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Inventory #: 01 Page 1 of 3 Inventory #: 01 Page 1 of 3 CDT CODE ACTION REQUEST Part 1 – Submitter Information A. Contact Information (Action Requestor) Date Submitted: 10/17/2019 Name: DentalCodeology Consortium B. Does this request represent the official position of either a dental organization or a recognized dental specialty, or a third-party payer or administrator, or the manufacturer/supplier of a product? Yes > ☒ If Yes, The Oral Cancer Foundation Name: No > ☐ Part 2 – Submission Details 1. Action Affected Code New ☒ Revise ☐ Delete ☐ (Mark one only) (Revise or Delete only) 2. Full nomenclature and descriptor (For “Revise” mark-up as follows: added text – blue underline; deleted text – red strike-through; unchanged text – black) Nomenclature an enhanced oral cancer examination to include a comprehensive risk Required for all assessment, visual and tactile, intra/extra oral and oropharyngeal screening to “New” identify abnormalities Descriptor This procedure involves a detailed risk assessment to include a verbal inquiry, and/or an updated or new written health history, with a visual inspection using operatory Optional for “New”; enter “None” if no lighting/loupes, and palpation, which are the necessary techniques used in oral and descriptor oropharyngeal cancer evaluations. NOTICE TO PREPARER AND SUBMITTER: All requested information in Parts 1-3 is required; limited exceptions are noted. Cells where information is entered have white backgrounds and will automatically expand as needed. Mark cells with “check boxes” (☐) by moving the cursor over the box and making a “left-click”. Completed Request must be submitted in unprotected MSWord® format via email to [email protected]. A submission will be returned for correction if it is: a) not an unprotected MS Word document; b) not on the current Action Request format; or c) it is missing “Required” information. Inventory #: 01 Page 2 of 3 CDT CODE ACTION REQUEST 3. Rationale for this request; your persuasive argument for CMC acceptance (Required for any type of requested action – New; Revise; Delete) From ADA News October 1, 2019: Resolution 65H-2019 amended the American Dental Association policy on early detection and prevention of oral cancer to include oropharyngeal cancer and cover all patients, not just those previously thought to be at an increased risk because of tobacco and alcohol use. This revised policy aligns with the Center for Disease Control and Prevention guidelines. According to the ADA “Every patient should be screened by their dentist and dental hygienist for possible early signs and symptoms of oral cancer, including HPV- associated oropharyngeal ones.” The expert panel suggests “…clinicians should obtain an updated medical, social, and dental history and perform an intraoral and extraoral conventional visual and tactile examination in all adult patients.” This is not optional. https://ebd.ada.org/en/evidence/guidelines/oral- cancer?source=promospots&content=OralCancerGuidelines&medium=ADANews&campaign=Best&_ga=2.18182768 7.155637336.1569341918-458445032.1567983569 In 2019 approximately 53,000 Americans will be diagnosed with oral/ oropharyngeal cancer. Breaking down to 145.2 Americans diagnosed every day, and 6 Americans diagnosed every hour. https://oralcancerfoundation.org/facts/ Video on ADA website: https://www.youtube.com/watch?v=_CSwFT42xCo#action=share In this video on the ADA website, an oropharyngeal cancer survivor explains how her new dentist performed an extensive oral exam and external exam, and discovered a swollen lymph node. She was referred, and subsequently diagnosed with oropharyngeal cancer. “…early diagnosis is associated with the best outcomes. Regular dental check-ups that include an examination of the entire head and neck can be vital in detecting cancer early.” Human papillomavirus (HPV)-related oropharyngeal cancer (OPC) is now considered an epidemic, causing three- quarters of all oropharyngeal cancer. https://www.dentistryiq.com/clinical/oral-cancer-article/16367615/the-101-on- hpv-what-healthcare-providers-need-to-know-about-the-hpvoral-cancer-epidemic. Oral and Oropharyngeal cancer will cause more than 9,750 deaths this year. Of those diagnosed, approximately 57%, will be alive in 5 years. Early detection gives an 83% chance of survival after five years. This statistic has not improved in decades. This increase has changed due to the rising of HPV16 causing cancers. https://oralcancerfoundation.org/facts/ Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality. The overall cost burden of OC/OP/SG cancer is significant and is experienced by all payers, Medicare, Medicaid, the employer, and the individual. https://headandneckoncology.biomedcentral.com/articles/10.1186/1758-3284-4-15 Squamous cell carcinoma of the mobile tongue appears to be progressively increasing in incidence, particularly in young adults and especially in females. No specific etiology has been identified. