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Medicare Compliance & Reimbursement

Coverage:

NCD A Washout For Arthroscopic Lavage

Published on Sat Aug 07, 2004

Why your arthritic patients may be turning away.

Providers hoping the Centers for Medicare & Medicaid Services would bend on its non-coverage of arthroscopic lavage and debridement for osteoarthritic knees got the thumbs down, according to a June 11 national coverage determination.
     
CMS said that the surgical procedure, which allows the direct visualization of the interior joint space of the knee to enable joint cleansing and removal of any loose bodies, is generally performed to reduce pain and improve function. However, scientifically controlled studies have not proven it to be clinically effective for the "reduction of mechanical symptoms."
      
After conferring with clinical investigators and the orthopedic community CMS said that effective July 11, arthroscopic lavage and/or debridement of the oseoarthritic knee would not be covered by Medicare because it was not "reasonable or necessary in treatment."
      
To read the NCD, go to http://www.cms.hhs.gov/manuals/pm_trans/R14NCD.pdf.
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