My "Professionalism" Stunk Tonight

[Twiggidy]

How do you guys cope/overcome when you know you're being taken advantage of/disrespected by various specialties/staff in the hospital? Usually I'm pretty good about just blowing things off and ignoring when people are just plain taking advantage of my services, but tonight I think I just hit a limit and blew a gasket.

In the age of anesthesiologist needing to save face with admins and nursing in order to keep contracts, how do you guys not blow a fuse when people are taking advantage of you or disrespecting you?

Any advice will be helpful? Sorry for the vent, but today was one of the worst since I've been practicing on my own.

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[Wiscoblue]

Can you be a little more specific about what happened? I'm curious.

I've been doing anesthesia for a long time now. Started my residency in 1983. I've worked at many hospitals and been called all sorts of names. I don't usually respond to 'anesthesia'. ' Dr' will usually get my attention.

Being in an all MD group will usually get you more respect. Being in a smaller hospital will also get you more respect than in a huge medial center where people don't even know your name.

Best thing to do is to walk away when you are being disrespected. Come back and tell that person later calmly what your problem is. They will usually not repeat it.


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[Twiggidy]

It's really hard to do this when doctors are asking you to come do procedures on patients, especially when they should know how to do them on their own. I can understand asking for help but just pointing me to a room to place multiple lines, having no assistance in the room from a nurse, no items ready in the room, and then to not even say thank you at the end...I think I'd just had it. There was no cursing or throwing but I really "strongly" emphasized that when I'm called to do a favor that I expect things ready and for someone to be around to help if needed. I literally placed an IV and had to hold my thumb over the opening because no heplock was ready, no flush was available, no IV line made, etc. I had to blood a bunch of things including me and the patient to find a syringe to pull blood. then the nurse go irritated because she was going to use a vacutainor (sp?) instead of using my 3 10cc syringes of blood. that's when the fuse blew and a different nurse came to help. I apologized to the first nurse after because I thought that was the right thing to do, but I was "hot" for a good 2 hrs after. I think I just couldn't take it. We get pushed around in this specialty and at this point the nurses know they can push us around and we just have to take it or they'll tell the administration. My Mr. Hyde came out and didn't care but at then end my Dr. Jekyll arrived and had to think about how it affected the group (and my future).

Anyway, I just need some words of encouragement of how to deal. I'm 4 years into PP (all MD/community hospital) and I'm still definitely learning. My patience ran out tonight.

 

[nimbus]

It's really hard to do this when doctors are asking you to come do procedures on patients, especially when they should know how to do them on their own. I can understand asking for help but just pointing me to a room to place multiple lines, having no assistance in the room from a nurse, no items ready in the room, and then to not even say thank you at the end...I think I'd just had it. There was no cursing or throwing but I really "strongly" emphasized that when I'm called to do a favor that I expect things ready and for someone to be around to help if needed. I literally placed an IV and had to hold my thumb over the opening because no heplock was ready, no flush was available, no IV line made, etc. I had to blood a bunch of things including me and the patient to find a syringe to pull blood. then the nurse go irritated because she was going to use a vacutainor (sp?) instead of using my 3 10cc syringes of blood. that's when the fuse blew and a different nurse came to help. I apologized to the first nurse after because I thought that was the right thing to do, but I was "hot" for a good 2 hrs after. I think I just couldn't take it. We get pushed around in this specialty and at this point the nurses know they can push us around and we just have to take it or they'll tell the administration. My Mr. Hyde came out and didn't care but at then end my Dr. Jekyll arrived and had to think about how it affected the group (and my future).

Anyway, I just need some words of encouragement of how to deal. I'm 4 years into PP (all MD/community hospital) and I'm still definitely learning. My patience ran out tonight.

Ummm.....you start IVs and draw blood? Is this a pedi hospital? I only ever start them on my own patients. I've never been asked to start one on some random patient. Seriously just say no.

Billable central line or Aline? "Yes"

IV? "Do it yourself"

 

[deleted171991]

No good deed goes unpunished. Seriously.

I have learned to just say No. I will do it as a favor to people who reciprocate either by helping me or being extra-nice, but otherwise I don't care. dingus eye surgeon missing updated H&P, unable to write his own? We'll wait one hour till the PCP's office opens. Nice podiatrist with expired H&P asking politely to be helped by an MD, no pressure, very appreciative? No problem, it will take me just a minute.

