanoma

172.7 MALIG MELANOMA LEG Skin Skin Malignant melanoma

172.8 MALIG MELANOMA SKIN NEC Skin Skin Malignant melanoma

172.9 MALIG MELANOMA SKIN NOS Skin Skin Malignant melanoma

173 OTHER MALIG NEOPL SKIN 

173.0 MALIG NEO SKIN LIP Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.1 MALIG NEO SKIN EYELID Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.2 MALIG NEO SKIN EAR Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.3 MALIG NEO SKIN FACE NEC Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.4 MALIG NEO SCALP/SKIN NECK Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.5 MALIG NEO SKIN TRUNK Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.6 MALIG NEO SKIN ARM Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.7 MALIG NEO SKIN LEG Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.8 MALIG NEO SKIN NEC Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

173.9 MALIG NEO SKIN NOS Skin Skin Non-melanoma skin-Basal cell OR

Non-melanoma skin-Squamous cell

174 MALIG NEO FEMALE BREAST 

174.0 MALIG NEO NIPPLE Breast Breast Breast

174.1 MALIG NEO BREAST-CENTRAL Breast Breast Breast

174.2 MALIG NEO BREAST UP-INNER Breast Breast Breast

174.3 MALIG NEO BREAST LOW-INNER Breast Breast Breast
Effective Date: 05/07/2004 Revision No. 01 PC-2 Document No. ORAUT-OTIB-0005 Page 8 of 19

174.4 MALIG NEO BREAST UP-OUTER Breast Breast Breast

174.5 MALIG NEO BREAST LOW-OUTER Breast Breast Breast

174.6 MALIG NEO BREAST-AXILLARY Breast Breast Breast

174.8 MALIG NEO BREAST NEC Breast Breast Breast

174.9 MALIG NEO BREAST NOS Breast Breast Breast

175 MALIG NEO MALE BREAST 

175.0 MALIG NEO MALE NIPPLE Breast Breast Breast

175.9 MALIG NEO MALE BREAST NEC Breast Breast Breast

176 KAPOSI'S SARCOMA

176.0 SKIN-KAPOSI'S SARCOMA Skin Skin Connective tissue AND

Non-melanoma skin-Squamous cell

176.1 SOFT TISSUE-KAPOSI'S SARCOMA Highest non-met 

org/tiss

Remainder2 Connective tissue AND

Non-melanoma skin-Squamous cell

176.2 PALATE-KAPOSI'S SARCOMA Highest non-met 

org/tiss

Thyroid/Remainder1 Connective tissue AND

Non-melanoma skin-Squamous cell

176.3 GI SITES-KAPOSI'S SARCOMA Colon Stomach/Colon

(location dependant)

