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Knee Arthritis (M17) Clinical Guidelines for Medical Necessity Review

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Knee Arthritis (M17) Clinical Guidelines for Medical Necessity Review Knee Arthritis (M17) Clinical Guidelines for Medical Necessity Review Version: ​2.0 Effective Date: ​September 1, ,2020 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Important Notices Notices & ​Disclaimers: GUIDELINES SOLELY FOR COHERE’S USE IN PERFORMING MEDICAL NECESSITY REVIEWS AND ARE NOT INTENDED TO INFORM OR ALTER CLINICAL DECISION MAKING OF END USERS. Cohere Health, Inc. (“​Cohere​”) has published these clinical guidelines to determine medical necessity of services (the “​Guidelines​”) for informational purposes only, and solely for use by Cohere’s authorized “​End User​s​”. These Guidelines (and any attachments or linked third party content) are not intended to be a substitute for medical advice, diagnosis, or treatment directed by an appropriately licensed healthcare professional. These Guidelines are not in any way intended to support clinical decision making of any kind; their sole purpose and intended use is to summarize certain criteria Cohere may use when reviewing the medical necessity of any service requests submitted to Cohere by End Users. Always seek the advice of a qualified healthcare professional regarding any medical questions, treatment decisions, or other clinical guidance. ​The Guidelines, including any attachments or linked content, are subject to change at any time without notice. ©2020 Cohere Health, Inc. All Rights Reserved. Other ​Notices: CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Guideline ​Information​: Specialty Area:​ Diseases & Disorders of the Musculoskeletal System (M00-M99) CarePath Group: ​Knee CarePath Name: ​Osteoarthritis of Knee Physician author: ​Mandy Armitage, MD (Sports Medicine) Peer reviewed by: ​Brian Covino, MD (Orthopedic Surgeon, Knee/Hip & Total Joint Replacement) Literature review current through​: 5/8/2020 Document last updated: ​9/1/2020 Type:​ [​X​] Adult (18+ yo) | [_] Pediatric (0-17yo) Page 2 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Table of Contents Important Notices 2 Care Path Clinical Discussion 7 Key Information 7 Definitions 8 Care Path Diagnostic Criteria 10 Disease Classification 10 ICD-10 Codes Associated with Classification 10 Presentation and Etiology 21 Causes and Risk Factors 21 Clinical Presentation 21 Typical Physical Exam Findings 21 Typical Diagnostic Findings 21 CarePath Services & Medical Necessity Criteria 22 Conservative Therapy 22 Service: Physical Therapy 22 General Guidelines 22 Medical Necessity Criteria 22 Indications 22 Non-Indications 23 Applicable CMS Medicare NCDs & LCDs 23 Site of Service Criteria 23 Procedure Codes (HCPCS/CPT) 23 *Default codes for suggested services 27 Service: Orthotics 28 General Guidelines 28 Medical Necessity Criteria 28 Indications 28 Non-Indications 29 Applicable CMS Medicare NCDs & LCDs 29 Site of Service Criteria 29 Procedure Codes (HCPCS/CPT) 29 Advanced Imaging 30 Service: Magnetic Resonance Imaging (MRI) (with or without contrast) 30 General Guidelines 30 Page 3 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Medical Necessity Criteria 30 Indications 30 Non-Indications 30 Applicable CMS Medicare NCDs & LCDs 31 Site of Service Criteria 31 Procedure Codes (HCPCS/CPT) 31 Service: Computed Tomography (CT) without contrast 32 General Guidelines 32 Medical Necessity Criteria 32 Indications 32 Non-Indications 32 Applicable CMS Medicare NCDs & LCDs 32 Site of Service Criteria 32 Procedure Codes (HCPCS/CPT) 32 Non-Surgical Management 33 Service: Intra-articular Injection (hyaluronic acid viscosupplementation) 33 General Guidelines 33 Medical Necessity Criteria 33 Indications 33 Non-Indications 34 Applicable CMS Medicare NCDs & LCDs 34 Site of Service Criteria 34 Procedure Codes (HCPCS/CPT) 34 Surgical Management 35 Service: Total Knee Arthroplasty (TKA) 35 General Guidelines 35 Medical Necessity Criteria 35 Indications 35 Non-Indications 36 Applicable CMS Medicare NCDs & LCDs 36 Site of Service Criteria 36 Procedure Codes (HCPCS/CPT) 36 Service: Proximal Tibial Osteotomy 38 General Guidelines 38 Medical Necessity Criteria 38 Indications 38 Page 4 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Non-Indications 39 Applicable CMS Medicare NCDs & LCDs 39 Site of Service Criteria 39 Procedure Codes (HCPCS/CPT) 39 Service: Distal Femoral Osteotomy (DFO) 40 General Guidelines 40 Medical Necessity Criteria 40 Indications 40 Non-Indications 41 Applicable CMS Medicare NCDs & LCDs 41 Site of Service Criteria 41 Procedure Codes (HCPCS/CPT) 41 Service: Unicompartmental Knee Arthroplasty (UKA) 42 General Guidelines 42 Medical