Arthroplasty Case Studies

Based on the progress report dated 03/28/16 by Dr. Bakhos, the patient presents for follow-up of his right knee

Raney was experiencing any pain to the area and Mrs. Raney replied that the only pain is in the right shoulder. Mrs. Raney was able to supinate and pronate her right wrist 30-40 degrees. Her skin was dry. Dr. Mendelson replied that at this time Mrs. Raney no longer required to wear the wrist brace and she can use the extremity. Dr. Mendelson obtained x-rays of her right shoulder as Mrs. Rainey has limited range of motion. After reviewing this, Dr. Mendelson replied that Mrs. Rainey as tremendous arthritis in her shoulder. I inquired if it was traumatic arthritis and the result of the accident. Dr. Mendelson replied that it was not related directly to the accident necessarily but her shoulder was aggravated from the accident. Dr. Mendelson continued to state that symptomatically it will get better and at some point Mrs. Raney did have a glenoral crack. Dr. Mendelson inquired about how Mrs. Raney’s shoulder was prior to the accident and she stated that it was fine and she could raise her arm above her shoulder and head but now she can’t and has had limited movement since the accident. Dr. Mendelson assessed and evaluated her lower extremity and replied that Mrs. Raney’s left incision is now healed. Her right ankle is still healing, the wound is dry and her skin is consolidating over the area. Mrs. Raney has an avagus external rotation of her foot.

Attached are chiropractic and PT notes. Patient has been previously denied with same request on 12/01/15 (Review

An attending physician statement completed by Dr. Peter Chweyah (Internal Medicine), dated 06/16/2016, indicated that the claimant presented with complaints of lower extremity weakness, neuropathy, weight loss, acute renal failure, and gout, as well as anemia. Objective findings showed an extreme weakness of the legs and pain in the feet. He also had diabetes mellitus type 2, chronic kidney disease, and hypertension. It was noted that the claimant was totally disabled from 05/30/2017 through 06/15/2017 and 05/23/2017 - 05/26/2017 secondary to gout.

Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.

Requested verification from the provider’s office on the correct surgery request, the IW’s conservative treatments to date (PT/ESI), and if the IW has had a psychological evaluation; however, no callback/report was received prior to the submission of this request to PA.

Treatment plan includes follow-up with orthopedics, follow-up with psychology, Dr. Gandolfo for additional treatments for major depressive disorder, additional PT 2 x 3 sessions to treat the lumbar spine, additional PT for vestibular rehabilitation, follow-up with neurologist, referral for psychology and follow-up with primary care physician (PCP).

Is the request for 12 Physical Therapy Visits for the Left Knee between 6/13/2016 and 8/12/2016 medically necessary?

Health History: A 25-year-old male injured his left knee in a recent skiing accident. The patient stated that he lost his balance because the inner edge of his right ski got caught while skiing. This resulted in the right leg being externally rotated followed by and audible “pop” as he lost footing. By evening, the right knee joint had become swollen, causing intense pain. The primary care physician referred the case to an orthopedist.

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

His symptoms included pain in his neck, mid back, upper back, lower back, and left knee pain. Plaintiff described his neck pain as a 3 on the pain scale, his back pain as a 5 and his knee pain as a 6 on the pain scale. Plaintiff was prescribed 3 sessions per week for 6 weeks of physical therapy.

The claimant had 9 physical therapy visits for cervicalgia and low back pain from 01/12/2017 t0 02/01/2017.

On 9/28/17 I spoke with C. Weaver physical therapy. The physical therapist advised that they do not offer occupational therapy just physical therapy. They also are not equipped to do more than one body part at a time. In reviewing the records and the FCE I had supplied them they determined she is not in the best location. They recommend Hope Network. I have contacted Hope Network and confirmed that this would be a more appropriate location for the 5 days a week therapy she needs and what the FCE had suggested. I have contacted Dr. VanderJagt’s office and requested an order for the therapy.

DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future

On April 11, 2014, I had the privilege of direct observation of a patient’s orthopedic surgery, from the pre-operative to post-operative setting. The patient with the initials N.R, which we will call Mrs. R, arrived to the hospital just prior to 6:30a.m. As the name implies, Mrs. R was a female patient, 76 years old with an admitting diagnosis of right hip osteoarthritis. Due to arthritis in her hip, Mrs. R’s ability to perform daily activities and participate in hobbies such as dancing has been extremely compromised over the last 2 years. The overall goal of Mrs. R’s surgery