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036956/ Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread. https://seer.cancer.gov/statfacts/html/oralcav.html A formalized oral/oropharyngeal cancer screening is beneficial for all individuals. Incentivizing dental professionals for their vigilance in this regard is aligned with good preventive dental care and recognizes the patient- clinician partnership in achieving improved overall health. Furthermore, formal procedure coding and reimbursement of this process acknowledges the clinical team’s added effort and their liability as they try to achieve the best possible clinical outcomes for every patient. NOTICE TO PREPARER AND SUBMITTER: All requested information in Parts 1-3 is required; limited exceptions are noted. Cells where information is entered have white backgrounds and will automatically expand as needed. Mark cells with “check boxes” (☐) by moving the cursor over the box and making a “left-click”. Completed Request must be submitted in unprotected MSWord® format via email to [email protected]. A submission will be returned for correction if it is: a) not an unprotected MS Word document; b) not on the current Action Request format; or c) it is missing “Required” information. Inventory #: 01 Page 3 of 3 CDT CODE ACTION REQUEST Mark if Revise or Delete 4. Complete a) – c) only if Action Request is for a New CDT Code ☐ [ “a) - c)” are not applicable] a) CDT Code currently used to report the procedure None b) Procedure technical description Clinicians should perform an enhanced evaluation by obtaining an updated medical,social, and dental history and perform an intraoral and extraoral conventional visual an tactile examination on all patients. c) Clinical scenario An enhanced oral and oropharyngeal cancer screening would be utilized for all individuals. It is recommended as a routine screening for every age and an appropriate medical referral made as indicated upon results. Part 3 – Additional Information 5. Supporting documentation or literature: “5.a)” must be completed for all requested actions; “b)” and “c)” are completed when indicated. If protected by copyright, written authorization to reprint and distribute must be provided All material must be submitted in electronic format. Yes > ☐ b) Protected by Yes > ☐ c) Permission Yes > ☐ a) Material copyright? to reprint? submitted? No > ☒ (If “a)” is “Yes”) No > ☐ (If “b)” is “Yes”) No > ☐ 6. Additional Comment or Explanation: CDT Procedure Codes D0120 and D0150 both state “an evaluation for oral cancer where indicated” allowing this evaluation to be optional. Code D0180 states, “this evaluation, may include oral cancer evaluation”, also allowing this evaluation to be optional. An enhanced oral cancer examination should not be optional. NOTICE TO PREPARER AND SUBMITTER: All requested information in Parts 1-3 is required; limited exceptions are noted. Cells where information is entered have white backgrounds and will automatically expand as needed. Mark cells with “check boxes” (☐) by moving the cursor over the box and making a “left-click”. Completed Request must be submitted in unprotected MSWord® format via email to [email protected]. A submission will be returned for correction if it is: a) not an unprotected MS Word document; b) not on the current Action Request format; or c) it is missing “Required” information. Inventory #: 02 Page 1 of 2 CDT CODE ACTION REQUEST Part 1 – Submitter Information A. Contact Information (Action Requestor) Date Submitted: 10/17/2019 Name: DentalCodeology Consortium B. Does this request represent the official position of either a dental organization or a recognized dental specialty, or a third-party payer or administrator, or the manufacturer/supplier of a product? Yes > ☒ If Yes, The Oral Cancer Foundation Name: No > ☐ Part 2 – Submission Details 1. Action Affected Code New ☐ Revise ☒ Delete ☐ D0120 (Mark one only) (Revise or Delete only) 2. Full nomenclature and descriptor (For “Revise” mark-up as follows: added text – blue underline; deleted text – red strike-through; unchanged text – black) Nomenclature Required
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