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Part B Insider (Multispecialty) Coding Alert

PHYSICIAN NOTES:

Osteoarthritic Knees Don't Live On Arthroscopic Lavage Alone

Published on Tue Jul 27, 2004 Print Friendly and PDF PDF

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 it 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.

But 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.

  • It's a wired world now. CMS announced new initiatives to promote electronic health records, drug prescriptions, and other health information technologies that will lower costs and lead to more personalized services.

    CMS will introduce an Internet portal for Medicare benes in Indiana to look up their claims information, including claims type, date of service and procedures. The portal will protect the privacy and security of their information. And CMS plans to add information on preventive services by the end of the year.

    CMS also will speed up the time-line for electronic prescriptions mandated by the Medicare Modernization Act of 2004, which originally called for e-prescribing by 2009. CMS expects to require an initial set of standards by January 2006, when the Medicare drug benefit begins. CMS will learn from other e-prescribing programs nationwide.

    And the Medicare program will encourage docs to start using electronic health records systems, especially in their offices. CMS has joined a national alliance of purchasers developing a "common agenda" for health information technology and will conduct demonstration projects to use financial incentives encourage EHR in physicians' offices.

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