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Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children by MININDER S
COPYRIGHT © 2004 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children BY MININDER S. KOCHER, MD, MPH, RAHUL MANDIGA, BS, DAVID ZURAKOWSKI, PHD, CAROL BARNEWOLT, MD, AND JAMES R. KASSER, MD Investigation performed at the Departments of Orthopaedic Surgery, Biostatistics, and Radiology, Children’s Hospital, Boston, Massachusetts Background: The differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. The purpose of the present study was to validate a previously published clinical prediction rule for this differentiation in a new patient population. Methods: We prospectively studied children who presented to a major children’s hospital between 1997 and 2002 with an acutely irritable hip. As in the previous study, diagnoses of septic arthritis (fifty-one patients) and transient synovitis (103 patients) were operationally defined on the basis of the white blood-cell count in the joint fluid, the re- sults of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression were used to compare the two groups. The predicted probability of septic arthritis of the hip from the prediction rule was compared with actual distributions in the current patient population. The area under the receiver operating char- acteristic curve was determined. Results: The same four independent predictors of septic arthritis of the hip (a history of fever, non-weight-bearing, an erythrocyte sedimentation rate of 40 mm/hr, and a serum white blood-cell count of >12,000 cells/mm3 (>12.0 × 109/L)) were identified in the current patient population. -
114.3 Cmr: Division of Health Care Finance and Policy Ambulatory Care
114.3 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY AMBULATORY CARE 114.3 CMR 40.00: RATES FOR SERVICES UNDER M.G.L. c. 152, WORKERS’ COMPENSATION ACT Section 40.01: General Provisions 40.02: General Definitions 40.03: Service and Rate Coverage Provisions 40.04: Provisions Affecting Eligible Providers 40.05: Policies for Individual Service Types 40.06: Fees 40.07: Appendices 40.08: Severability 40.01: General Provisions (1) Scope, Purpose and Effective Date. 114.3 CMR 40.00 governs the payment rates effective April 1, 2009 for purchasers of health care services under M.G.L. c. 152, the Workers’ Compensation Act. Payment rates for services provided by hospitals are set forth in 114.1 CMR 41.00. Program policies relating to medical necessity and clinical appropriateness are determined pursuant to M.G.L. c. 152 and 452 CMR 6.00. (2) Coverage. The payment rates set forth in 114.3 CMR 40.06 are full payment for services provided under M.G.L. c. 152, § 13, including any related administrative or overhead costs. The insurer, employer and health care service provider may agree upon a different payment rate for any service set forth in the fee schedule in 114.3 CMR 40.00. No employee may be held liable for the payment for health care services determined compensable under M.G.L. c. 152, § 13. (3) Administrative Bulletins. The Division may issue administrative bulletins to clarify substantive provisions of 114.3 CMR 40.00, or to publish procedure code updates and corrections. For coding updates and correction, the bulletin will list: (a) new code numbers for existing codes, with the corresponding cross references between existing and new codes numbers; (b) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing. -
Knee Joint Surgery: Open Synovectomy
Musculoskeletal Surgical Services: Open Surgical Procedures; Knee Joint Surgery: Open Synovectomy POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5588 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from HealthHelp. -
Ankle and Pantalar Arthrodesis
ANKLE AND PANTALAR ARTHRODESIS George E. Quill, Jr., M.D. In: Foot and Ankle Disorders Edited by Mark S. Myerson, M.D. Since reports in the late 19th Century, arthrodesis has been a successful accepted treatment method for painful disorders of the ankle, subtalar, and transverse tarsal joints. While the title of this chapter involves arthrodesis - the intentional fusion of a joint - as a form of reconstruction, this chapter will address not only surgical technique, but nonoperative methods of care as well. We will address the pathophysiology leading to ankle and hindfoot disability, succinctly review the existing literature on the topic of hindfoot and ankle arthrodesis, highlight the pathomechanics involved, and spend considerable time on establishing the diagnosis, indications, and preoperative planning when surgery is indicated. We also will discuss the rehabilitation of the postoperative patient, as well as the management of complications that may arise after ankle and pantalar arthrodesis. There are more than thirty different viable techniques that have been described in order to achieve successful ankle and hindfoot arthrodesis. It is not the purpose of this chapter to serve as compendium of all the techniques ever described. The author will, rather, attempt to distill into a useful amount of clinically applicable material this vast body of information that the literature and clinical experience provide. Ankle arthrodesis is defined as surgical fusion of the tibia to the talus. Surgical fusion of the ankle (tibiotalar) and subtalar (talocalcaneal) joints at the same operative sitting is termed tibiotalocalcaneal arthrodesis. Fusion of the talus to all the bones articulating with it (distal tibia, calcaneus, navicular, and cuboid) is termed pantalar arthrodesis. -
