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We have a patient with a history of squamous cell carcinoma of the right head and neck who completed radiation therapy on 10/15/2021. She presented to otolaryngology with three week history of pain right side of neck and face starting early February. With concern for return of disease, biopsies were done 2/25/22. Biopsies were negative for malignancy, but had necrotic centers and inflamed tissue. Radiation oncology has recommended HBOT. The symptoms started at a little less than 5 months since end of radiation. Will this be a concern for reimbursement, as it is less than 6 months post treatment?
Mar 3, 2022 by Brenda Megna, BSN RN CHRN
2 replies
Eugene Worth
Brenda: This is a quandary that we find ourselves in frequently. The answer is not what you are looking for, ... "It depends." You will need to examine the hyperbaric oxygen criteria for your medicare fiscal intermediary or insurance company requirements. Some do NOT state a minimum 6-month requirement after radiation. Some might initially deny the treatment, but after superb documentation is reviewed ... may go ahead and approve.

So, this is a case that requires creative writing of the history and physical examination. You might avail yourself to the indication section of Wound Reference, specifically looking at the section on radiation soft tissue injuries. You must convince your physician to be much more attuned to the documentation than he/she is used to doing.

So, my documentation would start with the following:
Type of cancer.
Date discovered.
Treatment, including IV chemotherapy agents and how many
Radiation ... type of radiation (electron beam vs neutron beam, etc) Just an aside, neutron beams are much more destructive than other radiation.
Overall dose of radiation and dose at any focal treatment areas or extensions (Head and neck cancers are frequently treated at 6000-7000 cGy, almost a maximum dose of radiation.
When the radiation started and when it ended.
Beginning of post-radiation tissue problems ... As you stated above ... some 5 months after radiation completed.
Workup for the pain syndrome
It is VERY important to include that the biopsy sites are non-healing and necrotic in appearance.
On the head and neck physical examination, you must describe the radiated tissue bed in terms of thin skin, hemangiectasias, tight skin, discolored, permanent sunburn, etc ... and state that these findings were in tissue within the boundaries of the radiation tattoos, etc.

Once you have a thorough documentation, then submit if for pre-approval to the insurer and hope for the best.

Hope that helps!
Mar 3, 2022
Brenda Megna
Thank-you! I will get this to Dr. Markus tomorrow for the consult.
Mar 8, 2022
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