post ovarion surgery check up frequency

[Bruja]

Am 15 years post endometrioid adenocarcinoma Stage I.  Oncologist stated I should be seen 2 times/year by oncologist 'forever'.  He further stated that Medicare would allow payments for his exams (as GYN oncologist) at that frequency. I felt regular GYN found the initial problem so after 6 years returned to regular as I thought reasonable to 'save the system money'. Now I find it is true Medicare only allows exams every 2 years despite post cancer status coded on visit to the regular GYN.  What is the actual recommendation, medically?  

[Curls]

I don't know what the medical recommendation is.  I do believe their general checkup policy is every two years or one years & that may be the case no matter what.

However, medicare has switched to an open visiblity policy.  You can now request a list of all the possible diagnositic codes to go with a CPT treatment code - at least if you've been turned down for payment.  It's a newish policy & getting someone to understand & do it can be tough.  Their website might have more clarity on it or how to ask for it.  

However, I was able to get a list of all the diagnositic codes for a CA125 after being turned down (I lucked into a new person who didn't know to give me a hard time).  The list is innande (I wish I could spell).  Things like, it wasn't covered for abnormal cystic ovarian growth, but was covered for anormal cystic ovarian adenoma (which means growth).  It was around four pages deep of codes.  

So, IF you can get the list, you can better judge what they really think of checkups after prior carcinoma.  It may be a policy of every two years after a prior cancer, but every 6 months after a prior carcinoma.  (When I saw one of these lists I finally figured out what my doctor had been muttering under his breath over the years about the codes & being wrong & needing fixing & it making him crazy & letting them know but they don't change it.)

There is also a Medicare appeal process for a denial.  They won't write to you about policy before you've been denied.  But afterwards they'd quote the policy in writing. They don't use intelligence & say that if you turned the page a quarter inch & used "that" relevant code it would have been approved.  But at least it's a statement of the policy limits and it's in writing.

Gotta love bureacracy.  At least it has rules.  

[Bruja]

Thanks.  I used to file Medicare for physician husband.  The sophistication of the oncologists may yield results.  However, they should share with other providers of care to their post-cancer patients.  I will look into the information you specifically suggest.  

[Curls]

Hi,
The physician I was referring to was my GP.  The oncol office (Hopkins) was not helpful at all at understanding their own stuff let alone follow up.  ...which is how I got myself mired in the suggestions I described.  They are convoluted, so hopefully you can get what you need with much less work. With your background if you try them, this should be easier than for the average folk!
Lots of success!