| | Joined: Jan 2014 Posts: 3 Member | OP  Member
Joined: Jan 2014 Posts: 3 | Maybe someone can help. I am a care manager for an oral cancer survivor. Unfortunately, he has lost part of his lower jaw, upper pallet and part of his top gum line. He has suffered multiple episodes of choking and aspiration pneumonia. Despite many requests from hi doctors and a large amount of weight loss and malnutrition, insurance continues to deny his claim for prosthetic "dentures". We have taken the word dental, dentures etc out of all the letters but he has still been denied this "dental" procedure. The dental office agrees that this is all coming down to not having the right icd-9 code. Just a long shot but has anyone ever gotten the company to pay for prothetic dentures and might be able to get us the icd-9 code used for the procedure. This family is losing hope so any help would be greatly appreciated! | | | | | Joined: Dec 2003 Posts: 2,606 Likes: 2 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Dec 2003 Posts: 2,606 Likes: 2 | I spoke with a couple dental oncologists and neither had a code. I know some have had full dentures after reconstruction but it was done through correspondence. It seems insurance approves dentures for younger people cancer free for a while.
This is definitely an area that needs a lot more visibility in 2014. It's just wrong.
SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
| | | | | Joined: Jun 2007 Posts: 10,507 Likes: 7 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 10,507 Likes: 7 | This is a big problem for oral cancer survivors. It takes an incredible effort to get these things approved by insurance companies. Im certain this is on a case by case basis. It may require the doctor/dentist to write an appeal letter to the insurance company. My oral surgeon has had to go to bat for me in several instances with minor oral surgeries.
Good luck!!!
ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive  | | | | | Joined: Jul 2011 Posts: 945 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: Jul 2011 Posts: 945 | The American Association of Maxillofacial and Oral Surgeons has some information on coding on its website - maybe there is a gem of knowledge in there somewhere. Bless you for working so hard for your clients. PM me if you have trouble with the links.
Maria
CG to husband - SCC Tonsil T1N2M0 HPV+ Never Smoker
First symptoms 7/2010, DX 12/2010
TX 40 IRMT (1.8 gy) + 10 Cetuximab
PET Scans 6/2011 + 3/2012 clear, 5 year physical exam clear; chest CT's clear of cancer. On thyroid pills. Life is good.
| | | | | Joined: Oct 2014 Posts: 5 Member | | Member
Joined: Oct 2014 Posts: 5 | My prosthodonist, Dr George C Bohle, is in OKC. I contacted his office to ask which codes they used for my prosthesis and got this information in return.
"All of them are different, but the ICD-9 Code we used for yours is 170.1"
I hope that gives you a jumping off place. I had 9 lower teeth removed and a partial mandibulectomy. Dr Bohle and several of my other doctors really went to bat for me.
Paula
59yo former smoker
SCC floor of mouth and mandible
Stage 2, T2N0M0, G2
DX 09.20.13
TX: 01.21.14 Surgical removal floor of mouth, hemiglossectomy,removal teeth #21-29, alveolar ridge, midline and right marginal mandibulectomy. Temp trach. Radical Neck Dissection.
No Chem or Rad
07.18.14 No sign of disease <yay!>
09.17.14 Temporary Fixed Prosthesis (Yay, some more!>
Frustration: pain and limited movement r arm/shoulder
Joy: I am so thankful to be alive and to enjoy life.
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