Connective tissue AND

Non-melanoma skin-Squamous cell

176.4 LUNG-KAPOSI'S SARCOMA Lung Lung Connective tissue AND

Non-melanoma skin-Squamous cell

176.5 LYMPH NODES-KAPOSI'S SARCOMA Highest non-met 

org/tiss

Remainder2 Connective tissue AND

Non-melanoma skin-Squamous cell

176.8 SPF STS-KAPOSI'S SARCOMA Highest non-met 

org/tiss

Remainder2 Connective tissue AND

Non-melanoma skin-Squamous cell

176.9 KAPOSI'S SARCOMA NOS Highest non-met 

org/tiss

Remainder2 Connective tissue AND

Non-melanoma skin-Squamous cell

179 MALIG NEO UTERUS NOS Uterus Uterus Female genitalia less ovary

180 MALIG NEO CERVIX UTERI 

180.0 MALIG NEO ENDOCERVIX Uterus Uterus Female genitalia less ovary

180.1 MALIG NEO EXOCERVIX Uterus Uterus Female genitalia less ovary

180.8 MALIG NEO CERVIX NEC Uterus Uterus Female genitalia less ovary

180.9 MALIG NEO CERVIX UTERI NOS Uterus Uterus Female genitalia less ovary

181 MALIG NEO PLACENTA Uterus Uterus Female genitalia less ovary

182 MALIG NEO UTERUS BODY 

182.0 MALIG NEO CORPUS UTERI Uterus Uterus Female genitalia less ovary

182.1 MALIG NEO UTERINE ISTHMUS Uterus Uterus Female genitalia less ovary

182.8 MALIG NEO BODY UTERUS NEC Uterus Uterus Female genitalia less ovary

183 MALIG NEO UTERINE ADNEXA 

183.0 MALIG NEO OVARY Ovaries Ovaries Ovary

183.2 MALIG NEO FALLOPIAN TUBE Ovaries Ovaries Ovary

183.3 MALIG NEO BROAD LIGAMENT Ovaries Ovaries Ovary

183.4 MALIG NEO PARAMETRIUM Uterus Ovaries Ovary

183.5 MALIG NEO ROUND LIGAMENT Uterus Ovaries Ovary

183.8 MALIG NEO ADNEXA NEC Ovaries Ovaries Ovary

183.9 MALIG NEO ADNEXA NOS Ovaries Ovaries Ovary

184 MALIG NEO FEM GEN NEC/NOS 

184.0 MALIG NEO VAGINA Muscle Uterus Female genitalia less ovary

184.1 MALIG NEO LABIA MAJORA Skin Uterus Female genitalia less ovary

184.2 MALIG NEO LABIA MINORA Skin Uterus Female genitalia less ovary

184.3 MALIG NEO CLITORIS Skin Uterus Female genitalia less ovary

184.4 MALIG NEO VULVA NOS Skin Uterus Female genitalia less ovary

184.8 MALIG NEO FEMALE GENIT NEC Uterus Uterus Female genitalia less ovary

184.9 MALIG NEO FEMALE GENIT NOS Uterus Uterus Female genitalia less ovary

185 MALIG NEO PROSTATE Highest non-met 

org/tiss

Bladder All male genitalia

186 MALIG NEO TESTIS 

186.0 MALIG NEO UNDESCEND TESTIS Testes Testes All male genitalia

186.9 MALIG NEO TESTIS NEC Testes Testes All male genitalia

187 MALIG NEO MALE GENITAL NEC 

187.1 MALIG NEO PREPUCE Skin Testes All male genitalia

187.2 MALIG NEO GLANS PENIS Skin Testes All male genitalia

187.3 MALIG NEO PENIS BODY Testes Testes All male genitalia

187.4 MALIG NEO PENIS NOS Testes Testes All male genitalia

187.5 MALIG NEO EPIDIDYMIS Testes Testes All male genitalia

187.6 MALIG NEO SPERMATIC CORD Testes Testes All male genitalia

187.7 MALIG NEO SCROTUM Testes Testes All male genitalia

187.8 MALIG NEO MALE GENITAL NEC Testes Testes All male genitalia

187.9 MALIG NEO MALE GENITAL NOS Testes Testes All male genitalia

188 MALIG NEO BLADDER 

188.0 MALIG NEO BLADDER-TRIGONE Bladder Bladder Bladder
Effective Date: 03/05/2004 Revision No. 01 PC-1 Document No. ORAUT-OTIB-0005 Page 9 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

188.1 MALIG NEO BLADDER-DOME Bladder Bladder Bladder

188.2 MALIG NEO BLADDER-LATERAL Bladder Bladder Bladder

188.3 MALIG NEO BLADDER-ANTERIOR Bladder Bladder Bladder

188.4 MALIG NEO BLADDER-POST Bladder Bladder Bladder

188.5 MALIG NEO BLADDER NECK Bladder Bladder Bladder

188.6 MALIG NEO URETERIC ORIFICE Bladder Bladder Bladder

188.7 MALIG NEO URACHUS Bladder Bladder Bladder

188.8 MALIG NEO BLADDER NEC Bladder Bladder Bladder

188.9 MALIG NEO BLADDER NOS Bladder Bladder Bladder

189 MALIG NEO URINARY NEC/NOS 

189.0 MALIG NEO KIDNEY Kidney Liver Urinary organs less bladder

189.1 MALIG NEO RENAL PELVIS Kidney Liver Urinary organs less bladder

189.2 MALIG NEO URETER Kidney Liver Urinary organs less bladder

189.3 MALIG NEO URETHRA Bladder Liver Urinary organs less bladder

189.4 MALIG NEO PARAURETHRAL Bladder Liver Urinary organs less bladder

189.8 MALIG NEO URINARY NEC Bladder Liver Urinary organs less bladder

189.9 MALIG NEO URINARY NOS Medical review Liver Urinary organs less bladder

190 MALIGANT NEOPLASM EYE 

190.0 MALIG NEO EYEBALL Brain Eye Lens Eye

190.1 MALIG NEO ORBIT Brain Eye Lens Eye

190.2 MALIG NEO LACRIMAL GLAND Skin Eye Lens Eye

190.3 MALIG NEO CONJUNCTIVA Skin Eye Lens Eye

190.4 MALIG NEO CORNEA Skin Eye Lens Eye

190.5 MALIG NEO RETINA Brain Eye Lens Eye

190.6 MALIG NEO CHOROID Brain Eye Lens Eye

190.7 MALIG NEO LACRIMAL DUCT Skin Eye Lens Eye

190.8 MALIG NEO EYE NEC Skin Eye Lens Eye

190.9 MALIG NEO EYE NOS Skin Eye Lens Eye

191 MALIG NEOASM BRAIN 

191.0 MALIG NEO CEREBRUM Brain Thyroid/Remainder1 Nervous system

191.1 MALIG NEO FRONTAL LOBE Brain Thyroid/Remainder1 Nervous system

191.2 MALIG NEO TEMPORAL LOBE Brain Thyroid/Remainder1 Nervous system

191.3 MALIG NEO PARIETAL LOBE Brain Thyroid/Remainder1 Nervous system

191.4 MALIG NEO OCCIPITAL LOBE Brain Thyroid/Remainder1 Nervous system

191.5 MALIG NEO CEREB VENTRICLE Brain Thyroid/Remainder1 Nervous system

191.6 MALIG NEO CEREBELLUM NOS Brain Thyroid/Remainder1 Nervous system

191.7 MALIG NEO BRAIN STEM Brain Thyroid/Remainder1 Nervous system

191.8 MALIG NEO BRAIN NEC Brain Thyroid/Remainder1 Nervous system

191.9 MALIG NEO BRAIN NOS Brain Thyroid/Remainder1 Nervous system

192 MALIG NEO NERVE NEC/NOS 

192.0 MALIG NEO CRANIAL NERVES Brain Thyroid/Remainder1 Nervous system

192.1 MALIG NEO CEREBRAL MENING Brain Thyroid/Remainder1 Nervous system

192.2 MALIG NEO SPINAL CORD Brain Thyroid/Remainder1 Nervous system

192.3 MALIG NEO SPINAL MENINGES Brain Thyroid/Remainder1 Nervous system

192.8 MALIG NEO NERVOUS SYST NEC Brain Thyroid/Remainder1 Nervous system

192.9 MALIG NEO NERVOUS SYST NOS Brain Thyroid/Remainder1 Nervous system

193 MALIG NEO THYROID Thyroid Thyroid Thyroid

194 MALIG NEO OTHER ENDOCRINE 

194.0 MALIG NEO ADRENAL Adrenals Thyroid/Remainder1 Other endocrine glands

194.1 MALIG NEO PARATHYROID Thyroid Thyroid/Remainder1 Other endocrine glands

194.3 MALIG NEO PITUITARY Brain Thyroid/Remainder1 Other endocrine glands

194.4 MALIG NEO PINEAL GLAND Brain Thyroid/Remainder1 Other endocrine glands

194.5 MALIG NEO CAROTID BODY Brain Thyroid/Remainder1 Other endocrine glands

194.6 MALIG NEO PARAGANGLIA NEC Brain Thyroid/Remainder1 Other endocrine glands

194.8 MALIG NEO ENDOCRINE NEC Medical review Remainder2 Other endocrine glands

194.9 MALIG NEO ENDOCRINE NOS Medical review Remainder2 Other endocrine glands

195 MALIG NEO OTH/ILL-DEF SITE 

195.0 MALIG NEO HEAD/FACE/NECK Highest non-met 

org/tiss

Thyroid/Remainder1 Other and ill-defined sites

195.1 MALIG NEO THORAX Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

195.2 MALIG NEO ABDOMEN Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

195.3 MALIG NEO PELVIS Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

195.4 MALIG NEO ARM Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

195.5 MALIG NEO LEG Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 10 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

