Qtr 1 Physician IRR 2017 MSK (Joint Surg) case study # 5
AETNA COMMERCIAL
59 year old male with prior authorization request for Right Total Hip Arthroplasty CPT 27130.
The patient has complained of bilateral hip pain for 10 years and has resorted to use of a cane.
He underwent successful left THA last year and continues with right hip and groin discomfort. His treatment regimens have included NSAIDS, analgesic medications and physical therapy over the last 6 months.
PE findings suggest a morbidly obese male with BMI 46 with significant limitation in ROM of the right hip with antalgic, painful gait.
X-rays suggest severe osteoarthritis with severe sclerosis, joint space narrowing and bony destruction, osteophyte formation.
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