anesthesiologists reading and billing echos?

[soxman]

Can anesthesiologists who do a cardiac anes fellowship read and bill for echos like cardiologists do? I think that would be a sweet gig to do on the side

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[secants]

I remember reading on other threads that it will create a potential turf war with cards in your hospital unless you're doing it on your ICU patients or something. Do EM trained doc with fellowship in U/S bill for their reads/reports?

 

[Ezekiel2517]

I can bill for TTE/TEE's I do in the ICU. Pretty sure I can't bill for TTE's done as an anesthesiologist. Obviously you can bill for TEE's in the OR but it's not like you can start dropping TEE probes in everybody unless in the heart room. Don't see why you can't be consulted to perform and read TEE's outside the OR but I don't think this would be a "sweet gig"

 

[Ignatius J]

I can bill for TTE/TEE's I do in the ICU. Pretty sure I can't bill for TTE's done as an anesthesiologist. Obviously you can bill for TEE's in the OR but it's not like you can start dropping TEE probes in everybody unless in the heart room. Don't see why you can't be consulted to perform and read TEE's outside the OR but I don't think this would be a "sweet gig"

That $14 dollar you get from the Medicare CABG patient isn't worth it?

I kid. I kid.

 

[drmwvr]

If it were a sweet gig, there would be cardiologists beating a path to every heart room in America.

 

[deleted547339]

Do EM trained doc with fellowship in U/S bill for their reads/reports?

It depends on where you work. It's a turf battle thing, not a education thing.

I'm not 100%, but my understanding is:

You don't need a fellowship to bill. You are required to have a recording mechanism and a QI system. Most places will hire a fellowship trained US doc to run the image review and then have the EM docs that are comfortable do it perform them.

Mind you, we're not going comprehensive exams. We'll use it to evaluate for whether or not there is an abscess or a AAA or if there is free fluid on a FAST. If we look at the RUQ, were trained to look for stones, pericholecystitic fluid, GB wall thickening and CBD enlargement - that's it. If we look at the heart, were grossly assessing EF, effusions, LV/RV, etc. Were not trained to look for vegetations, subtle valvular abnormalities, etc.

Again, I'm not 100%, but that's what I've been told.

 

[DrBeaker]

We read and bill for TEE whether it's the heart room, trauma, or a consult from the ICU. We do a thorough exam. Assess valve function, endocarditis. Also billed for limited TTE exams on Preop patients. Picked up a few things, including a major valve issue previously undiagnosed. It is a turf war of sorts. I admit, we have s good setup where I am.

 

[Sirach38]

I don't mean to high jack this thread but rather than start a new thread, since this thread deals with billing, I wanted to ask a question. I always here people state that Anesthesiologist gave no power at hospitals because they are just an expense for the hospital and don't bring in their own money. People make it seem like the surgeon brings the money and the anesthesiologist just gets paid a cut from the surgeon's billing. However, it is my understanding that the anesthesiologist does their own billing separate from the surgeon and is therefore, bringing money to the hospital. Is this how anesthesiologists get paid? Is it not a totally separate billing system than the surgeon's? Am I missing something? Thanks guys.

 

[deleted171991]

The ACA is trying to package the entire billing for a hospital admission into one single bundled payment to the hospital . Then the hospital can do whatever they want with it, because they are not getting more, not even for complications. Hence anesthesia becomes an expense, and the surgeon is the only one bringing in profit.

Not the present yet, but the near future. This is why we advise you to go into a specialty that allows you to have your own patients, not just be a consultant for others. Unless you love the rat race.

 

[BLADEMDA]

There is NOTHING which precludes you for billing for TTE or TEE. If you have hospital privileges for the procedure or test you can bill for it. That said, CMS pays around $60-$70 for a TEE exam with a full report on the chart. You won't make "bank" with a TTE/TEE service but I readily admit it provides useful information for our perioperative care.

 

[deleted171991]

$60-70 for a TEE? Unbelievable!

 

[Sirach38]

The ACA is trying to package the entire billing for a hospital admission into one single bundled payment to the hospital . Then the hospital can do whatever they want with it, because they are not getting more, not even for complications. Hence anesthesia becomes an expense, and the surgeon is the only one bringing in profit.

Not the present yet, but the near future. This is why we advise you to go into a specialty that allows you to have your own patients, not just be a consultant for others. Unless you love the rat race.

So, if this is currently not the model yet, and may be the model in the future depending how long Obamacare lasts, why is it that currently anesthesiologists complain about not having power because they bring no money to the hospital. Seems to me that while the future may be uncertain, at the present gas is bringing their own billing and money to the hospital so why the current complaining?

 

[deleted171991]

Because not only the reimbursements are going down, but hospitals don't optimize for anesthesia billing (they expect us to provide the same expensive services to elective Medicare/Medicaid patients as to private patients, they run rooms with few cases just to keep surgeons happy etc.). So, in many places, anesthesia ends up being a/the money-loser, despite the fact that overall the hospital is making good money in the OR.

The big money-maker for the hospitals are the facility fees. That's why, in 2014, it's financially more rewarding to own a surgicenter than to be a great surgeon.