195.8 MALIG NEO SITE NEC Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

196 MALIG NEO LYMPH NODES

196.0 MALIG NEO LYMPH-HEAD/NECK NA3 NA3 NA3

196.1 MALIG NEO LYMPH-INTRATHOR NA3 NA3 NA3

196.2 MALIG NEO LYMPH-INTRA-ABD NA3 NA3 NA3

196.3 MALIG NEO LYMPH-AXILLA/ARM NA3 NA3 NA3

196.5 MALIG NEO LYMPH-INGUIN/LEG NA3 NA3 NA3

196.6 MALIG NEO LYMPH-INTRAPELV NA3 NA3 NA3

196.8 MALIG NEO LYMPH-MULT NA3 NA3 NA3

196.9 MALIG NEO LYMPH NOS NA3 NA3 NA3

197 SEC MALIG NEO GI/RESP

197.0 SEC MALIG NEO LUNG NA3 NA3 NA3

197.1 SEC MALIG NEO MEDIASTINUM NA3 NA3 NA3

197.2 SEC MALIG NEO PLEURA NA3 NA3 NA3

197.3 SEC MALIG NEO RESP NEC NA3 NA3 NA3

197.4 SEC MALIG NEO SM BOWEL NA3 NA3 NA3

197.5 SEC MALIG NEO LG BOWEL NA3 NA3 NA3

197.6 SEC MALIG NEO PERITONEUM NA3 NA3 NA3

197.7 SEC MALIG NEO LIVER NA3 NA3 NA3

197.8 SEC MALIG NEO GI NEC NA3 NA3 NA3

198 SEC MALIG NEO OTHER SITES

198.0 SEC MALIG NEO KIDNEY NA3 NA3 NA3

198.1 SEC MALIG NEO URIN NEC NA3 NA3 NA3

198.2 SEC MALIG NEO SKIN NA3 NA3 NA3

198.3 SEC MALIG NEO BRAIN/SPINE NA3 NA3 NA3

198.4 SEC MALIG NEO NERVE NEC NA3 NA3 NA3

198.5 SEC MALIG NEO BONE NA3 NA3 NA3

198.6 SEC MALIG NEO OVARY NA3 NA3 NA3

198.7 SEC MALIG NEO ADRENAL NA3 NA3 NA3

198.8 OTHER SECONDARY MALIG NEO 

198.81 SEC MALIG NEO BREAST NA3 NA3 NA3

198.82 SEC MALIG NEO GENITAL NA3 NA3 NA3

198.89 SEC MALIG NEO NEC NA3 NA3 NA3

199 MALIG NEOPLASM NOS

199.0 MALIG NEO DISSEMINATED Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

199.1 MALIG NEO NOS Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

200 LYMPHOSARC/RETICULOSARC 

200.0 RETICULOSARCOMA Medical review Remainder2 Lymphoma and multiple myeloma

200.00 RETCLSRC UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

200.01 RETICULOSARCOMA HEAD Medical review Remainder2 Lymphoma and multiple myeloma

200.02 RETICULOSARCOMA THORAX Medical review Remainder2 Lymphoma and multiple myeloma

200.03 RETICULOSARCOMA ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

200.04 RETICULOSARCOMA AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

200.05 RETICULOSARCOMA INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

200.06 RETICULOSARCOMA PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

200.07 RETICULOSARCOMA SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

200.08 RETICULOSARCOMA MULT Medical review Remainder2 Lymphoma and multiple myeloma

200.1 LYMPHOSARCOMA Medical review Remainder2 Lymphoma and multiple myeloma

200.10 LYMPHSRC UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

200.11 LYMPHOSARCOMA HEAD Medical review Remainder2 Lymphoma and multiple myeloma

200.12 LYMPHOSARCOMA THORAX Medical review Remainder2 Lymphoma and multiple myeloma

200.13 LYMPHOSARCOMA ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

200.14 LYMPHOSARCOMA AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

200.15 LYMPHOSARCOMA INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

200.16 LYMPHOSARCOMA PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

200.17 LYMPHOSARCOMA SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

200.18 LYMPHOSARCOMA MULT Medical review Remainder2 Lymphoma and multiple myeloma

200.2 BURKITT'S TUMOR/LYMPHOMA Medical review Remainder2 Lymphoma and multiple myeloma

200.20 BURKITT'S TUMOR UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

200.21 BURKITT'S TUMOR HEAD Medical review Remainder2 Lymphoma and multiple myeloma

200.22 BURKITT'S TUMOR THORAX Medical review Remainder2 Lymphoma and multiple myeloma

200.23 BURKITT'S TUMOR ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

200.24 BURKITT'S TUMOR AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

200.25 BURKITT'S TUMOR INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

200.26 BURKITT'S TUMOR PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

200.27 BURKITT'S TUMOR SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 11 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

