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Meniscal tear injury and MRI

Patient: young patient. partial lateral discoid meniscus with complex tear and associated parameniscal cyst


Imaging: MRI


Is Preauth Required? The patient must meet the criteria for a meniscal tear injury as outlined in the Appropriate Use Criteria Imaging of the Extremities. This includes physical exam findings and imaging findings such as joint swelling or effusion, positive McMurray or Apley test, joint line tenderness, reduced range of motion, persistent or frequent mechanical symptoms, imaging demonstrating a meniscal tear consistent with the clinical presentation, and x-ray findings demonstrating no more than moderate osteoarthritis as evidenced by imaging showing greater than or equal to 50 joint space preservation. In addition, the patient must be under age 40 and have a partial lateral discoid meniscus with complex tear and associated parameniscal cyst.

Will the claim be denied? A claim for an MRI for a young patient with a partial lateral discoid meniscus with a complex tear and an associated parameniscal cyst would likely be approved since the estimates sensitivity and specificity of MRI for lateral meniscal tears was 78% (95% CI, 66-87) and 95% (95% CI, 91-97), respectively.

When is the following treatment medically necessary for the condition specified? Meniscal repair or partial meniscectomy is considered medically necessary for this condition if the patient is under age 40 and has physical exam findings of joint swelling or effusion, a positive McMurray or Apley test, joint line tenderness, and reduced range of motion. Imaging must also demonstrate a meniscal tear consistent with the clinical presentation and x-rays must show no more than moderate osteoarthritis.




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