If you call me for an IV, you'd better tried it yourself, have everything ready, AND stay there to help me. It's a favor to your sorry ass, not the patient! Etc.

I get disrespected regularly (but not frequently). I alternate between ignoring them, being sarcastic or disrespecting them back. While I was a resident, I thought that I wouldn't care as a well-paid attending, since I'll be the one laughing all the way to the bank. Not true. Some of us have a bit of an ego and want to be appreciated for all the hard work. No shame in that.

 

[teeva]

Always be able to shrug things (like people, money, possessions, emotions) off and walk away. Makes life easier. And work too.

 

[Twiggidy]

Ummm.....you start IVs and draw blood? Is this a pedi hospital? I only ever start them on my own patients. I've never been asked to start one on some random patient. Seriously just say no.

Billable central line or Aline? "Yes"

IV? "Do it yourself"

Unfortunately a culture has been created here by former workers that is hard to undo. I really wish I could tell people to piss off (so to speak) but Im on a high desired area and like you guys there's likely a line 20 deep out the door even for my workhorse job. The saving grace is that i do bill EVERYTHING. I used to say the hell with the IVs because it was sometimes longer to write the note then to actually do the IV but i reallized over the course of 5 or 6 calls that it adds up.

There are days (OB call days) where I definitely long for an OR only job

 

[Planktonmd]

It's really hard to do this when doctors are asking you to come do procedures on patients, especially when they should know how to do them on their own. I can understand asking for help but just pointing me to a room to place multiple lines, having no assistance in the room from a nurse, no items ready in the room, and then to not even say thank you at the end...I think I'd just had it. There was no cursing or throwing but I really "strongly" emphasized that when I'm called to do a favor that I expect things ready and for someone to be around to help if needed. I literally placed an IV and had to hold my thumb over the opening because no heplock was ready, no flush was available, no IV line made, etc. I had to blood a bunch of things including me and the patient to find a syringe to pull blood. then the nurse go irritated because she was going to use a vacutainor (sp?) instead of using my 3 10cc syringes of blood. that's when the fuse blew and a different nurse came to help. I apologized to the first nurse after because I thought that was the right thing to do, but I was "hot" for a good 2 hrs after. I think I just couldn't take it. We get pushed around in this specialty and at this point the nurses know they can push us around and we just have to take it or they'll tell the administration. My Mr. Hyde came out and didn't care but at then end my Dr. Jekyll arrived and had to think about how it affected the group (and my future).

Anyway, I just need some words of encouragement of how to deal. I'm 4 years into PP (all MD/community hospital) and I'm still definitely learning. My patience ran out tonight.

When you get called to do a procedure out of the OR, call the nurses before you get there and tell them what you need to be ready and tell them to call you when these things are done.
But if you want to be done quickly so you can go back to bed then you need to everything by yourself and not wait for anyone.
As for how you cope with disrespectful people and megalomaniacs, you need to always start your day thinking that it's just a few hours and you will be out of this **** hole and it will be cocktail hour.

 

[cognitus]

Unfortunately a culture has been created here by former workers that is hard to undo. I really wish I could tell people to piss off (so to speak) but Im on a high desired area and like you guys there's likely a line 20 deep out the door even for my workhorse job. The saving grace is that i do bill EVERYTHING. I used to say the hell with the IVs because it was sometimes longer to write the note then to actually do the IV but i reallized over the course of 5 or 6 calls that it adds up.

There are days (OB call days) where I definitely long for an OR only job

Billing and Making money off of these procedures is all the "thanks" I need. Easy to check your ego at the door when folks are just giving you the opportunity to bill more

 

[Consigliere]

We get pushed around in this specialty and at this point the nurses know they can push us around and we just have to take it or they'll tell the administration.

"We" don't get pushed around unless "we" allow ourselves to be pushed around. Grow a set, man. You don't have to be an asshat about it, but be assertive and not a doormat. "They" know "they" can push you around because you let them.

 

[chfo]

Bill it as an anesthesia consult and IV therapy initiation. I think most people can turn their perspective around 180 degrees when they realize they can bill for these "favors".