200.28 BURKITT'S TUMOR MULT Medical review Remainder2 Lymphoma and multiple myeloma

200.8 MIXED LYMPHOSARCOMA Medical review Remainder2 Lymphoma and multiple myeloma

200.80 OTHER VARN UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

200.81 MIXED LYMPHOSARC HEAD Medical review Remainder2 Lymphoma and multiple myeloma

200.82 MIXED LYMPHOSARC THORAX Medical review Remainder2 Lymphoma and multiple myeloma

200.83 MIXED LYMPHOSARC ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

200.84 MIXED LYMPHOSARC AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

200.85 MIXED LYMPHOSARC INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

200.86 MIXED LYMPHOSARC PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

200.87 MIXED LYMPHOSARC SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

200.88 MIXED LYMPHOSARC MULT Medical review Remainder2 Lymphoma and multiple myeloma

201 HODGKIN'S DISEASE 

201.0 HODGKIN'S PARAGRANULOMA Medical review Remainder2 Lymphoma and multiple myeloma

201.00 HODGKINS PARAGRANULOMA UNSPEC 

EXT ORG 

Medical review Remainder2 Lymphoma and multiple myeloma

201.01 HODGKINS PARAGRAN HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.02 HODGKINS PARAGRAN THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.03 HODGKINS PARAGRAN ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.04 HODGKINS PARAGRAN AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.05 HODGKINS PARAGRAN INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.06 HODGKINS PARAGRAN PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.07 HODGKINS PARAGRAN SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.08 HODGKINS PARAGRAN MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.1 HODGKIN'S GRANULOMA Medical review Remainder2 Lymphoma and multiple myeloma

201.10 HODGKINS GRANULOM UNSPEC EXT 

ORG 

Medical review Remainder2 Lymphoma and multiple myeloma

201.11 HODGKINS GRANULOM HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.12 HODGKINS GRANULOM THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.13 HODGKINS GRANULOM ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.14 HODGKINS GRANULOM AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.15 HODGKINS GRANULOM INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.16 HODGKINS GRANULOM PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.17 HODGKINS GRANULOM SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.18 HODGKINS GRANULOM MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.2 HODGKIN'S SARCOMA Medical review Remainder2 Lymphoma and multiple myeloma

201.20 HODGKINS SRC UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

201.21 HODGKINS SARCOMA HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.22 HODGKINS SARCOMA THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.23 HODGKINS SARCOMA ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.24 HODGKINS SARCOMA AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.25 HODGKINS SARCOMA INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.26 HODGKINS SARCOMA PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.27 HODGKINS SARCOMA SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.28 HODGKINS SARCOMA MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.4 HODGKINS LYMPH-HISTIOCYT Medical review Remainder2 Lymphoma and multiple myeloma

201.40 LYM-HST UNSPEC EXT ORGN Medical review Remainder2 Lymphoma and multiple myeloma

201.41 HODGKINS LYMPH-HISTIO HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.42 HODGKINS LYMPH-HISTIO THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.43 HODGKINS LYMPH-HISTIO ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.44 HODGKINS LYMPH-HISTIO AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.45 HODGKINS LYMPH-HISTIO INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.46 HODGKINS LYMPH-HISTIO PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.47 HODGKINS LYMPH-HISTIO SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.48 HODGKINS LYMPH-HISTIO MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.5 HODGKINS NODULAR SCLEROS Medical review Remainder2 Lymphoma and multiple myeloma

201.50 NODULAR SCLEROS UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

201.51 HODGKINS NODUL SCLERO HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.52 HODGKINS NODUL SCLERO THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.53 HODGKINS NODUL SCLERO ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.54 HODGKINS NODUL SCLERO AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.55 HODGKINS NODUL SCLERO INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.56 HODGKINS NODUL SCLERO PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.57 HODGKINS NODUL SCLERO SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.58 HODGKINS NODUL SCLERO MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.6 HODGKINS MIX CELLULARITY Medical review Remainder2 Lymphoma and multiple myeloma

201.60 MXD CELR UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

201.61 HODGKINS MIX CELL HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.62 HODGKINS MIX CELL THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.63 HODGKINS MIX CELL ABDOM Medical review Remainder2 Lymphoma and multiple myeloma
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 12 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

201.64 HODGKINS MIX CELL AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.65 HODGKINS MIX CELL INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.66 HODGKINS MIX CELL PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.67 HODGKINS MIX CELL SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.68 HODGKINS MIX CELL MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.7 HODG LYMPHOCYTIC DEPLET Medical review Remainder2 Lymphoma and multiple myeloma

201.70 LYM DPLT UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

201.71 HODGKINS LYMPH DEPLET HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.72 HODGKINS LYMPH DEPLET THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.73 HODGKINS LYMPH DEPLET ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.74 HODGKINS LYMPH DEPLET AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.75 HODGKINS LYMPH DEPLET INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.76 HODGKINS LYMPH DEPLET PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.77 HODGKINS LYMPH DEPLET SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.78 HODGKINS LYMPH DEPLET MULT Medical review Remainder2 Lymphoma and multiple myeloma

201.9 HODGKINS DISEASE NOS Medical review Remainder2 Lymphoma and multiple myeloma

201.90 HDGK DISEASE UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

201.91 HODGKINS DISEASE NOS HEAD Medical review Remainder2 Lymphoma and multiple myeloma

201.92 HODGKINS DISEASE NOS THORAX Medical review Remainder2 Lymphoma and multiple myeloma

201.93 HODGKINS DISEASE NOS ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

201.94 HODGKINS DISEASE NOS AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

201.95 HODGKINS DISEASE NOS INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

201.96 HODGKINS DISEASE NOS PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

201.97 HODGKINS DISEASE NOS SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

201.98 HODGKINS DISEASE NOS MULT Medical review Remainder2 Lymphoma and multiple myeloma

202 OTHER MALIG NEO LYMPH/HISTIO 

202.0 NODULAR LYMPHOMA Medical review Remainder2 Lymphoma and multiple myeloma

202.00 NDLR LYM UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.01 NODULAR LYMPHOMA HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.02 NODULAR LYMPHOMA THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.03 NODULAR LYMPHOMA ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.04 NODULAR LYMPHOMA AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.05 NODULAR LYMPHOMA INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.06 NODULAR LYMPHOMA PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.07 NODULAR LYMPHOMA SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.08 NODULAR LYMPHOMA MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.1 MYCOSIS FUNGOIDES Skin Skin Lymphoma and multiple myeloma

