Nadia Haddad
Needs a human
52 F · MRN TCPT-0048188 · Maxillary sinus SCC, pT4a N0, post maxillectomy
Aetna Open Access PPO (Commercial) · W301877254
Ordered by R. Lee, MD · Sep 23, 2026 · CPT 77525 · C31.0 Malignant neoplasm of maxillary sinus
| Required by Aetna policy AET-PBRT-DEMO | Source in chart | Match | Status |
|---|---|---|---|
Histologic confirmation (recurrence biopsy) C-1 · §I.A.1 | Maxillectomy pathology Aug 27, 2026 · US Oncology Pathology · p. 1 | Exact | Included |
Restaging imaging within 60 days, no distant disease C-2 · §I.A.2 | Postoperative CT and MRI Sep 14, 2026 · Baylor Radiology · p. 1 | Exact | Included |
Karnofsky performance status ≥ 70 C-3 · §I.A.3 | Nursing assessment Sep 17, 2026 · K. Duran, RN · p. 1 | Exact | Included |
Multidisciplinary tumor board recommendation C-4 · §I.B.1 | Not found in G2 | — | Missing → PA coordinator |
Prescription dose and fractionation C-5 · §I.C.1 | Physics note Sep 22, 2026 · D. Okafor, PhD · p. 1 | Exact | Included |
Comparative IMRT plan showing a dosimetric advantage C-6 · §I.C.2 | Comparative plan report Sep 22, 2026 · K. Bhatt, CMD · p. 1 | Exact | Included |
HPV/p16 status (newly diagnosed oropharynx) C-7 · §II.A.1 · Not on branch: requires newly diagnosed, definitive treatment | Not required on this branch | — | Not on branch |
Parotid and oral cavity sparing (no prior RT) C-8 · §II.A.2 | Comparative plan report — salivary DVH Sep 22, 2026 · K. Bhatt, CMD · p. 1 | Exact | Included |
Prior course: dates, total dose and fractionation C-9 · §III.A.1 · Not on branch: requires prior RT to the treatment field | Not required on this branch | — | Not on branch |
At least 6 months since the prior course C-10 · §III.A.2 · Not on branch: requires prior RT to the treatment field | Not required on this branch | — | Not on branch |
Surgical evaluation: salvage surgery not feasible or declined C-11 · §III.A.3 · Not on branch: requires prior RT to the treatment field | Not required on this branch | — | Not on branch |
Cumulative spinal cord and brainstem dose (composite plan) C-12 · §III.B.1 · Not on branch: requires prior RT to the treatment field | Not required on this branch | — | Not on branch |
Signed letter of medical necessity C-13 · §IV.A · signature required | Letter of medical necessity Sep 23, 2026 · R. Lee, MD · p. 1 | Exact | Included |
None yet. When the audit fails a criterion, ACE searches the chart again before asking a person.