 

[Noyac]

I had something similar happen one night on OB. I came very closing to losing my cool and probably had a few nurses looking at me a bit differently for a while. I got called for an epidural at 2am and when I arrived nothing was done. IV bag was empty, no paperwork (nurses are responsible for getting this together), and nobody around to assist. I calmly walked out of the room and told the nurse who was new and I had never met before that she needed to get another bad of fluids and some paperwork. She said, "I don't do paperwork." I looked at her and and said, "I well, I don't do epidurals without paperwork." She storms off and the charge nurse came back with everything for me and did the procedure. Then I'm finished and a midwife calls me from her bad and asked me to place an epidural while I'm there in a pt who is 1cm and not contracting. My response was "NO" and I hung up the phone.
It turned out to cost me a completely unnecessary mtg with the midwife and some others.
The nurse that refused to help was fired.

 

[IlDestriero]

Ummm.....you start IVs and draw blood? Is this a pedi hospital? I only ever start them on my own patients. I've never been asked to start one on some random patient. Seriously just say no.

Billable central line or Aline? "Yes"

IV? "Do it yourself"

Exactly.
They can consult IR and they can place a line, maybe a PICC with ultrasound and bill for the procedure.

 

[Twiggidy]

Like I said, you guys don't work where I work. Those other threads where people make talk of groups being thrown on the street, well, that really happens out here. This is the land high demand and low supply. I can't tell people "DIY" or "Call IR"....I'll be calling unemployment the next month. As I said, a culture has been developed at this hospital and the only reason we're in the position WE are in as a group is because the former group told to many people "No". Your "NO" here turns into a guy down the street who needs a perm position saying "YES" to everything. I think it's easy to tell people those things in a forum, but the reality, especially given AMC takeover, contracts, etc, we have be more, wait, what's that word again? Oh, "affable" (i hate that word too).

I guess the take away is what was said in another post and that is to "do it", bill, and be the bigger man, especially when that paycheck comes at the end of the month. I realize this wasn't the best place to vent because everyone on the internets will be say, "Yeah. Put up your dukes and fight like a man." We know that's not the reality. Anesthesiologists are a dime a dozen, especially is big markets (where I am).

 

[deleted171991]

Like I said, you guys don't work where I work. Those other threads where people make talk of groups being thrown on the street, well, that really happens out here. This is the land high demand and low supply. I can't tell people "DIY" or "Call IR"....I'll be calling unemployment the next month. As I said, a culture has been developed at this hospital and the only reason we're in the position WE are in as a group is because the former group told to many people "No". Your "NO" here turns into a guy down the street who needs a perm position saying "YES" to everything. I think it's easy to tell people those things in a forum, but the reality, especially given AMC takeover, contracts, etc, we have be more, wait, what's that word again? Oh, "affable" (i hate that word too).

I guess the take away is what was said in another post and that is to "do it", bill, and be the bigger man, especially when that paycheck comes at the end of the month. I realize this wasn't the best place to vent because everyone on the internets will be say, "Yeah. Put up your dukes and fight like a man." We know that's not the reality. Anesthesiologists are a dime a dozen, especially is big markets (where I am).

That's the future of anesthesia, right there.

 

[Carbocation1]

So is it possible to bill for an anesthesia consult and IV initiation therapy or not? I wouldn't mind doing this extra work as long as I am compensated for it.

 

[Twiggidy]

So is it possible to bill for an anesthesia consult and IV initiation therapy or not? I wouldn't mind doing this extra work as long as I am compensated for it.

You can bill for just about any contact with a patient....just about. I'm sending you a DM @Carbocation1

 

[teeva]

Is this in NYC?

 

[IlDestriero]

Next time I guess you can say "Thank you Sir, can I have another?"
I tell people "no" all the time when they ask for something ridiculous. That's actually one of the reasons that they made me the chief resident, a story came up at the discussion about a particular "no". I don't live in fear of losing my job because I think it's inappropriate to ask for services that I/we don't provide.
It sounds like IVs are a service that you actually are expected to provide, so there's no reason to be too annoyed about it
There's a lot of things I/we won't do on call. Nobody's calling me an obstructionist.
And I'm definitely in a desirable job with no shortage of applicants.

