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Medical appropriateness guidline

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Orthopedic Office
Memo
To:
Business Manager
From:
Dawn Smith
Date:
2/27/2021
Re:
Hyaluronic acid for use with DJD
I have been researching an article that was published on Medscape regarding using
Hyaluronic acid to treat DJD. It was published today and discusses the thought process
of using Hyaluronic Acid. It’s considered viscosupplementation because hyaluronic acid
is a naturally occurring macromolecule that is essential in synovial fluid. It theorizes that
injecting it directly into joints can help restore some of the properties of the synovial fluid
which would synthesize into a more functional hyaluronic acid that would increase
mobility while decreasing pain and could potentially restore function. They have been
FDA approved for use in the knee only. It’s also recommended by many medical
organizations including the American College of Rheumatology. It’s a relatively well
established treatment option for osteoarthritis in the knee.
I would suggest to change the diagnosis to Osteoarthritis which is the same as
Degenerative Joint Disease, resubmitting the claim and seeing if that will be approved.
The information I have found discusses it as being a very well know option in
osteoarthritis treatment in the knee so the verbage should match.
It would be appropriate to consult with the physician that is ordering the injections to
have them list the diagnosis as OA instead of DJD for insurance coverage purposes.
The article states these injections are appropriate treatment for moderate DJD.
I believe the insurance payment denials should be challenged based on the information
in the above article

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Orthopedic Office Memo To: Business Manager From: Dawn Smith Date: 2/27/2021 Re: Hyaluronic acid for use with DJD I have been researching an article that was published on Medscape regarding using Hyaluronic acid to treat DJD. It was published today and discusses the thought process of using ...
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