Billing and Coding: Total Knee Arthroplasty

Total knee arthroplasty is covered only when the medical record fully documents medical necessity for both Medicare Part A inpatient and Part B provider services; services without adequate documentation will be denied as not reasonable and necessary. Required documentation includes a history & physical, discharge summary, physician progress notes and operative report, plus imaging (X‑ray/MRI/CT) showing arthritis with ≥1 finding (subchondral cysts or sclerosis, periarticular osteophytes, joint subluxation, joint space narrowing, avascular necrosis, or bone‑on‑bone) and documented knee pain or functional disability (e.g., interference with ADLs).