Review queue

Member

Synthetic M-51874, 67 M, Medicare Advantage HMO (sample)

Service

CPT 27447 Total knee arthroplasty, right

Diagnosis

M17.11 Unilateral primary osteoarthritis, right knee

Provider

Northgate Joint Center, Orthopedic surgery, in-network

Policy

DEMO-ORT-007 Total knee arthroplasty

Patient: Raymond Okafor   DOB: 11/02/1959   MRN: 00917705
Phone: 555-338-9012

HPI: 67 y/o M with right knee pain for 3 years, worse over the last 6 months. Pain with stairs and standing; can no longer walk more than 2 blocks or kneel at church. Started physical therapy on 08/20/2026 and completed 6 weeks. Meloxicam 15 mg daily since 08/20/2026. One corticosteroid injection on 09/12/2026 with 2 weeks of relief.

Exam: Varus deformity, crepitus, range of motion 5 to 100 degrees. No erythema, warmth or effusion. Skin intact. No history of joint infection.

Vitals: BMI 34.1.

Assessment: Severe right knee osteoarthritis with functional limitation.

Plan: Patient wishes to proceed with right total knee arthroplasty.

Findings: Severe medial joint-space narrowing with bone-on-bone contact. Large osteophytes and subchondral sclerosis. Kellgren-Lawrence grade 4.
Impression: Advanced tricompartmental osteoarthritis, right knee.