Diagnoses:

Tear of Medial Cartilage or Meniscus of Knee

Summary:

The provider requested an arthroscopic knee repair, however, when the MRC UR Nurse Consultant contacted the surgeon directly, his comments indicated that the knee was stable and there were no indications to meet criteria for this surgery to be medically necessary. Therefore, the surgery was denied as not being medically necessary and saving the patient from an invasive non-necessary procedure. A peer-to-peer review requested by the participant’s surgeon confirmed the denial determination.

Cost Savings:


• Avoided arthroscopy knee surgery professional fees: $ 16,555

• Avoided arthroscopy knee surgery facility fees: $ 11,900

• Specialty Physician Review: $ (770)

Total Cost Savings: $ 27,685