Specialty

MSK & Orthopedic Spine

Top denial drivers

  • Conservative care described but not itemized by treatment, duration, and response
  • Imaging findings not explicitly matched to the exam and diagnosis
  • Functional impact inferred from a pain score instead of a validated instrument

What reviewers expect to see

  • Named conservative treatments, duration, dates, and response to each
  • Level-specific match between imaging, dermatomal findings, and exam
  • A validated functional measure (for example, ODI) and specific activity limits

Medicare ASM relevance

Orthopedic surgery is part of the ASM low back pain cohort. ReCapture is building ASM measure mapping (functional status, depression screening, BMI follow-up, high-risk medication review) on top of its production denial-recovery engine.