202.10 MYCS FNG UNSPEC EXT ORG Skin Skin Lymphoma and multiple myeloma

202.11 MYCOSIS FUNGOIDES HEAD Skin Skin Lymphoma and multiple myeloma

202.12 MYCOSIS FUNGOIDES THORAX Skin Skin Lymphoma and multiple myeloma

202.13 MYCOSIS FUNGOIDES ABDOM Skin Skin Lymphoma and multiple myeloma

202.14 MYCOSIS FUNGOIDES AXILLA Skin Skin Lymphoma and multiple myeloma

202.15 MYCOSIS FUNGOIDES INGUIN Skin Skin Lymphoma and multiple myeloma

202.16 MYCOSIS FUNGOIDES PELVIC Skin Skin Lymphoma and multiple myeloma

202.17 MYCOSIS FUNGOIDES SPLEEN Skin Skin Lymphoma and multiple myeloma

202.18 MYCOSIS FUNGOIDES MULT Skin Skin Lymphoma and multiple myeloma

202.2 SEZARY'S DISEASE Medical review Remainder2 Lymphoma and multiple myeloma

202.20 SZRY DISEASE UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.21 SEZARY'S DISEASE HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.22 SEZARY'S DISEASE THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.23 SEZARY'S DISEASE ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.24 SEZARY'S DISEASE AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.25 SEZARY'S DISEASE INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.26 SEZARY'S DISEASE PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.27 SEZARY'S DISEASE SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.28 SEZARY'S DISEASE MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.3 MALIG HISTIOCYTOSIS Medical review Remainder2 Lymphoma and multiple myeloma

202.30 MLG HIST UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.31 MALIG HISTIOCYTOSIS HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.32 MALIG HISTIOCYTOSIS THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.33 MALIG HISTIOCYTOSIS ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.34 MALIG HISTIOCYTOSIS AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.35 MALIG HISTIOCYTOSIS INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.36 MALIG HISTIOCYTOSIS PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.37 MALIG HISTIOCYTOSIS SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.38 MALIG HISTIOCYTOSIS MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.4 LEUKEM RETICULOENDOTHEL Medical review Remainder2 Lymphoma and multiple myeloma

202.40 LK RTCTL UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.41 HAIRY-CELL LEUKEM HEAD Medical review Remainder2 Lymphoma and multiple myeloma
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 13 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

202.42 HAIRY-CELL LEUKEM THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.43 HAIRY-CELL LEUKEM ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.44 HAIRY-CELL LEUKEM AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.45 HAIRY-CELL LEUKEM INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.46 HAIRY-CELL LEUKEM PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.47 HAIRY-CELL LEUKEM SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.48 HAIRY-CELL LEUKEM MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.5 LETTERER-SIWE DISEASE Medical review Remainder2 Lymphoma and multiple myeloma

202.50 LTR-SIWE UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.51 LETTERER-SIWE DISEASE HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.52 LETTERER-SIWE DISEASE THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.53 LETTERER-SIWE DISEASE ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.54 LETTERER-SIWE DISEASE AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.55 LETTERER-SIWE DISEASE INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.56 LETTERER-SIWE DISEASE PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.57 LETTERER-SIWE DISEASE SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.58 LETTERER-SIWE DISEASE MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.6 MALIG MAST CELL TUMORS Medical review Remainder2 Lymphoma and multiple myeloma

202.60 MALIG MAST UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.61 MALIG MASTOCYTOSIS HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.62 MALIG MASTOCYTOSIS THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.63 MALIG MASTOCYTOSIS ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.64 MALIG MASTOCYTOSIS AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.65 MALIG MASTOCYTOSIS INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.66 MALIG MASTOCYTOSIS PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.67 MALIG MASTOCYTOSIS SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.68 MALIG MASTOCYTOSIS MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.8 LYMPHOMAS NEC Medical review Remainder2 Lymphoma and multiple myeloma

202.80 OTHER LYMP UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.81 LYMPHOMAS NEC HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.82 LYMPHOMAS NEC THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.83 LYMPHOMAS NEC ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.84 LYMPHOMAS NEC AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.85 LYMPHOMAS NEC INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.86 LYMPHOMAS NEC PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.87 LYMPHOMAS NEC SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.88 LYMPHOMAS NEC MULT Medical review Remainder2 Lymphoma and multiple myeloma

