TN 34 (08-20)

DI 23022.190 Head and Neck Cancers

COMPASSIONATE ALLOWANCES INFORMATION

HEAD AND NECK CANCERS

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

DESCRIPTION

Head and Neck Cancers includes those cancers that arise in the head or neck region (e.g., nasal cavity, sinuses, lips, mouth, tongue, throat, or larynx [voice box]).

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The following may be used to diagnose the disease:

  • Physical exam and history;

  • Endoscopy;

  • Laboratory tests including blood and urine analysis;

  • X-rays;

  • Computed tomography (CT) scan;

  • Biopsy;

  • Magnetic resonance imaging (MRI); and

  • Positron emission tomography (PET) scan.

Physical findings:

  • Persistent sore throat;

  • Mouth sores that won't heal;

  • Hoarseness;

  • Persistent swelling of the neck

ICD-9: 173.02,

ICD-10: C30, C44.40, C80.1

PROGRESSION

When cancer of any of the sites is advanced, the prognosis is very poor.

TREATMENT

Treatment may include surgery, radiation, and/or chemotherapy. These treatments may affect eating, speaking, or even breathing.

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

13.02

Head and Neck Cancer that is inoperable or unresectable, has distant metastasis, or is a small cell (oat cell) carcinoma, meets the requirements in listing 13.02.

Equals

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022190
DI 23022.190 - Head and Neck Cancers - 08/28/2020
Batch run: 07/20/2021
Rev:08/28/2020