Knee Joint Surgery: Open Arthodesis of the Knee, Unspecified
Musculoskeletal Surgical Services: Open Surgical Procedures; Knee Joint Surgery: Open Arthodesis of the knee, unspecified POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5623 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission -
DISSERTATION INVESTIGATION of CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY for the EVALUATION of EQUINE ARTICULAR CARTILAGE Su
DISSERTATION INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Submitted by Bradley B. Nelson Department of Clinical Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Fall 2017 Doctoral Committee: Advisor: Christopher E. Kawcak Co-Advisor: Laurie R. Goodrich C. Wayne McIlwraith Mark W. Grinstaff Myra F. Barrett Copyright by Bradley Bernard Nelson 2017 All Rights Reserved ABSTRACT INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Osteoarthritis and articular cartilage injury are substantial problems in horses causing joint pain, lameness and decreased athleticism resonant of the afflictions that occur in humans. This debilitating joint disease causes progressive articular cartilage degeneration and coupled with a poor capacity to heal necessitates that articular cartilage injury is detected early before irreparable damage ensues. The use of diagnostic imaging is critical to identify and characterize articular cartilage injury, though currently available methods are unable to identify these early degenerative changes. Cationic contrast-enhanced computed tomography (CECT) uses a cationic contrast media (CA4+) to detect the early molecular changes that occur in the extracellular matrix. Glycosaminoglycans (GAGs) within the extracellular matrix are important for the providing the compressive stiffness of articular cartilage and their degradation is an early event in the development of osteoarthritis. Cationic CECT imaging capitalizes on the electrostatic attraction between CA4+ and GAGs; exposing the proportional relationship between the amount of GAGs present within and the amount of CA4+ that diffuses into the tissue. The amount of CA4+ that resides in the tissue is then quantified through CECT imaging and estimates tissue integrity through nondestructive assessment. -
Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures
SCIENTIFIC ARTICLE Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures Paul W. L. ten Berg, MSc, Chaitanya S. Mudgal, MD, Matthew I. Leibman, MD, Mark R. Belsky, MD, David E. Ruchelsman, MD Purpose Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-di- mensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures. Methods We simulated retrograde intramedullary insertion of 2.4- and 3.0-mm HCS and 1.1-mm Kirschner wires for metacarpal neck fracture fixation in 3-dimensional models from 16 adults. We used metacarpal head articular surface area (mm2) and subchondral volumes (mm3) and coronal and sagittal plane arcs of motion, during which we analyzed the center and rim of the articular base of the proximal phalanx engaging the countersunk entry site. Results Mean metacarpal head surface area mated to the proximal phalangeal base in neutral position was 93 mm2; through the coronal plane arc (45°), 129 mm2, and through the sagittal plane arc (120°), 265 mm2. The mean articular surface area used by countersunk HCS threads was 12%, 8%, and 4%, respectively, in each of these arcs. The 1.1-mm Kirschner wire occupied 1.2%, 0.9%, and 0.4%, respectively. Mean metacarpal head volume was 927 mm3. Mean subchondral volume occupied by the countersunk portion was 4%. The phalan- geal base did not overlap the dorsally located countersunk entry site through most of the sagittal plane arc. -
CMM-314: Hip Surgery-Arthroscopic and Open Procedures Version 1.0.2019
CLINICAL GUIDELINES CMM-314: Hip Surgery-Arthroscopic and Open Procedures Version 1.0.2019 Clinical guidelines for medical necessity review of speech therapy services. © 2019 eviCore healthcare. All rights reserved. Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-314: Hip Surgery-Arthroscopic and Open Procedures CMM-314.1: Definitions 3 CMM-314.2: General Guidelines 4 CMM-314.3: Indications and Non-Indications 4 CMM-314.4 Experimental, Investigational, or Unproven 6 CMM-314.5: Procedure (CPT®) Codes 7 CMM-314.6: References 10 © 2019 eviCore healthcare. All rights reserved. Page 2 of 13 400 Buckwalter Place Boulevard, Bluffton, SC 29910 • (800) 918-8924 www.eviCore.com Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-314.1: Definitions Femoroacetabular Impingement (FAI) is an anatomical mismatch between the head of the femur and the acetabulum resulting in compression of the labrum or articular cartilage during flexion. The mismatch can arise from subtle morphologic alterations in the anatomy or orientation of the ball-and-socket components (for example, a bony prominence at the head-neck junction or acetabular over-coverage) with articular cartilage damage initially occurring from abutment of the femoral neck against the acetabular rim, typically at the anterosui per or aspect of the acetabulum. Although hip joints can possess the morphologic features of FAI without symptoms, FAI may become pathologic with repetitive movement and/or increased force on the hip joint. High-demand activities may also result in pathologic impingement in hips with normal morphology. s It ha been proposed that impingement with damage to the labrum and/or acetabulum is a causative factor in the development of hip osteoarthritis, and that as many as half of cases currently categorized as primary osteoarthritis may have an etiology of FAI. -
