Documentation requirements
Documentation in the patient's medical record must support the patient failed to respond adequately over a three-month period to a past history of treatment with analgesics and conservative nonpharmacological therapy (exercise or physical therapy, weight loss if appropriate, use of assistive devices).
A radiological exam to support the clinical diagnosis of osteoarthritis of the knee will be available in the patient’s medical record.
If subsequent courses of treatment are given, the medical records must support the effectiveness of the prior treatment and must clearly establish reduction of patient symptomatology and medication usage. This documentation must be submitted upon request. Claims submitted without requested supporting evidence in the medical record will be denied as being not medically necessary.
Dosing frequency of injections per series and/or dosing frequency per series as listed/supported with the FDA approved dosing/package insert must be documented in the medical record.
Providers are required to document the discarded drug or biological in the patient’s medical record.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 20610 | HCPCS | Covered |
| 20611 | HCPCS | Covered |
| J7318 | HCPCS | Covered |
| J7320 | HCPCS | Covered |
| J7321 | HCPCS | Covered |
| J7322 | HCPCS | Covered |
| J7323 | HCPCS | Covered |
| J7324 | HCPCS | Covered |
| J7325 | HCPCS | Covered |
| J7326 | HCPCS | Covered |
| J7327 | HCPCS | Covered |
| J7328 | HCPCS | Covered |
| J7329 |