202.9 MALIG NEO LYM/HIST TIS NEC Medical review Remainder2 Lymphoma and multiple myeloma

202.90 UNSPEC LYM UNSPEC EXT ORG Medical review Remainder2 Lymphoma and multiple myeloma

202.91 LYMPHOID MALIG NEC HEAD Medical review Remainder2 Lymphoma and multiple myeloma

202.92 LYMPHOID MALIG NEC THORAX Medical review Remainder2 Lymphoma and multiple myeloma

202.93 LYMPHOID MALIG NEC ABDOM Medical review Remainder2 Lymphoma and multiple myeloma

202.94 LYMPHOID MALIG NEC AXILLA Medical review Remainder2 Lymphoma and multiple myeloma

202.95 LYMPHOID MALIG NEC INGUIN Medical review Remainder2 Lymphoma and multiple myeloma

202.96 LYMPHOID MALIG NEC PELVIC Medical review Remainder2 Lymphoma and multiple myeloma

202.97 LYMPHOID MALIG NEC SPLEEN Medical review Remainder2 Lymphoma and multiple myeloma

202.98 LYMPHOID MALIG NEC MULT Medical review Remainder2 Lymphoma and multiple myeloma

203 MULTIPLE MYELOMA ET AL 

203.0 MULTIPLE MYELOMA Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

203.00 MULT MYELM W/O REMISSION Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

203.01 MULT MYELM W/REMISSION Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

203.1 PLASMA CELL LEUKEMIA Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

203.10 PLSM CELL LEUK W/O REMISSON Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

203.11 PLSM CELL LEUK W/REMISS Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

203.8 IMMUNOPROLIFERAT NEOPLASM NEC Medical review Red Bone Marrow Lymphoma and multiple myeloma

203.80 OTHER IMNPRFL NPL W/O REMISS Medical review Red Bone Marrow Lymphoma and multiple myeloma

203.81 OTHER IMNPRFL NPL W/REMISS Medical review Red Bone Marrow Lymphoma and multiple myeloma

204 LYMPHOID LEUKEMIA 

204.0 ACUTE LYMPHOID LEUKEMIA Medical review Red Bone Marrow Acute lymphoid leukemia

204.00 ACT LYM LEUK W/O REMISS Medical review Red Bone Marrow Acute lymphoid leukemia

204.01 ACT LYM LEUK W/REMISS Medical review Red Bone Marrow Acute lymphoid leukemia

204.1 CHRONIC LYMPHOID LEUKEMIA NA NA NA4

204.10 CHRONIC LYM LEUK W/O REMISS NA NA NA4

204.11 CHRONIC LYM LEUK W/REMISS NA NA NA4

204.2 SUBACUTE LYMPHOID LEUKEMIA Medical review Red Bone Marrow Leukemia, less CLL

204.20 SBAC LYM LEUK W/O REMISS Medical review Red Bone Marrow Leukemia, less CLL

204.21 SBAC LYM LEUK W/REMISS Medical review Red Bone Marrow Leukemia, less CLL

204.8 LYMPHOID LEUKEMIA NEC Medical review Red Bone Marrow Leukemia, less CLL

204.80 OTHER LYM LEUK W/O REMISS Medical review Red Bone Marrow Leukemia, less CLL
Effective Date: 03/05/2004 Revision No. 01 PC-1 Document No. ORAUT-OTIB-0005 Page 14 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

204.81 OTHER LYM LEUK W/REMISS Medical review Red Bone Marrow Leukemia, less CLL

204.9 LYMPHOID LEUKEMIA NOS Medical review Red Bone Marrow Acute lymphoid leukemia

204.90 UNS LYM LEUK W/O REMISS Medical review Red Bone Marrow Acute lymphoid leukemia

204.91 UNS LYM LEUK W/REMISS Medical review Red Bone Marrow Acute lymphoid leukemia

205 MYELOID LEUKEMIA 

205.0 ACUTE MYELOID LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute myeloid leukemia

205.00 ACT MYL LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute myeloid leukemia

205.01 ACT MYL LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute myeloid leukemia

205.1 CHRONIC MYELOID LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Chronic myeloid leukemia

205.10 CHRONIC MYL LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Chronic myeloid leukemia

205.11 CHRONIC MYL LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Chronic myeloid leukemia

205.2 SUBACUT MYELOID LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.20 SBAC MYL LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.21 SBAC MYL LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.3 MYELOID SARCOMA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.30 MYL SRCOMA W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.31 MYL SRCOMA W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.8 MYELOID LEUKEMIA NEC Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.80 OTHER MYL LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.81 OTHER MYL LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

205.9 MYELOID LEUKEMIA NOS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute myeloid leukemia

205.90 UNS MYL LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute myeloid leukemia

205.91 UNS MYL LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute myeloid leukemia

206 MONOCYTIC LEUKEMIA 

206.0 ACUTE MONOCYTIC LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.00 ACT MONO LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.01 ACT MONO LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.1 CHRONIC MONOCYTIC LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.10 CHRONIC MONO LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.11 CHRONIC MONO LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.2 SUBAC MONOCYTIC LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.20 SBACUTE MONO LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.21 SBACUTE MONO LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.8 MONOCYTIC LEUKEMIA NEC Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.80 OTHER MONO LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.81 OTHER MONO LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.9 MONOCYTIC LEUKEMIA NOS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.90 UNS MONO LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

206.91 UNS MONO LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207 OTHER SPECIFIED LEUKEMIA 

207.0 ACUTE ERYTHREMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.00 ACT ERTH/ERYLK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.01 ACT ERTH/ERYLK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.1 CHRONIC ERYTHREMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.10 CHRONIC ERYTHRM W/O REMISION Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.11 CHRONIC ERYTHRM W/REMISION Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.2 MEGAKARYOCYTIC LEUKEMIA Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.20 MGKRYCYT LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.21 MGKRYCYT LEUK W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.8 SPECIFIED LEUKEMIA NEC Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.80 OTHER SPF LEUK W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

207.81 OTHER SPF LEUK W/REMSION Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208 LEUKEMIA-UNSPECIF CELL

208.0 ACT LEUK UNS CL W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute lymphoid leukemia AND

Acute myeloid leukemia

208.00 ACT LEUK UNS CL W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute lymphoid leukemia AND

Acute myeloid leukemia
Effective Date: 05/07/2004 Revision No. 01 PC-2 Document No. ORAUT-OTIB-0005 Page 15 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

208.01 ACT LEUK UNS CL W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute lymphoid leukemia AND

Acute myeloid leukemia

208.1 CHRONIC LEUKEMIA NOS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Chronic myeloid leukemia

208.10 CHRONIC LEUK UNS CL W/O REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Chronic myeloid leukemia

208.11 CHRONIC LEUK UNS CL W/REMISS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Chronic myeloid leukemia

208.2 SUBACUTE LEUKEMIA NOS Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208.20 SUBACUTE LEUKEMIA UNS CL W/O 

REMISSION 

Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208.21 SUBACUTE LEUKEMIA UNS CL 

W/REMISSION

Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208.8 LEUKEMIA-UNSPEC CELL NEC Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208.80 OTHER LEUK UNS CL W/O REMISSION Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208.81 OTHER LEUK UNS CL W/REMISSION Red Bone Marrow Red Bone Marrow Leukemia, less CLL

