Hyaluronan or Derivative, Hyalgan, Supartz or Visco-3, for Intra-Articular Injection, per dose (HCPCS J7321)

Name of the Procedure:

Commonly referred to as "knee injections" or "hyaluronan injections," the technical term is "intra-articular injection of hyaluronan or its derivatives" (e.g., Hyalgan, Supartz, Visco-3).

Summary

This procedure involves injecting hyaluronan or its derivative directly into a joint, usually the knee, to provide lubrication and cushioning, often alleviating pain and improving joint function in patients suffering from osteoarthritis.

Purpose

Medical Conditions:

• Osteoarthritis of the knee.

Goals:

• Alleviate joint pain.
• Improve joint function and mobility.
• Reduce the need for more invasive treatments such as surgery.

Indications

Symptoms or Conditions:

• Persistent knee pain due to osteoarthritis.
• Limited mobility and daily activity impairment.
• Ineffectiveness of other treatment options like pain relievers, physical therapy, or corticosteroids.

Patient Criteria:

• Diagnosed osteoarthritis confirmed by imaging studies.
• Pain severity that impacts quality of life and functioning.
• Patient is not a candidate for or has chosen to delay surgical intervention.

Preparation

Pre-Procedure Instructions:

• No specific fasting required.
• Continue regular medications unless instructed otherwise by the healthcare provider.
• Inform the healthcare provider of any allergies, especially to hyaluronan products or bird proteins.

Diagnostic Tests or Assessments:

• Imaging tests such as X-rays or MRI to confirm the extent of osteoarthritis.

Procedure Description

1. Initial Assessment: The patient is evaluated, and the affected knee is examined.
2. Preparation: The skin around the injection site is cleaned and sterilized.
3. Anesthesia: Local anesthesia may be applied to ensure comfort.
4. Injection: Using a fine needle, the healthcare provider injects the hyaluronan substance into the knee joint.
5. Post-Injection Care: The injection site is covered with a sterile bandage.

Tools and Equipment:

• Sterile syringes and needles.
• Hyaluronan product (Hyalgan, Supartz, or Visco-3).
• Local anesthesia (if used).

Duration

The entire procedure usually takes around 15 to 30 minutes.

Setting

Typically performed in an outpatient setting, such as a doctor's office, outpatient clinic, or hospital.

Personnel

• Orthopedic surgeon or rheumatologist.
• Nurse or medical assistant for preparation and support.

Risks and Complications

Common Risks:

• Pain or swelling at the injection site.
• Localized infection.

Rare Risks:

• Allergic reactions.
• Bleeding inside the joint.
• Temporary flare of inflammation.

Benefits

• Pain relief usually starts within a few days to a week.
• Improved joint function and mobility.
• Potential to delay more invasive treatments like knee replacement surgery.

Recovery

Post-Procedure Care:

• Avoid strenuous activities for 48 hours post-injection.
• Apply ice packs if there is swelling or discomfort.
• Follow-up appointments as advised by the healthcare provider.

Recovery Time:

• Most patients resume normal activities within a few days.

Alternatives

Other Treatment Options:

• Oral pain medications and anti-inflammatory drugs.
• Physical therapy.
• Corticosteroid injections.
• Surgical options like arthroscopy or knee replacement.

Pros and Cons:

Alternatives like pain medications or steroids may provide quicker relief but might not last as long. In contrast, surgical options are more invasive and come with longer recovery times.

Patient Experience

During the Procedure:

• Mild pressure or discomfort during the injection.
• Localized numbing if anesthesia is used.

After the Procedure:

• Some soreness at the injection site which can be managed with over-the-counter pain relievers.
• Gradual relief from knee pain within a few days to a week.
• Full return to normal activities expected within a few days.