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DI 23022.190: Head and Neck Cancers

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  • Effective Dates: 01/06/2017 - Present
  • Effective Dates: 03/28/2018 - Present
  • TN 1 (10-08)
  • TN 16 (03-18)
  • DI 23022.190 Head and Neck Cancers
  • COMPASSIONATE ALLOWANCE INFORMATION
  • HEAD AND NECK CANCERS
  • DESCRIPTION
  • Head and Neck Carcinoma includes those cancers that arise in the head or neck region (e.g., nasal cavity, sinuses, lips, mouth, tongue, throat, or larynx [voice box]).
  • ALTERNATE NAMES
  • Squamous Cell Carcinoma of the nasal cavity, sinuses, lips, mouth, nose, tonsils, tongue, throat, or larynx (voice box); Adenocarcinoma of the nasal cavity, sinuses, lips, mouth, nose, tonsils, tongue, throat, or larynx (voice box); Squamous Cell Cancer of the nasal cavity, sinuses, lips, mouth, nose, tonsils, tongue, throat, or larynx (voice box); Metastatic Squamous Cell Neck Cancer; Metastatic Squamous Cell Neck Carcinoma; Head and Neck Carcinomas. Small Cell or Oat Cell Carcinoma
  • DIAGNOSTIC TESTING AND CODING
  • The following may be used to diagnose the disease: physical exam and history, endoscopy, laboratory tests including blood and urine analysis, x-rays, CT scan, biopsy, MRI, and/or PET scan.
  • TREATMENT
  • Treatment may include surgery, radiation, and/or chemotherapy. These treatments may affect eating, speaking, or even breathing.
  • PROGRESSION
  • When cancer of any of the sites is advanced, the prognosis is very poor.
  • SUGGESTED PROGRAMMATIC ASSESSMENT*
  • Suggested MER for Evaluation: A pathology report and an operative report are the preferred methods for documentation. In the absence of these reports, the adjudicator may use a physician's opinion that indicates the cancer is inoperable or unresectable based on described objective findings. “Inoperable” refers to a physician's opinion that surgery would not be beneficial based on a review of imaging studies, laboratory results, and physical examination findings. Unresectable cancer is established when the operative report indicates that the cancer is not completely removed or the pathology report notes that the surgical specimen has positive margins.
  • Suggested Listings for Evaluation:
  • DETERMINATION
  • LISTING
  • REMARKS
  • Meets Listing
  • 13.02 A, C or D
  • 13.02
  • Head and Neck cancer that is inoperable or unresectable, has distant metastasis, or is a small cell (oat cell) carcinoma, meets Listing 13.02 A, C or D.
  • Head and Neck cancer that is inoperable or unresectable, has distant metastasis, or is a small cell (oat cell) carcinoma, meets Listing 13.02.
  • Medical Equals
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  • * Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.
  • Last Updated: 9/30/08
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