208.9 LEUKEMIA-UNSPEC CELL NOS Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute lymphoid leukemia AND 

Acute myeloid leukemia AND

Chronic myeloid leukemia

208.90 OTHER LEUK NOS W/O REMISSION Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute lymphoid leukemia AND

Acute myeloid leukemia AND

Chronic myeloid leukemia

208.91 OTHER LEUK NOS W/REMISSION Red Bone Marrow Red Bone Marrow Leukemia, less CLL AND

Acute lymphoid leukemia AND

Acute myeloid leukemia AND

Chronic myeloid leukemia

230 CA IN SITU DIGESTIVE ORG 

230.0 CA IN SITU ORAL CAV/PHAR Highest non-met 

org/tiss

Thyroid Oral cav. and pharynx

230.1 CA IN SITU ESOPHAGUS Esophagus Esophagus Esophagus

230.2 CA IN SITU STOMACH Stomach Stomach Stomach

230.3 CA IN SITU COLON Colon Colon Colon

230.4 CA IN SITU RECTUM LLI Colon Rectum

230.5 CA IN SITU ANAL CANAL LLI Colon Rectum

230.6 CA IN SITU ANUS NOS LLI Colon Rectum

230.7 CA IN SITU BOWEL NEC/NOS Colon Colon All digestive

230.8 CA IN SITU LIVER/BILIARY Liver Liver Liver

230.9 CA IN SITU GI NEC/NOS Highest non-met 

org/tiss

Remainder2 All digestive

231 CA IN SITU RESPIRATORY 

231.0 CA IN SITU LARYNX ET2 Esophagus Other respiratory

231.1 CA IN SITU TRACHEA BB Thyroid Lung

231.2 CA IN SITU BRONCHUS/LUNG Lung Lung Lung

231.8 CA IN SITU RESP SYS NEC Medical review Medical review Other respiratory

231.9 CA IN SITU RESP SYS NOS Lung Lung Other respiratory

232 CARCINOMA IN SITU SKIN 

232.0 CA IN SITU SKIN LIP Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.1 CA IN SITU EYELID Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.2 CA IN SITU SKIN EAR Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.3 CA IN SITU SKIN FACE NEC Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.4 CA IN SITU SCALP Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.5 CA IN SITU SKIN TRUNK Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.6 CA IN SITU SKIN ARM Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.7 CA IN SITU SKIN LEG Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.8 CA IN SITU SKIN NEC Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

232.9 CA IN SITU SKIN NOS Skin Skin Malignant melanoma AND

Non-melanoma skin-Squamous cell

233 CA IN SITU BREAST/GU 
Effective Date: 05/07/2004 Revision No. 01 PC-2 Document No. ORAUT-OTIB-0005 Page 16 of 19

ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

233.0 CA IN SITU BREAST Breast Breast Breast

233.1 CA IN SITU CERVIX UTERI Uterus Uterus Female genitalia less ovary

233.2 CA IN SITU UTERUS NEC Uterus Uterus Female genitalia less ovary

233.3 CA IN SITU FEM GEN NEC Uterus Uterus Female genitalia less ovary AND

Ovary

233.4 CA IN SITU PROSTATE Highest non-met 

org/tiss

Testes All male genitalia

233.5 CA IN SITU PENIS Testes Testes All male genitalia

233.6 CA IN SITU MALE GEN NEC Testes Testes All male genitalia

233.7 CA IN SITU BLADDER Bladder Bladder Bladder

233.9 CA IN SITU URINARY NEC Medical review Liver Urinary organs less bladder

234 CA IN SITU NEC/NOS 

234.0 CA IN SITU EYE Brain Eye Lens Eye

234.8 CA IN SITU NEC Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

234.9 CA IN SITU NOS Highest non-met 

org/tiss

Remainder2 Other and ill-defined sites

235 UNCERT BEHAV NEOPLASM GI/RESP 

235.0 UNCERT BEHAV NEOPLASM SALIVARY Highest non-met 

org/tiss

Thyroid/Remainder1 Oral cav. and pharynx

235.1 UNCERT BEHAV NEOPLASM ORAL/PHAR Highest non-met 

org/tiss

Thyroid/Remainder1 Oral cav. and pharynx

235.2 UNCERT BEHAV NEOPLASM INTESTINE 

(stomach)

Stomach Stomach Stomach

235.2 UNCERT BEHAV NEOPLASM INTESTINE 

(colon)

Colon Colon Colon

235.2 UNCERT BEHAV NEOPLASM INTESTINE 

(rectum)

