cwilson3333
Expert
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.
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.