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Question Documentation in notes for Gel injections

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Biller2023

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I believe most insurance carriers require clear documentation of failed conservative treatments before approving gel injections for knee osteoarthritis.

Could you please check and let us know if the below verbiage is sufficient to be included in our progress notes or if anything else needs to be included to this. Thank you.

Recent imaging shows the presence of degenerative changes/osteoarthritis. Symptoms have not significantly improved after 3 months of conservative treatment, including rest, activity modification, bracing, a physician-supervised home exercise program, formal physical therapy, and a [right/left] knee intra-articular corticosteroid injection. Therefore, discussed the role of intra-articular hyaluronic acid injection with [], which I feel that [] would benefit from.
 
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Sounds like a provider emailed a question on this? Did you look it up and try to find the information for them? Most folks probably aren't going to advise yes or no when being asked if a cloning type template is "ok".
This is one of the most clearly documented policies across most health plans. It is spelled out step by step as far as documentation requirements in the LCD.
Most orthopedic and other EMRs probably have templates or guidance.
The health plan has to be checked for policy and pre-auth or other requirements. Some plans the drug has to be obtained from the specialty pharmacy and can't be "buy and bill".

This is a retired LCD but as an example: https://localcoverage.cms.gov/mcd_archive/view/lcd.aspx?lcdInfo=35427:73
This is the proposed one: https://localcoverage.cms.gov/mcd_archive/view/lcd.aspx?lcdInfo=37932:15
Also retired but an article example: https://localcoverage.cms.gov/mcd_archive/view/article.aspx?articleInfo=55036:63

Health plan examples: https://www.uhcprovider.com/content...cies/comm-medical-drug/sodium-hyaluronate.pdf
Other resources: https://www.zimmerbiomet.com/en/support/reimbursement/hyaluronic-acid.html
 
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