 

[amyl]

I do lines and ivs if asked.... If they have tried - mostly bc I think it's the best for the patient. I haven't been abused and feel like I'm called after legitimate attempts. If stuff isn't ready I start asking with a stern (bitchy) face and they usually run and get it. I'm not sure how you were disrespected but i find calling people unprofessional (channeling my dads "I'm very disappointed in you" tone of voice) and pointing out how this is not the best care of the patient is pretty effective.

 

[IlDestriero]

You can bill for just about any contact with a patient....just about. I'm sending you a DM @Carbocation1

I've never heard of billing for an IV before today and I know it's not on our procedure list. Maybe I'll ask my IR pals the next time I'm there.

 

[aneftp]

Seems to me your "group" needs to have a "group" meeting/discussion and than present a unified proposal to administration.

At my current practice, we have "line service" and yes anesthesia is "part" of line service. But general surgeons are also part of line service.

1. Nurse tries IV
2. Nurse 2 tries IV
3. Call Ultrasound/line team
4. Call MD (whoever is on line service for the day)

Seems to be that your hospital doesn't have a ultrasound tech/IV tech? If not, you need to tell administration they need to hire one

Tell them costs vs the all important PATIENT SATISFACTION . If tech with ultrasound can get to patient, patients more satisfied, faster service, instead of waiting for available MD

 

[pjl]

We made a deal with the hospital that they reimburse us $50 or $75 for every IV we place on the floor. No insurance or any of that junk. They have chosen to take it out of the nurses fund from whichever floor calls for it.

The nurses quickly have gotten better at IVs.

 

[cognitus]

Like I said, you guys don't work where I work. Those other threads where people make talk of groups being thrown on the street, well, that really happens out here. This is the land high demand and low supply. I can't tell people "DIY" or "Call IR"....I'll be calling unemployment the next month. As I said, a culture has been developed at this hospital and the only reason we're in the position WE are in as a group is because the former group told to many people "No". Your "NO" here turns into a guy down the street who needs a perm position saying "YES" to everything. I think it's easy to tell people those things in a forum, but the reality, especially given AMC takeover, contracts, etc, we have be more, wait, what's that word again? Oh, "affable" (i hate that word too).

I guess the take away is what was said in another post and that is to "do it", bill, and be the bigger man, especially when that paycheck comes at the end of the month. I realize this wasn't the best place to vent because everyone on the internets will be say, "Yeah. Put up your dukes and fight like a man." We know that's not the reality. Anesthesiologists are a dime a dozen, especially is big markets (where I am).

I'm not sure why you're so upset at folks calling you for procedures that you can bill and make more money from. There's a disconnect and I'm sure I wouldn't respond this way

 

[Mman]

Like I said, you guys don't work where I work. Those other threads where people make talk of groups being thrown on the street, well, that really happens out here. This is the land high demand and low supply. I can't tell people "DIY" or "Call IR"....I'll be calling unemployment the next month. As I said, a culture has been developed at this hospital and the only reason we're in the position WE are in as a group is because the former group told to many people "No". Your "NO" here turns into a guy down the street who needs a perm position saying "YES" to everything.

This is not an issue for you as an individual, it's a department/group issue. What is your department policy? Who makes that policy? At our hospital we are literally never consulted for a peripheral IV. RN on the floor tries. If she can't, she gets another RN or her charge RN. If they can't, there is an IV team (the same ones that do PICC lines) that will come try. If they can't, it's up to the attending MD to arrange for another option up to placing a CVP.

I'd suggest that you bring up the issue with your department chair or group president.

 

[nimbus]

For people who bill for IVs what cpt code do you use? Do you actually get paid?

 

[narcusprince]

At my previous gig I was called for difficult iv's and difficult phlebotomies in the blood lab. Very small hospital so I mostly complied. Check yourself at times its tough dealing with difficult nurses at times. Also and this is the .mil in me when doing an IV anywhere I assume I am the smartest provider in the room, therefore I check to make sure an iv line and or heplock is ready tegaderms are ready and all the supplies. Lack of preperation on their part does not constitute an explosive attitude on your part.

