Medicare Compliance & Reimbursement

For patients with knee osteoarthritis, arthroscopy offers a way to look inside the joint. But if all the physician is using arthroscopy for is cleaning the joint out, then Medicare won't cover the procedure.
 
Arthroscopy lets physicians use either a large or small volume of saline fluid to irrigate the knee and also remove any loose bodies from the interior joint space. But "lavage" and "debridement" don't have any proven patient benefits by themselves, the Centers for Medicare & Medicaid Services said in a national coverage determination that took effect July 11.
 
CMS said it would leave it up to the carriers whether to cover debridement for patients without severe osteoarthritis who show up with symptoms besides pain. These symptoms could include mechanical problems like locking, popping or snapping, limb and knee joint alignment problems and less severe and early degenerative arthritis.
 
To  prove the necessity of lavage and/or debridement in those circumstances, CMS advises sending the carriers operative notes, reports of standing X-rays, or arthroscopy results.