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Indications for Medical Necessity

⃝     Weakness of the knee and requires stabilization
⃝     Deformity of the knee that requires stabilization
⃝     A knee orthosis with condylar pads with OR without patellar control (circle one)
⃝     Has had a recent knee injury to the knee or a surgical procedure on the knee(s)

 

Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen.

OA Indications for Prescribed PT:

(Must select one of the following):

OA Brace

L1851/L1852

Most common ICD-10 codes:

M05.461- Rheumatoid myopathy w/arthritis of right 
M05.462 - Rheumatoid myopathy w/arthritis of left 

M17.0 - Bilateral primary osteoarthritis of knee

M17.2 - Bilateral post-traumatic osteoarthritis of knee

M17.31 - Unilateral post-traumatic osteoarthritis, right 
M17.32 - Unilateral post-traumatic osteoarthritis, left 

M17.9* - Osteoarthritis of knee, unspecified

M23.206    Derangement of unspecified meniscus due to old tear or injury, right knee
M23.207    Derangement of unspecified meniscus due to old tear or injury, left knee

M23.91- Unspecified internal derangement of right knee
M23.92 - Unspecified internal derangement of left knee

S83.2 - Tear of meniscus, current injury

S83.3 - Tear of articular cartilage of knee, current

RX/DWO

OA Document Requirements: Signed/Dated RX, Clinicals with Indications. Up to date patient demographics with insurance information.

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Post-Op Knee Indications for Prescribed PT:

(Must select one of the following):

⃝     Weakness of the knee and requires stabilization
⃝     Deformity of the knee that requires stabilization
⃝     A knee orthosis with condylar pads with OR without patellar control (circle one)
⃝     Has had a recent knee injury to the knee or a surgical procedure on the knee(s)

 

Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen.

Post- Op Knee Brace

L1851/L1852

Most common ICD-10 codes:

M23.00X - Cystic meniscus,  lateral 
M23.003 - Cystic meniscus, medial 
M23.51- Chronic instability of knee, right knee
M23.52 - Chronic instability of knee, left knee

M94.261 - Chondromalacia, right knee

M94.262 - Chondromalacia, left knee

S76.121A    Laceration of right quadriceps muscle, fascia and tendon, initial encounter

S83.27 - Complex tear of lateral meniscus

S83.32X - Tear of articular cartilage of knee

S83.4 - Sprain of collateral ligament of knee

S83.5 - Sprain of cruciate ligament of knee


 

Additional DX Codes

Post-Op Document Requirements: Signed/Dated RX, Clinicals with Indications. Signed/Dated CMN. Up to date patient demographics with insurance information.

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