 

[Wiscoblue]

It's 3-4 units and if it's Medicaid you'll get paid $60-80 and if the patient has commercial insurance it could be $200-300. We don't do IVs at my hospital but if I do get called (rarely) we bill for it.

 

[Shimmy8]

I'm the northeast and at my particular hospital there was a very big "IV team" of RNs that was separate from the rapid response team. They did almost every IV on the floor. It is seriously not a skill that the nurses have here, which is ridiculous.

My wife got a job in MICU here when we moved for residency and she was shocked. Even half the ICU don't "do" IVs because they legitimately were never taught in nursing school up here. Well in the last year the IV team has become toast for financial reasons, and the stupid nurses union about lost their ****. Well the unfortunate result, as we here all know is that anesthesia has become the backup plan basically after 1 pitiful attempt.

We've had a lot of problems with this, because of course it falls on the residents/call pager.

Our administration has fought for us, and even though it is not supposed to happen we get calls all the time, especially at night for stupid ****.

My response now, after reading some helpful posts here, is that I ask who/how many tries, why it is necessary, and if I can't get it do they want a central line. If the answers are appropriate and yes, then I feel it's important enough for the patient and I'll help out. Otherwise, I've gotten very comfortable saying no. It's very liberating.

 

[pjl]

We used to have a large number of refused payments for IV placement, maybe we were doing it wrong... I'll have to look again if what wiscoblue said is right.

 

[Twiggidy]

Point taken from everyone. I just need to learn to channel my energy. I was just very frustrated that someone asked for my help with something and when I arrived there were no supplies, no second hands, and people expecting me to open my shirt to reveal an "S" on my chest. The patient was sick, stunk, and definitely needed help. Ended up with an IV, CVP, and a dialysis line in the end so I definitely got mine out of it, but I was just really upset with I guess their professional manner and in the end my reaction to it. I think I just needed some encouragement from colleagues (outside my own very political colleagues) to just keep cool and get paid. It's all good.

 

[jwk]

We will help with IV's for surgical patients if our really good pre-op nurses can't get them. The hospital has an excellent IV team with ultrasound, so if they can't get an IV, it's a central line. It's the hospitalist problem at that point. Most of the time we're simply too busy to do procedures on non-surgical patients.

 

[Noyac]

I had something similar happen one night on OB. I came very closing to losing my cool and probably had a few nurses looking at me a bit differently for a while. I got called for an epidural at 2am and when I arrived nothing was done. IV bag was empty, no paperwork (nurses are responsible for getting this together), and nobody around to assist. I calmly walked out of the room and told the nurse who was new and I had never met before that she needed to get another bad of fluids and some paperwork. She said, "I don't do paperwork." I looked at her and and said, "I well, I don't do epidurals without paperwork." She storms off and the charge nurse came back with everything for me and did the procedure. Then I'm finished and a midwife calls me from her bad and asked me to place an epidural while I'm there in a pt who is 1cm and not contracting. My response was "NO" and I hung up the phone.
It turned out to cost me a completely unnecessary mtg with the midwife and some others.
The nurse that refused to help was fired.

So I realized that I never really got to the point here, damn martini's.
The point is, had this happened in my younger days when I thought everyone saw things the way I did and if not then they needed too, I would have reacted much differently. I would have berated that nurse for not being prepared and even worse for her attitude. But instead I just calmly but sternly stated my POV and walked away. I made it clear to her that I was the "Doctor" called by her department to assist with "their" issue. If I walk away for lack of resources and for concerns with nursing care that made me feel that I would be putting the pt at increased risk if I proceeded with this nurse attending to her afterwards then she would be responsible. That's when the charge nurse stepped in and took over. As much as I bitch about OB, I actually do have a darn good relationship with the staff. I was called the next day and informed that the nurse was "let go".
The other part of all this was the phone call from the midwife. I was already in a very fed up state of mind. I could have been more diplomatic with the midwife but I wasn't. I hung up on her after saying something like, " no way". This is what bought me the meeting the next week with the midwife, the OB director (a doctor) and the anesthesia director ( a doctor). Needless to say, this midwife doesn't question me or ask me for unusual **** any longer. But I think the met was called because they felt I was inappropriate and disrespectful. I explained the preceding events and the unusual nature of the request and the mtg turned. I felt bad for making her cry but medicine isn't for crybabies so tough **** I guess.
All of this happened about 6 yrs ago and I haven't respond like this since. Haven't needed to.
Sometimes you need to show your frustration and sometimes you need to take a deep breath and move on.
You will know when to respond aggressively and when to smile and bend over. Experience will teach you. You know where experience comes from, right?