Necessity Criteria 42 Indications 42 Non-Indications 43 Applicable CMS Medicare NCDs & LCDs 43 Site of Service Criteria 43 Procedure Codes (HCPCS/CPT) 43 Service: Revision of Knee Arthroplasty 45 General Guidelines 45 Medical Necessity Criteria 45 Indications 45 Non-Indications 46 Applicable CMS Medicare NCDs & LCDs 46 Site of Service Criteria 46 Procedure Codes (HCPCS/CPT) 46 Surgical Risk Factors 47 Post- Operative Care 50 Service: Physical Therapy 50 General Guidelines 50 Medical Necessity Criteria 50 Indications 50 Non-Indications 50 Applicable CMS Medicare NCDs & LCDs 50 Site of Service Criteria 50 Page 5 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Procedure Codes (HCPCS/CPT) 50 Service: Home Health Care 55 General Guidelines 55 Medical Necessity Criteria 55 Indications 55 Non-Indications 55 Applicable CMS Medicare NCDs & LCDs 55 Site of Service Criteria 55 Procedure Codes (HCPCS/CPT) 55 Service: Inpatient Rehabilitation 56 General Guidelines 56 Medical Necessity Criteria 56 Indications 56 Non-Indications 56 Applicable CMS Medicare NCDs & LCDs 57 Site of Service Criteria 57 Procedure Codes (HCPCS/CPT) 57 Service: Skilled Nursing Facility 58 General Guidelines 58 Medical Necessity Criteria 58 Indications 58 Non-Indications 58 Applicable CMS Medicare NCDs & LCDs 58 Site of Service Criteria 58 Procedure Codes (HCPCS/CPT) 58 References 62 Page 6 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Care Path Clinical Discussion Osteoarthritis (OA) is a degenerative condition of the joints that contributes to significant disability in adults, especially older adults. It can be mild, moderate, or severe, depending upon quality of pain, joint function, and quality of life. Physical therapy (exercise, education, strengthening) is 1,2 commonly recommended to improve pain levels and function.​ ​ ​ ​ OA is the leading cause of joint replacement surgery in the United States. Total knee arthroplasty (TKA) is the definitive treatment for advanced OA that persists despite conservative measures such as exercise, medications, and weight loss.1​,​3 ​ Arthroscopic procedures such as debridement and meniscectomy for ​ 2,3 OA are not recommended.​ ​ ​ Radiography is the recommended primary imaging modality of choice, and magnetic resonance imaging (MRI), computed tomography (CT), or magnetic resonance (MR) arthrogram may be utilized to better appreciate anatomy, depending upon presentation and previous history.4 ​ Postoperative 5​ imaging recommendations are also outlined in this overview.​ Postoperatively, rehabilitation is essential. Location and disposition may vary as guidelines are lacking. The information contained herein gives a general overview of the pathway of this specific diagnosis, beginning with initial presentation, recommended assessments, and treatment options as supported by the medical literature and existing guidelines. The information below is meant to support clinical decision making in adult patients. It is not necessarily applicable to every case, as the entire clinical picture (including comorbidities, joint health history, etc.) should be considered. Case-by-case treatment decisions are encouraged. Key Information ➢ OA is a degenerative disorder of joints and is predominantly noninflammatory but can have inflammatory flares. ➢ Symptomatic prevalence of OA significantly increases with age, and in the knee, up to 17% of adults >45 years of age will exhibit symptoms. ➢ Radiography is the recommended primary imaging modality of choice, and is most appropriate if surgical intervention is not being considered by the ordering physician. ➢ Core treatments for all types include patient education on goals and self-management, multimodal exercise, and weight reduction for those overweight. ➢ Initial treatment may include topical or oral anti-inflammatory medication, exercise, and weight loss Page 7 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. ➢ Insufficient evidence available to support recommendation for or against: intra-articular corticosteroid injection; growth factor or platelet-rich plasma (PRP) injection. Definitions ● Osteoarthritis (OA)​ is a degenerative condition of the joints that contributes to significant disability in adults, especially older adults. It can be mild, moderate, or severe, depending upon quality of pain, joint function, and quality of life. Page 8 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Page 9 of 63 Knee Arthritis (Version 2.0) © 2020 Cohere Health, Inc. All Rights Reserved. Care Path Diagnostic Criteria Disease Classification Knee Arthritis ICD-10 Codes Associated with Classification ● M02.361 Reiter's disease, right knee ● M02.362 Reiter's disease, left knee ● M02.369 Reiter's disease, unspecified
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