asking surgeon about blocks

[pjl]

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Bad for billing...amazing for the patient.

Hmmm.....

But to be fair - if I worked in private practice and had to block my own patients before they went to sleep, I think less than 1% of my patients would get blocks.

It's easy for me to talk up the regional game when I work in a system with an Acute Pain Service.

Single shot and done.

 

[GA8314]

meh

After my N of thousands I still put in 30 ms of 0.5% ropivicaine for a single shot brachial plexus unless a patient is drastically smaller than average. Works every time and not causing systemic toxicity.

Yikes. It just sounds like a lot to me. But, I know you've been around longer than I so I'll take your word for it.

 

[Mman]

Yikes. It just sounds like a lot to me. But, I know you've been around longer than I so I'll take your word for it.

On what planet is 150 mg of ropivicaine with epi a lot for an average 70-100 kg patient? Especially when it's injected under u/s guidance? Toxic dose is what 2.5-3 mg/kg?

 

[Ignatius J]

Bad for billing...amazing for the patient.

Hmmm.....

But to be fair - if I worked in private practice and had to block my own patients before they went to sleep, I think less than 1% of my patients would get blocks.

It's easy for me to talk up the regional game when I work in a system with an Acute Pain Service.

Naw, you would get it done. With a tech and nurse, it delays the procedure about 3 minutes. Get in. I prep while nurse places monitors and tech preoxygenates. Do block in a minute for adductor, femoral, and upper extremity blocks. Walk around and push propofol as soon as I'm done.

For Taps, I put them in while the nurse places the foley after the tube is in. Almost zero time wasted.

 

[RxBoy]

Not if you do you blocks with bupi and bump the Ketofol up to "GA" levels 😉

I agree with preblock and bill for postanesthesia analgesia "per surgeon request". But the problem is billing a sedation case as a GA case, you'll get dinged for it unless you have an airway device in place. In reality a biller will bill your case as sedation with the regional as the primary anesthetic, and ull get zero units even if you say its a postop block. Ask your biller how they bill, and you'll be surprised. If you throw in an LMA, problem solved.

 

[deleted162650]

I agree with preblock and bill for postanesthesia analgesia "per surgeon request". But the problem is billing a sedation case as a GA case, you'll get dinged for it unless you have an airway device in place. In reality a biller will bill your case as sedation with the regional as the primary anesthetic, and ull get zero units even if you say its a postop block. Ask your biller how they bill, and you'll be surprised. If you throw in an LMA, problem solved.

I think that's a quirk specific to your billing company. Our billers are in house so I'll ask next time I'm at the office. As I'm sure you know, nowhere in the definition of GA is an airway device specified or required. Think of all the mask cases that have been done before the LMA or the pedi BMT's that continue to be done everyday without an airway device. Perhaps your billers need to be educated.

If you've got a pt wearing a simple mask and running on prop at a sufficient level to not react to a "surgical stimulus" then that is a legit GA and you should be able to call it that. I realize that's not the exact scenario I originally described, but I would hate for you to feel limited in how you run your anesthetic because you have ignorant billers.

 

[OneFellSwoop]

Adding an LMA removes doubt from an uneducated insurance company that can still control the payment regardless of what you document, and can save a lot of headache if they come back and argue the point

 

[pjl]

Adding an LMA removes doubt from an uneducated insurance company that can still control the payment regardless of what you document, and can save a lot of headache if they come back and argue the point

General anesthesia should be billed if the deepest level of sedation obtained meets definition of general anesthesia. General anesthesia refers to a level of responsiveness, NOT whether you have an airway.
Although you will never get called on it, underbilling is just as fraudulent as overbilling 🙂