Reply
Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Medical documentation necessary before joint replacement

New laws passed are going to require medical documentation of the necessity for surgical replacement before medicare will pay for a new joint surgery. This should make it a bit longer time from when you first see the doc until you have the operation but could also stop any doctors who are just routinely doing the surgery instead of going through other types of therapies first - which I feel is a good thing. It seems that everyone is getting new hips and knees as soon as they first see a doctor, instead of going through some other therapies like injections and PT etc. I know my surgeon jumped right on scheduling me for knee replacement surgery at my very first visit. 

Honored Contributor
Posts: 10,495
Registered: ‎06-19-2010

Re: Medical documentation necessary before joint replacement

Yes, this is a good thing.  I think some of these doctors scare you into thinking you need a knee replacement like yesterday.  I had problems last year that therapy didn't help.  I was sent to a specialist and the first thing he said was that he would do a knee injection that might give me some time BUT that a knee replacement was the only thing that would really help.  Well, the injection helped but not as much as I'd like.  This doctor never once suggested that I lose weight.  I have since lost 35 lbs and feel 85% better.  I can go up and down my stairs without pain or holding on.  I might have to have a replacement but it won't be as soon as he suggested.

"The quieter you become, the more you can hear". (By Ram Dass, an American Spiritual Teacher) \em>
Respected Contributor
Posts: 3,256
Registered: ‎06-15-2015

Re: Medical documentation necessary before joint replacement

 

 

A post similar to this "got moved" by a moderator on community chat.  Just sayin'

hckynut(john)
Trusted Contributor
Posts: 1,305
Registered: ‎06-15-2015

Re: Medical documentation necessary before joint replacement

I think a second even a third opinion is a good idea. But, to put off the inevitable joint replacement too long with shots etc is not a good idea. They are not going to get better.  I am 59 and have had both knees and both hips replaced over the last three years. I  am just two weeks out from my right hip replacement as I type!  I wanted to get knees and hips done while my health was good, and when I had good insurance. I am now a bionic woman!

 

The surgery is major and not to be taken lightly. I found an excellent surgeon rated a top Doc nationwide in his field. My knees and hips started bothering me in my 30's. I was on crutches by the time I got the courage to have my knees done at age 57. It was such a success I decide to do my hips. 

 

I got got my life back from joint replacement. If you need it done, do not wait too long when you may have health issues...and do not depend on Medicare.  Get it done now.

 

 

Honored Contributor
Posts: 8,923
Registered: ‎03-10-2010

Re: Medical documentation necessary before joint replacement

The doctor may have been afraid to "insult" you. Americans put far too much on the cosmetic aspects of obesity, but the physical toll taken by carrying too many pounds is far more important and often ignored, even by DOCTORS!

 

Esteemed Contributor
Posts: 5,258
Registered: ‎03-10-2010

Re: Medical documentation necessary before joint replacement

I waited to have my knee addressed until after retirement, knowing that if something major were found, I'd have been automatically retired.  Am glad that I did, because I'm in that population with a surgeon who said, "You need this surgery now, before this condition worsens and causes increased incidence of buckling."  As it turned out, I didn't have one of those terribly arthritic knees with moderate to severe pain, but had developed a "valgus" left knee.  This meant that my left knee was going slightly knocked kneed, though I was unable to detect it.  The x-rays taken were quite surprising. My knee would buckle out of the blue and I'd find myself running into walls at work and home or into cars, if in the parking lot at home.  I was very fortunate not to have taken a full forward fall.

 

My surgeon indicated that he'd be sending all of the appropriate documentation to Medicare and my secondary insurance, so it would appear that something is already in place.

Esteemed Contributor
Posts: 5,843
Registered: ‎04-14-2013

Re: Medical documentation necessary before joint replacement

[ Edited ]

@151949:  Could you please clarify what the new laws are, or where we could find additional information?

Cogito ergo sum
Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: Medical documentation necessary before joint replacement

Medicare .gov

Honored Contributor
Posts: 10,495
Registered: ‎06-19-2010

Re: Medical documentation necessary before joint replacement


@sfnative wrote:

I waited to have my knee addressed until after retirement, knowing that if something major were found, I'd have been automatically retired.  Am glad that I did, because I'm in that population with a surgeon who said, "You need this surgery now, before this condition worsens and causes increased incidence of buckling."  As it turned out, I didn't have one of those terribly arthritic knees with moderate to severe pain, but had developed a "valgus" left knee.  This meant that my left knee was going slightly knocked kneed, though I was unable to detect it.  The x-rays taken were quite surprising. My knee would buckle out of the blue and I'd find myself running into walls at work and home or into cars, if in the parking lot at home.  I was very fortunate not to have taken a full forward fall.

 

My surgeon indicated that he'd be sending all of the appropriate documentation to Medicare and my secondary insurance, so it would appear that something is already in place.


Oh my!  I went to google/look at that...never heard of it.  I am slightly knock kneed from birth but nothing like that.  I'm assuming this happens slowly over time.  Hope your surgery goes well.

"The quieter you become, the more you can hear". (By Ram Dass, an American Spiritual Teacher) \em>
Trusted Contributor
Posts: 1,627
Registered: ‎03-09-2010

Re: Medical documentation necessary before joint replacement

I've had knee problems since I was about 20 years old...ligament in nature.  They flared up every once in a while, and I couldn't do anything that was high impact in nature.  But, then they settled down for a while.

 

Two years ago, after losing about 40 pounds, they started to give me a lot of problems.  I think losing the weight may have changed my gait enough to throw off my knees.

 

I was lucky enough to find an ortho doctor who did a very thorough examination.  And, of course, I had developed some arthritis over the years.  My knees would lock and occasionally buckle.  And, I was having some mild/moderate discomfort.

 

I was afraid I was heading towards knee replacement.  Instead, he shocked me when he sent me for aquatic therapy.  It really worked!  My knees haven't buckled on me in a year.  

 

I still have some discomfort, but nothing major.  The big challenge was finding a neutral pair of athletic shoes.  After doing a lot of reading online, I discovered that you don't want overly supportive shoes if you have knee arthritis.  You need to wear what is comfortable.

"I've been here since October 2006. Wow!"