Qtr 1 Physician IRR 2017 MSK (Joint Surg) case study # 4
Cigna Commercial
62 year old woman with prior authorization request for Arthroscopy shoulder surgery: Distal claviculectomy including distal articular surface (29824), Arthroscopy shoulder surgery: decompression with partial acromioplasty (29826)
The patient has had shoulder pain for 4 months. She has pain throughout the day and worse at night interfering with sleeping.
She failed 3 months of non-operative care including NSAID’s and physical therapy.
Physical examination shows full active range of motion with no noted strength deficit. There is tenderness over the acromioclavicular joint.
The Neer and Hawkins Kennedy Impingement tests are positive.
The MRI shows acromioclavicular joint arthritis with impingement without tear of the rotator cuff.
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