The dental community is among the first line of defense when it comes to early detection of disease.  And with oral cancer being one of the highest-ranking killers, the ADA has assumed the task of increasing public awareness about this often underrated disease.  Their efforts include taking a more aggressive approach to the importance of annual screening of all patients who visit their practices.

The ADHA recently outlined updated questions to ask when conducting an oral cancer screening as well as the correct coding to use when submitting to insurance.

Take a look at their suggestions and decide how you can use them in your own practice and do your part to assist in the efforts of creating awareness of oral cancer.

Medical History Updated Questions: see more at: http://oralcancerfoundation.org/discovery-diagnosis/public-description-proper-exam/

1. Have you noticed any changes in swallowing?
2. Do things seem to stick or catch in your throat when you swallow?
3. Have you had any chronic hoarseness (a condition that has lasted for over two weeks)?
4. Have you noticed/felt any small lumps when feeling the side of your neck putting on makeup or shaving? (Painful swollen nodes are usually a sign of infection, not cancer-painless ones are red flags.)
5. Have you had any earaches that seem to persist, particularly unilateral (only on one side)?
6. Have you or any of your friends noticed a change in your voice?
7. Have you (or your kids) been vaccinated against HPV?
8. Have you or your family had a history of head and neck cancer?

HPV Conversations:

“HPV is the fast-growing sexually transmitted virus in America. Most adults have had an HPV infection at some point in their life. Most people can clear the virus, but in some cases, the virus cannot be cleared. There are over 200 strains of HPV, we are particularly concerned with the strain #18 as it can put you at high risk for oral cancer.”

A conversation regarding the physical head and neck exam and use of adjuncts:

1. “We have always screened the soft tissues as part of your routine check-up.”
2. We are not working to increase your own awareness of the importance of oral cancer screening.”
3. “Evidence suggests that the incidence of oral cancer is increasing and we believe we should be taking a more active role in increasing your awareness of the importance of complete oral health and oral cancer screening.”
4. “We need to keep more detailed records, including information about your lifestyle so that we can offer you a more comprehensive oral health care service.
5. “We are extending the range of healthcare provided at this practice.”

*Average fees can vary and take into consideration all procedures that are listed under that category. Procedures can range in difficulty/size of neoplasm. Take into consideration outside lab fees, are you paying these or is the patient being billed separately? https://fairhealthconsumer.org/index.php to look at average fees in a specific area. They are vague averages and should be researched fully before charging out.

**CytID encourages offices to contact them to discuss fees, as their recommendations are lower than this average. Take into consideration CytID also bills for their services.

ICD-9 and ICD-10 Codes

ICD-9 or ICD-10 Codes: International Classification of Disease Codes. ICD Codes, aka diagnosis codes, are required with all medical (AMA) claims.

Effective for procedures after the date of service October 1, 2015, ICD-10 codes are to be used. There are, however, some insurances that are still asking for ICD-9 codes. If you’re not sure what code they will take, send ICD-10 if the date of service is after October 1. If the date of service is before October 1, 2015, send with ICD-9.

ICD-9/10 code for screening for malignant neoplasms in the oral cavity:

ICD-9: V76.42                                                                        ICD-10:   Z12.81

If they’re familiar with a certain set of ICD-9 codes, there a great website that will translate codes: https://www.aapc.com/icd-10/codes/

Submitting oral cancer screening/procedures to insurances:

Most insurances, medical and dental alike, do not cover oral cancer tests (like OralID). Oral cancer screens can be sent directly to dental insurance. Contact the patient’s plan to confirm coverage.

Biopsies/cytologies: dental typically requests this go to medical before they will consider coverage. Send to medical (make sure to set up medical/dental cross coding in your claim formatter) then send it to dental with an attached medical EOB (explanation of benefits). Most dental plans will also require a lab report/narrative to be sent with the claim before consideration as well.

No double-dipping. Don’t submit to medical and dental without informing the other.

Reference

Is Your Office Providing the Right Oral Cancer Exam? June 16, 2017 American Dental Hygienists’ Association (adha) 94^th Annual Conference

 Resources

Professional and Patient websites:
Oral Cancer Foundation: http://oralcancerfoundation.org/
Six Step Screening:   http://www.sixstepscreening.org/