Anesthesia for Tandem and Ring insertion

[XRT_doc]

What kind of anesthesia do you give for Tandem and Ring insertion?

---

Members don't see this ad.

 

[medgator]

I've seen anywhere from Valium /percocet in the office, to conscious sedation to spinal block to full on general in the OR. It's really dealers choice, imo more is better than less, although the ring may be an easier applicator in terms of amount of anesthesia needed

 

[taserlaser]

I’ll echo medgator. We do weekly x3 HDR tandem + ring +-interstitial needles, with spinal.

 

[Mandelin Rain]

I think Smit Sleeve would make a difference too. If you have to dilate, you're going to need more.

More is definitely better than less. Especially for tough cases.

 

[seper]

With a Smit sleeve most patients are OK with Demerol+Valium.
If you sound the uterus each time in the office, or have a lot of anxious, needy patients, request short procedural sedation by an anesthesiologist. Once insertion is over, wake the patient up.

 

[Spiced Meats]

With a Smit sleeve most patients are OK with Demerol+Valium.
If you sound the uterus each time in the office, or have a lot of anxious, needy patients, request short procedural sedation by an anesthesiologist. Once insertion is over, wake the patient up.

What kind of office setup/nursing support do you have during placement? I'm used to full OR staff in training but getting a much more pared down setup as we establish a new HDR program.

 

[seper]

Are you asking about setup with or without brief sedation?

What kind of office setup/nursing support do you have during placement? I'm used to full OR staff in training but getting a much more pared down setup as we establish a new HDR program.

 

[Spiced Meats]

With sedation - without I'm assuming stirrups and your clinic nurse?

 

[seper]

Most people set-up "brachy suite" with a table, RadOnc RN trained in helping with implants. Radiation oncologist writes for pain meds.

If you need sedation, the setup is usually tailored to Anesthesia, who prescribe and carry out sedation. One easy way is to perform all insertions in OR, then recover the patients and send them down to radiation. In reality, that is often suboptimal (e.g. implants fall out in transit), so high-functioning places create dedicated brachytherapy suites in RadOnc and Anesthesia comes to them to serve.

 

[evilbooyaa]

We do OR sedation (MAC with LMA, generally not general with ETT) and US-guided placement. Workflow is functional for our department, saves patient a procedure for smit sleeve placement.

We would consider in-department conscious sedation for US-guided placement as an option but do not have buy-in from our Anesthesia department for that.

 

[Irradi8or]

Related question - when you all do your own moderate sedation for these brachy, who here is using the 99151, 99152, or 99153 codes to report that extra work? For those who have anesthesia to the moderate sedation, who's using 99155, 99156, 99157 codes? Anyone have luck getting it paid, or getting push back from payers or NCCI edits?

 

[Palex80]

We use general anaesthesia in the OR for the insertion of the smit sleeve. It is followed by MRI- & CT-based-planning with the applicator in-site. During this time the patients often require further medication, mostly morphine, since the effects of general anaesthesia have faded off. Until all is done and the applicator is removed it can take 5+ hours.
1 hour OR + 1 hour recovery from anaesthesia + 1 hour MRI + 20 min CT +1 hour fusion/contouring/planning/optimization/QA + 20' treatment + 20' transportation (gyn department in other building, MRI on other floor). It is time consuming and we only do something like 5-6 cases per year, so "routine" is not the case.

Follow-on treatments are done with spinal anaesthesia or short-duration larynx-mask-based anaesthesia (10-15'). We do these in our department and since we do not redo MRI but only CT we are usually done within 2 hours.

 

[seper]

I have a set-up when anesthesia comes to me on case-by-case basis. We let them use all of the anesthesia-related cpt codes. Some of my managers expressed an interest to capture some of these codes, but the anesthesia department has not yet agreed.

Related question - when you all do your own moderate sedation for these brachy, who here is using the 99151, 99152, or 99153 codes to report that extra work? For those who have anesthesia to the moderate sedation, who's using 99155, 99156, 99157 codes? Anyone have luck getting it paid, or getting push back from payers or NCCI edits?

 

[Irradi8or]

I have a set-up when anesthesia comes to me on case-by-case basis. We let them use all of the anesthesia-related cpt codes. Some of my managers expressed an interest to capture some of these codes, but the anesthesia department has not yet agreed.

Thanks so much seper. What code is anesthesia billing for your vaginal (T&O) procedures? Ours is billing 00940, which may make it a challenge to bill ours. Plus, 99155-99157 basically doesn't get paid in the freestanding setting, and requires increasing hospital charge master on the HOPPS side. Just wanted to see if anyone has had success in this arena...

 

[seper]

Don't know the answer. Anesthesia Dept charges everything sedation-related although they administer it in the RadOnc Department. They call it "MAC" in the billing records, although in reality is more of a conscious sedation type of a drug cocktail. I'm at a hospital-based RadOnc center.

Thanks so much seper. What code is anesthesia billing for your vaginal (T&O) procedures? Ours is billing 00940, which may make it a challenge to bill ours. Plus, 99155-99157 basically doesn't get paid in the freestanding setting, and requires increasing hospital charge master on the HOPPS side. Just wanted to see if anyone has had success in this arena...