Jaycee Brown

Jaycee Brown

Director of Communications

Dental and Medical Coverage for Procedures Related to Oral Cancer

People may experience different symptoms “of a pathologic process or cancerous growth” in the mouth, such as “reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth,” “chronic sore throat or hoarseness,” an oral lesion (which “is an ulcer that occurs on the mucous membrane of the oral cavity”) with no indication of recovery, etc. (“Oral Pathology/Biopsies”; “Oral Science Protocol Oral Lesions”). People can check whether they have oral cancer “during routine dental or medical exams” (“Oral Cancer: Overview”). If a patient does have oral cancer, depending on the stage of this disease, a patient “may see a number of dental and medical specialists, including surgeons, oral surgeons, radiation oncologists, chemotherapy oncologists and restorative specialists” (Keefe 2016). Dental and medical insurance can cover procedures related to oral cancer.
Dental insurance can different services related to oral cancer. Dental insurance plans can cover oral cancer screenings as preventive services for 100 percent of the cost (Keefe 2016). These plans usually cover oral cancer screenings as “inclusive in the dental exam codes” (Nierman 2018). Dentists can bill different procedures to dental insurance companies for an oral cancer screening, such as “adjunctive pre-diagnostic test that helps with the detection of mucosal abnormalities, including premalignant and malignant lesions;” incisional biopsies for oral tissues, “Exfoliative Cytological Sample Collection,” and brush biopsy for transepithelial sample collection (Summerford 2015). Dentists need to send a “narrative that describes the reason of necessity and pathology report” for biopsies, exfoliative cytology, and brush biopsies (Summerford 2015). The biopsies are important because they are “the only way to confirm cancer” (“Oral Cancer: Overview”). In these biopsies, dentists get a “sample of tissues or cells” from the unusual area and send the sample “to an oral or medical pathologist depending on [the patient’s] insurance” (“Diagnosing oral cancer”; “Oral Pathology/Biopsies”).
Medical insurance can also cover procedures related to oral cancer. Dentists can bill some procedures for an oral cancer screening to medical insurance, when dental insurance does not cover services for oral cancer screenings (Taxin 2014). Dentists must show medical insurance that procedures and services, such as biopsies, “removal of lesions,” Cone-beam Computed Tomography (CBCT), etc., are medically necessary for patients (Nierman 2018). Medical insurance could also cover “cancer-related treatment” provided by dentists (Philhower and Blair 2016). For instance, medical insurance could cover “the removal of teeth before radiation therapy,” which may be “part of the treatment plan for oral cancer…” (“Diagnosing Oral Cancer”; Taxin 2016). Patients could also receive dental or medical coverage for procedures provided by specialists, such as oral surgeons, chemotherapy oncologists, etc. (Keefe 2016).
Dental and medical providers deliver different types of services to diagnose the patient’s oral cancer. If the patient has oral cancer, he or she can undergo a treatment plan for his or her condition. Fortunately, the patient can utilize his or her dental and medical insurance for procedures related to oral cancer in order to reduce his or her expenses.
Works Cited

Keefe, Anna. “Are Oral Cancer Services Covered By Dental or Medical Benefits?” Delta Dental,
November 29, 2016. https://deltadentalwiblog.com/oral-cancer-services-covered-dental-medical-benefits/.
“Diagnosing oral cancer.” Cancer Treatment Centers of America. Accessed March 7, 2019.
Nierman, Rose. “Medical Billing for Dentists – Oral Cancer Screenings.” Nierman Practice
Management, April 17, 2018. https://niermanpm.com/blog/medical-billing-dentists-oral-cancer-screenings/.
“Oral Cancer: Overview.” University of Rochester Medical Center. Accessed March 7, 2019.
“Oral Pathology/Biopsies.” VC Oral and Facial Surgery. Accessed March 7, 2019.
“Oral Science Protocol Oral Lesions.” oral science. Accessed March 7, 2019.
Philhower, Jim and Charles Blair. “Submitting dental procedures to medical insurance has been
voodoo–until now.” Dental Economics, September 22, 2016. https://www.dentaleconomics.com/articles/print/volume-106/issue-9/practice/submitting-dental-procedures-to-medical-insurance-has-been-voodoo-until-now.html.
Summerford, Kyle L. “How to maximize oral cancer screening reimbursement.” DentistryiQ,
May 13, 2015. https://www.dentistryiq.com/articles/2015/05/how-to-maximize-oral-cancer-screening-reimbursement.html.
Taxin, Christine. “A dental guide to cross-coding for oral cancer screening.” Dental Practice
Management, April 24, 2014. http://practicemanagement.dentalproductsreport.com/management/article/dental-guide-cross-coding-oral-cancer-screening.
Taxin, Christine. “What makes it medical? A basic guide to medical vs. dental procedures.”
DentistryiQ, June 22, 2016. https://www.dentistryiq.com/articles/2016/06/what-makes-it-medical-a-basic-guide-to-medical-vs-dental-procedures.html.


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