tci Medicare Compliance & Reimbursement - 2004 Issue 31

Medicare Doesn't Always Cover Arthroscopy

For patients with knee osteoarthritis, arthroscopy offers a way to look inside the joint. But if all the physician is using arthroscopy for is cleaning the joint out, then Medicare won't cover the procedure. Arthroscopy lets physicians use either a large or small volume of saline fluid to irrigate the knee and also remove any loose bodies from the interior joint space. But "lavage" and "debridement" don't have any proven patient benefits by themselves, the Centers for Medicare & Medicaid Services said in a national coverage determination that took effect July 11. CMS said it would leave...

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