 

[Noyac]

It's 3-4 units and if it's Medicaid you'll get paid $60-80 and if the patient has commercial insurance it could be $200-300. We don't do IVs at my hospital but if I do get called (rarely) we bill for it.

Exactly!

 

[Noyac]

I'm the northeast and at my particular hospital there was a very big "IV team" of RNs that was separate from the rapid response team. They did almost every IV on the floor. It is seriously not a skill that the nurses have here, which is ridiculous.

My wife got a job in MICU here when we moved for residency and she was shocked. Even half the ICU don't "do" IVs because they legitimately were never taught in nursing school up here. Well in the last year the IV team has become toast for financial reasons, and the stupid nurses union about lost their ****. Well the unfortunate result, as we here all know is that anesthesia has become the backup plan basically after 1 pitiful attempt.

We've had a lot of problems with this, because of course it falls on the residents/call pager.

Our administration has fought for us, and even though it is not supposed to happen we get calls all the time, especially at night for stupid ****.

My response now, after reading some helpful posts here, is that I ask who/how many tries, why it is necessary, and if I can't get it do they want a central line. If the answers are appropriate and yes, then I feel it's important enough for the patient and I'll help out. Otherwise, I've gotten very comfortable saying no. It's very liberating.

You could also attempt to set up some guidelines.
1-2 attempts by the nurse, if unsuccessful then an attempt by a more experienced nurse. If still unsuccessful and IV failure will lead to central line then call anesthesiologist.

 

[Noyac]

We will help with IV's for surgical patients if our really good pre-op nurses can't get them. The hospital has an excellent IV team with ultrasound, so if they can't get an IV, it's a central line. It's the hospitalist problem at that point. Most of the time we're simply too busy to do procedures on non-surgical patients.

This is what I was thinking earlier today but never got around to posting.
Tell them you are busy and it will be at least an hour or more before you can get there. Happy to help but will have to wait.

They will usually get it started on their own.

 

[BIGphysician]

It's really hard to do this when doctors are asking you to come do procedures on patients, especially when they should know how to do them on their own. I can understand asking for help but just pointing me to a room to place multiple lines, having no assistance in the room from a nurse, no items ready in the room, and then to not even say thank you at the end...I think I'd just had it. There was no cursing or throwing but I really "strongly" emphasized that when I'm called to do a favor that I expect things ready and for someone to be around to help if needed. I literally placed an IV and had to hold my thumb over the opening because no heplock was ready, no flush was available, no IV line made, etc. I had to blood a bunch of things including me and the patient to find a syringe to pull blood. then the nurse go irritated because she was going to use a vacutainor (sp?) instead of using my 3 10cc syringes of blood. that's when the fuse blew and a different nurse came to help. I apologized to the first nurse after because I thought that was the right thing to do, but I was "hot" for a good 2 hrs after. I think I just couldn't take it. We get pushed around in this specialty and at this point the nurses know they can push us around and we just have to take it or they'll tell the administration. My Mr. Hyde came out and didn't care but at then end my Dr. Jekyll arrived and had to think about how it affected the group (and my future).

Anyway, I just need some words of encouragement of how to deal. I'm 4 years into PP (all MD/community hospital) and I'm still definitely learning. My patience ran out tonight.

Isn't it normal to make sure you have all that stuff ready and basically in front of you before you go sticking someone first?

 

[Mman]

It's 3-4 units and if it's Medicaid you'll get paid $60-80 and if the patient has commercial insurance it could be $200-300. We don't do IVs at my hospital but if I do get called (rarely) we bill for it.

under what code? because that's more than you can bill for an entire anesthetic for some simple surgical procedures

 

[Wiscoblue]

under what code? because that's more than you can bill for an entire anesthetic for some simple surgical procedures

I've been doing my own billing for 15 years and am not aware of any surgical procedure where the anesthetic charge would be less than 3 startup units. I use 36000 for IV placement. 36556 for central line 36569 for PIC lines. And then add the ultrasound code if you use the sonosite and that's worth one extra unit.

