Diagnosis: Arthritis of right knee.
Treatment: Computer-Assisted Surgical Navigation.
The insurer denied Computer-Assisted Surgical Navigation for Musculoskeletal Procedures.
The denial is overturned.

The patient is a female who underwent a right total knee arthroplasty with use of robotic assistance for arthritis of right knee. The computer-assisted surgical navigation for the procedure has been denied. This request was previously denied as 20985 (computer-assisted surgical navigation) is unproven and not medically necessary. The operative report states that the surgery was performed with robotic assistance.
At issue is the medical necessity of Computer-Assisted Surgical Navigation for Musculoskeletal Procedures.

The health plan's determination of medical necessity is overturned in whole.

Yes, the requested health service/treatment of Computer-Assisted Surgical Navigation for Musculoskeletal Procedures was medically necessary for this patient.
As noted in the article from the Journal of Knee Surgery, robotic-assisted total knee arthroplasty is associated with less use of articular constraint, shorter length of stay, and fewer manipulations under anesthesia with no increase in complications when compared to manual total knee arthroplasty. As noted in the article from Arthroplasty Today, patients undergoing robotic-assisted total knee have earlier discharge and higher likelihood of discharge home instead of discharge to a subacute rehabilitation facility when compared to patients undergoing conventional total knee arthroplasty. As noted in the referenced article from the Bone and Joint Open Journal, patients undergoing robotic assisted total knee arthroplasty have lower pain levels at both rest and with activity, request less opioid medication, and have a shorter length of stay than patients undergoing conventional total knee arthroplasty. As noted in the referenced review article from StatPearls, robotic total knee arthroplasty has better surgical and clinical patient outcomes than conventional total knee arthroplasty.
In this case, the patient underwent a right total knee arthroplasty with use of robotic assistance. There is current medical literature that indicates that this approach is efficacious and superior to the conventional technique without robotic assistance.
Therefore, the requested health service/treatment of Computer-Assisted Surgical Navigation for Musculoskeletal Procedures was medically necessary.