LLI Colon Rectum

235.3 UNCERT BEHAV NEOPLASM LIVER Liver Liver Liver

235.4 UNCERT BEHAV NEOPLASM 

PERITONEUM 

Highest non-met 

org/tiss

Colon All digestive

235.5 UNCERT BEHAV NEOPLASM GI NEC Colon Colon All digestive

235.6 UNCERT BEHAV NEOPLASM LARYNX ET2 Esophagus Other respiratory

235.7 UNCERT BEHAV NEOPLASM LUNG Lung Lung Lung

235.8 UNCERT BEHAV NEOPLASM PLEURA Medical review Lung Other respiratory

235.9 UNCERT BEHAV NEOPLASM RESP NEC Medical review Lung Other respiratory

236 UNCERT BEHAV NEOPLASM GU 

236.0 UNCERT BEHAV NEOPLASM UTERUS Uterus Uterus Female genitalia, less ovary

236.1 UNCERT BEHAV NEOPLASM PLACENTA Uterus Uterus Female genitalia, less ovary

236.2 UNCERT BEHAV NEOPLASM OVARY Ovaries Ovaries Ovary

236.3 UNCERT BEHAV NEOPLASM FEMALE NEC Medical review Uterus Female genitalia, less ovary

236.4 UNCERT BEHAV NEOPLASM TESTIS Testes Testes All male genitalia

236.5 UNCERT BEHAV NEOPLASM PROSTATE Highest non-met 

org/tiss

Testes All male genitalia

236.6 UNCERT BEHAV NEOPLASM MALE NEC Testes Testes All male genitalia

236.7 UNCERT BEHAV NEOPLASM BLADDER Bladder Bladder Bladder

236.9 UNCERT BEHAV NEOPLASM OTHER 

URINAR 

Medical review Liver Urinary organs less bladder

236.90 UNCERT BEHAV NEOPLASM URINAR 

NOS 

Medical review Liver Urinary organs less bladder

236.91 UNCERT BEHAV NEOPLASM KIDNEY Medical review Liver Urinary organs less bladder

236.99 UNCERT BEHAV NEOPLASM URINAR 

NEC 

Medical review Liver Urinary organs less bladder

237 UNCER NEOPLASM ENDOCRINE/NERV 

237.0 UNCERT BEHAV NEOPLASM PITUITARY Brain Thyroid/Remainder1 Thyroid

237.1 UNCERT BEHAV NEOPLASM PINEAL Brain Thyroid/Remainder1 Thyroid

237.2 UNCERT BEHAV NEOPLASM ADRENAL Adrenal Liver Urinary organs less bladder

237.3 UNCERT BEHAV NEOPLASM PARAGANG Brain Thyroid/Remainder1 Nervous system

237.4 UNCER NEOPLASM ENDOCRINE NEC Medical review Remainder2 Thyroid

237.5 UNCERT BEH NEOPLASM BRAIN/SPINAL Brain Thyroid/Remainder1 Nervous system

237.6 UNCERT BEHAV NEOPLASM MENINGES Brain Thyroid/Remainder1 Nervous system

237.7 NEUROFIBROMATOSIS Medical review Remainder2 Nervous system

237.70 NEUROFIBROMATOSIS NOS Medical review Remainder2 Nervous system

237.71 NEUROFIBROMATOSIS TYPE I Medical review Remainder2 Nervous system

237.72 NEUROFIBROMATOSIS TYP II Medical review Remainder2 Nervous system

237.9 UNCERT BEH NEOPLASM NERV SYS 

NEC 

Medical review Remainder2 Nervous system

238 UNCERT BEHAV NEOPLASM NEC/NOS 

238.0 UNCERT BEHAV NEOPLASM BONE Medical review Red Bone Marrow Bone
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ICD-9 

Code Cancer code explanation

IMBA applicable 

organ External organ IREP model

238.1 UNCERT BEHAV NEOPLASM SOFT TISSU Medical review Remainder2 Connective Tissue

238.2 UNCERT BEHAV NEOPLASM SKIN Medical review Skin 

Malignant melanoma AND

non-melanoma skin-Basal cell

238.3 UNCERT BEHAV NEOPLASM BREAST Medical review Breast Breast

238.4 POLYCYTHEMIA Red Bone Marrow Red Bone Marrow Bone

238.5 MASTOCYTOMA NOS Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

238.6 PLASMACYTOMA NOS Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

238.7 LYMPHOPROLIFERAT DISEASE NOS Red Bone Marrow Red Bone Marrow

Bone AND

Lymphoma and multiple myeloma

238.8 UNCERT BEHAVIOR NEOPLASM NEC Medical review Remainder2 Other and ill-defined sites

238.9 UNCERT BEHAVIOR NEOPLASM NOS Medical review Remainder2 Other and ill-defined sites

239 UNSPECIFIED NEOPLASM 

239.0 DIGESTIVE NEOPLASM NOS Medical review Stomach All digestive

239.1 RESPIRATORY NEOPLASM NOS Medical review Lung

Lung AND

Other respiratory

239.2 BONE/SKIN NEOPLASM NOS (Bone) Medical review Red Bone Marrow Bone

239.2 BONE/SKIN NEOPLASM NOS (Skin) Medical review skin Non-melanoma skin-Basal cell

239.3 BREAST NEOPLASM NOS Breast Breast Breast

239.4 BLADDER NEOPLASM NOS Bladder Bladder Bladder

239.5 OTHER GU NEOPLASM NOS (Female) Medical review Bladder

Female genitalia less ovary AND

Ovary AND

All urinary organs

239.5 OTHER GU NEOPLASM NOS (Male) Medical review Testes

All male genitalia AND

All urinary organs

239.6 BRAIN NEOPLASM NOS Brain Thyroid/Remainder1 Nervous system

239.7 BRAIN/NERV NEOPLASM NOS Medical review Remainder2 Nervous system

239.7 ENDOCRINE NOS Medical review Remainder2

Thyroid AND

Other endocrine glands

239.8 NEOPLASM NOS, SITE NEC Medical review Remainder2 Other and ill-defined sites

239.9 NEOPLASM NOS Medical review Remainder2 Other and ill-defined sites

273

DISORDERS OF PLASMA PROTEIN 

METABOLISM

273.3 WALDENSTROM'S MACROGLOBULINEMIA Red Bone Marrow Red Bone Marrow Lymphoma and multiple myeloma

289 OTHER SPECIFIED BLOOD DISORDER

289.8

 OTHER SPECIFIED DISEASES OF BLOOD 

AND BLOOD-FORMING ORGANS Red Bone Marrow Red Bone Marrow Bone

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 7 of the 

NIOSH-IREP Technical Documentation.

4 - 42 CFR 81.30 states this cancer is non-radiogenic for the purposes of EEOICPA and assigns zero probability of causation.

4.0 Discussion

4.1 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.
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 18 of 19

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 are unknown, such as with lymphatic 

cancers, 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 
Effective Date: 01/23/2004 Revision No. 01 Document No. ORAUT-OTIB-0005 Page 19 of 19

“Non-melanoma skin-Basal cell OR Non-melanoma skin-Squamous cell” in the IREP Model column. 

The appropriate IREP model would be selected and run based on the type of skin cancer (Basel cell 

or Squamous cell) listed in the claim’s DOL documentation.

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.

5.0 References

1. 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

2. 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

3. NIOSH, (2002) External Dose Reconstruction Implementation Guideline, Rev 1, OCAS-IG001, National Institute for Occupational Safety and Health, Office of Compensation 

Analysis and Support, Cincinnati, Ohio, August 2002

4. 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

5. NIOSH, NIOSH-Interactive RadioEpidemiological Program (NIOSH-IREP), Technical

Documentation, Office of Compensation Analysis and Support, Cincinnati, Ohio, June

2002