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!
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.
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!!!
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
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.