Orthopaedics AMPUTATION PRE-APPROVAL CODE DESCRIPTION REQUIRED PAYMENT INDICATORS PAYMENT RULES
Schedule of Benefits for Professional Fees 2020 Orthopaedics AMPUTATION PRE-APPROVAL CODE DESCRIPTION REQUIRED PAYMENT INDICATORS PAYMENT RULES Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including 3140 neurectomies; with direct closure (use also for traumatic amputations) No 3145 Amputation of two or more fingers No 3280 Amputation through forearm No 3415 Amputation through arm No 3464 Fore quarter amputation No 3645 Above knee amputation No 3690 Hind quarter amputation No 3790 Below knee amputation No 4255 Trans metatarsal amputation of foot No 4260 Trans metatarsal amputation of one toe No 4261 Trans metatarsal amputation of two or more toes No 4330 Trimming of stump following amputation of limb No ANKLE PRE-APPROVAL CODE DESCRIPTION REQUIRED PAYMENT INDICATORS PAYMENT RULES 3955 Arthrodesis of ankle joint No Arthroscopy, ankle, with or without removal of loose body or foreign body, with or without 3956 synovectomy, debridement (I.P.) No Independent Procedure, Day Care Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/ or tibia, including 3961 drilling of the defect (I.P.) No Independent Procedure 1 Night Only Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or 3962 tibial plafond fracture, with or without internal fixation (includes arthroscopy) (I.P.) No Independent Procedure 3963 Arthroscopy, subtalar joint, surgical, with subtalar arthrodesis (I.P.) No Independent Procedure 3965 Fracture of medial or lateral malleolus (1st -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Knee Replacement Surgery (Arthroplasty), Total and Partial
UnitedHealthcare® Commercial Medical Policy Surgery of the Knee Policy Number: 2021T0553S Effective Date: July 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policy Coverage Rationale ........................................................................... 1 • Unicondylar Spacer Devices for Treatment of Pain Documentation Requirements......................................................... 1 or Disability Definitions ........................................................................................... 2 Community Plan Policy Applicable Codes .............................................................................. 2 • Surgery of the Knee U.S. Food and Drug Administration ................................................ 3 References ......................................................................................... 4 Medicare Advantage Coverage Summary Policy History/Revision Information................................................ 4 • Joints and Joint Procedures Instructions for Use ........................................................................... 5 Coverage Rationale Surgery of the Knee is proven and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual® 2021, Apr. 2021 Release, CP: Procedures: • Arthroscopy, Diagnostic, +/- Synovial Biopsy, Knee • Arthroscopy or Arthroscopically Assisted Surgery, Knee • Arthrotomy, Knee • Total Joint Replacement (TJR), Knee • Removal and Replacement, Total Joint Replacement (TJR), -
Talectomy (Astragalectomy) and Tibiocalcaneal Arthrodesis Following Traumatic Talus Fracture-Dislocation
Talectomy (astragalectomy) and tibiocalcaneal arthrodesis following traumatic talus fracture-dislocation The Foot and Ankle Online Journal 12 (2): 4 1 by Dr Alison Zander, MBBCh, BSc (hons), MSc (PHNutr) , Mr Anirudh Gadgil, MBBS, M.S. (Orth), 2 3* FRCS (Ed), FRCS (Trauma & Ortho) , Derek Protheroe, BSc(Hons), MSc, PgDip Talus fractures occur rarely but are often associated with complications and functional limitations. Urgent reduction of associated dislocations is recommended with open-reduction and internal fixation of displaced fractures when adjacent soft tissue injury permits [1]. However, it is important to remember that there is a high incidence of long term complications, along with a significant impact on activities of daily living and quality of life. This case report describes the successful treatment of a severely comminuted talar fracture dislocation with primary talectomy and tibio-calcaneal arthrodesis. A reminder that in selected cases that the talectomy (astragalectomy) may be a viable alternative. Keywords: talus, comminuted, tibiocalcaneal arthrodesis, fusion, talectomy, astragalectomy, trauma, avascular-necrosis, AVN This is an Open Access article distributed under the terms of the Creative Commons Attribution License. It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot and Ankle Online Journal (www.faoj.org), 2019. All rights reserved. alus fractures account for less than 1% of all surfaces is precluded secondary to comminution [4]. fractures, they may be caused by high-energy The talus is the second largest of the tarsal bones, trauma, and any other form of forced with more than half of its surface being covered with dorsiflexion injury to the ankle and foot [1].