 

[RuralMedicine]

So is it possible to bill for an anesthesia consult and IV initiation therapy or not? I wouldn't mind doing this extra work as long as I am compensated for it.

You can bill for physician inserted IVs. I do it sometimes when the patient really just needs a PIV and nursing can't get it but I feel something that feels promising. I'll give that a try before I put the patient through a CVL. If I can't get a PIV then I will do a CVL for access if necessary. I'm not an anesthesiologist so I don't bill for anesthesia and I'm usually doing this on patient's admitted to my service so consultations are not applicable so I'm not sure about the consultation aspect.

 

[epidural man]

I think it is only 0.18 RVU's for IV start (CPT 36000).

But bill for a consult - in fact, do a physical exam and take a small history - you can bill a ton (bill a level III 99203) ..brilliant idea.

Also bill for the prehydration if you hang the bag (CPT 96365, 96366).

I think when you are asked to do it next time - now you have learned - ask a few questions on the phone. "Do you mind having a bag of LR, spiked ready, with some guaze, tape, tegaderm, alcohol wipes, tape, and a bunch of 18 and 20g catheters? Text me when all this is in the room so I can rush right down. Also, in case you want to be the bestest nurse on the floor, the last nurse that called me for an IV had an ice cold diet coke waiting for me...i'm just saying...."

 

[deleted171991]

I think it is only 0.18 RVU's for IV start (CPT 36000).

But bill for a consult - in fact, do a physical exam and take a small history - you can bill a ton (bill a level III 99203) ..brilliant idea.

Also bill for the prehydration if you hang the bag (CPT 96365, 96366).

I think when you are asked to do it next time - now you have learned - ask a few questions on the phone. "Do you mind having a bag of LR, spiked ready, with some guaze, tape, tegaderm, alcohol wipes, tape, and a bunch of 18 and 20g catheters? Text me when all this is in the room so I can rush right down. Also, in case you want to be the bestest nurse on the floor, the last nurse that called me for an IV had an ice cold diet coke waiting for me...i'm just saying...."

Billing for a consult in this context sounds like fraud to me. Just saying...

 

[pgg]

Billing for a consult in this context sounds like fraud to me. Just saying...

Well, if one is being consulted for vascular access, how does one determine what kind of access is most appropriate without a quick H&P?

 

[deleted171991]

Well, if one is being consulted for vascular access, how does one determine what kind of access is most appropriate without a quick H&P?

The one you were asked for. I don't know but, if I were a patient and would be billed as a consult, I would get really mad. Mad enough to report the doc.

Now using and billing for ultrasound for an assumed difficult iv is a different story.

 

[pgg]

OK, fair enough, can't argue with that.

 

[Twiggidy]

Im not sure that really is fraud. If another service calls you in, you sit and get relevant info from a patient, then do a procedure to the patient. Ill buy it. Im not gonna do it because to me thats too much work for my time, but i buy it

 

[deleted171991]

Im not sure that really is fraud. If another service calls you in, you sit and get relevant info from a patient, then do a procedure to the patient. Ill buy it. Im not gonna do it because to me thats too much work for my time, but i buy it

Seriously, does a nurse do a "consult" for an IV?

 

[Pooh & Annie]

I'm pretty sure he was kidding. The whole "you can bill a ton" being the giveaway.

 

[chocomorsel]

If you guys are having a difficult time in the OR with an Aline, and end up using ultrasound, do you bill for the U/S guidance? Is it the same code as U/S for a CVC?

 

[chfo]

The one you were asked for. I don't know but, if I were a patient and would be billed as a consult, I would get really mad. Mad enough to report the doc.

Now using and billing for ultrasound for an assumed difficult iv is a different story.

Explain to the patient that "Dr PCP wanted me to come by and evaluate you for IV access, because I know they have had a really hard time already, and everyone wants to spare you the trouble of more pokes." Establish the relationship. Talk with them. Be their friend.

And bill for an anesthesia consult.

You are a consultant. You have been consulted for IV access. You should be paid for your consult.