Wiki Help with Appeal of CPT 29881

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cwilson3333

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I need some help on doing an appeal of an arthroscopic menisectomy that was denied as "experimental/investigational] CPT 29881

Patient had MRI which confirmed a complex tear of the posterior aspect of the medial meniscus. There was a displaced meniscal flap tear.

The doctor dictates that the meniscal tear was symptomatic and medically necessary. Per operative note.....medial compartment examined...patient found to have complex tear of posterior aspect of medial meniscus. Approximately 40% of meniscus was removed. Abnormal area was removed with ubiter and shaver, bringing it back to stable rim. Grade 3 defect in mid-aspect of weight bearing surface of medial femoral condyle and mild fraying on medial tibial plateau........

Clinical History: Surgery necessitated by patient complaints of chronic pain, swelling; lacking full extension; point tender over MJL; gait abnormality; had been doing home physical therapy with no relief.

Yet, Aetna has denied this procedure [29881] as experimental/investigational.

Would like to know if anyone out there has suggestions for this appeal.
 
Appeal of Menisectomy

I used 717.2
[for internal derangement of posterior medial meniscal tear]

Per her initial visit, there was no precipating event/injury. She had been experiencing pain for 2 months, swelling and moderate effusion. No prior knee problems.

Thanks for replying,
Carol
 
Sounds to me like it would be a degenerative tear which is not covered by Aetna(just as everything else is never covered).
I would try searching PubMed for studies regarding the treatment of 29881 for degenerative tears. Since insurance companies love to use studies as a ground for denial of coverage, use studies found to show that it can be beneficial for the patient.
 
cwilson3333 said:
I need some help on doing an appeal of an arthroscopic menisectomy that was denied as "experimental/investigational] CPT 29881

Patient had MRI which confirmed a complex tear of the posterior aspect of the medial meniscus. There was a displaced meniscal flap tear.

The doctor dictates that the meniscal tear was symptomatic and medically necessary. Per operative note.....medial compartment examined...patient found to have complex tear of posterior aspect of medial meniscus. Approximately 40% of meniscus was removed. Abnormal area was removed with ubiter and shaver, bringing it back to stable rim. Grade 3 defect in mid-aspect of weight bearing surface of medial femoral condyle and mild fraying on medial tibial plateau........

Clinical History: Surgery necessitated by patient complaints of chronic pain, swelling; lacking full extension; point tender over MJL; gait abnormality; had been doing home physical therapy with no relief.

Yet, Aetna has denied this procedure [29881] as experimental/investigational.

Would like to know if anyone out there has suggestions for this appeal.
Click to expand...
Was this tear due to a recent injury?
 
Appeal for CPT 29881

No injury or precipating event. Knee pain for 2 months. Swelling, pain getting gradually worse. Pain with stairs, getting out of chair. No prior knee problems.
She had moderate effusion on initial visit, tenderness over MJL and increased pain with Steinmann test.
Had MRI to check for medial meniscal tear.
MRI revealed complex "tear" of posterior aspect of medial meniscus.

The doctor removed approximately 40% of meniscus at time of surgery. She also had grade 3 defect in mid-aspect of weight bearing surface of medial femoral condyle.

Appreciate your response.
 
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