Sarah:

Interesting presentation, and not uncommon one at that. These women were some of our most appreciative patients ... read that as cookies, brownies, etc.

This is soft tissue radiation necrosis. The key to coverage for this case depends entirely on your physician documentation. For example, the documentation must address the following ...

1. How much radiation (and the timeframe currently ... just like you presented to us.

2. The long-term changes in anatomy due to the radiation, such as permanent skin darkening in the area of radiation marks/tattoos. Also document the skin appearance changes, thin, presence of telangiectasias, evidence of localized lympedema of the affected breast (look for very small light colored donuts around hair follicles, pain in the breast, firm breast tissue (not compliant) ... you get the picture. The more details you can provide to support your diagnosis of breast STRN, the more your case stands up to review.

I'm going to attach several papers that show the documentation, treatment regimen, and outcomes for these women. Good luck.

Treatment protocol is 2.4ATA for 90 minutes of O2 breathing x 15 treatments.

gene

I agree with Gene. The only other thing that I can think of that you even could consider is a skin biopsy to confirm STRN which should make the diagnosis unquestionable. However, the biopsy is certainly not a requirement and if you document as Gene suggested then that should paint a clear clinical picture.

Mike