Bill patient for blood patch after wet tap epidural?

[caligas]

Yes? No? Maybe? Any thoughts?

thanks.

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[IlDestriero]

Yes.

 

[nimbus]

Yes

 

[deleted171991]

No. Bill for epidural only. Wet tap is an error in technique, not an operator-independent complication (such as hematoma). When in doubt, there is this thing called ultrasound...

You broke it, you fix it. For free.

 

[chocomorsel]

I don't think we should bill them but my group does. I am just a lowly associate.
There's a lot to be said for customer service. I agree with FFP and if I had my way, as in was in charge of my own group, I wouldn't.

 

[aneftp]

I don't think we should bill them but my group does. I am just a lowly associate.
There's a lot to be said for customer service. I agree with FFP and if I had my way, as in was in charge of my own group, I wouldn't.

Most will bill for it.

But watch out. In this day of high deductibles. If patient hasn't met deductible or has prepaid (self pay) and gets breakdown of bill. You better be prepared to waive the charges immediately.

Had colleague get blasted by patient over this. Patient threaten to report to medical board.

It's a pure money grub. We all know it. We figure most have met their deductibles.

That's why in this day and age of remote billing companies. We tend to lose interaction with patient costs.

I'd personally follow up with billing company.

 

[deleted171991]

Deductible met or not, the patient might get a bill for a 10-20-30% copay (depending on the Obamacare "metallic" plan level), or just a plain bill showing the insurance company having paid money for a dereliction of duty that produced direct damage. It might just piss her off enough. It would certainly make me complain about the anesthesiologist's "nerve".

 

[kazuma]

I've only done about 70 epidurals so far and knock on wood, I haven't had a wet tap yet. But I have placed several blood patches for wet taps I've inherited from post call colleagues which I did not submit a bill for. Seems like good customer service. Ultimately I'll do whatever my future group wants me to do, but if it's my choice I'd prefer to not bill for blood patches associated with an epidural or spinal I placed.

 

[BobBarker]

I've only done about 70 epidurals so far and knock on wood, I haven't had a wet tap yet. But I have placed several blood patches for wet taps I've inherited from post call colleagues which I did not submit a bill for. Seems like good customer service. Ultimately I'll do whatever my future group wants me to do, but if it's my choice I'd prefer to not bill for blood patches associated with an epidural or spinal I placed.

Your department is ok with you not billing? Most of the ebp's I have done have been for neurology so of course I bill.

 

[caligas]

I've only done about 70 epidurals so far and knock on wood, I haven't had a wet tap yet. But I have placed several blood patches for wet taps I've inherited from post call colleagues which I did not submit a bill for. Seems like good customer service. Ultimately I'll do whatever my future group wants me to do, but if it's my choice I'd prefer to not bill for blood patches associated with an epidural or spinal I placed.

Anybody else make it thru their 1st 70 epidurals without a wet tap?! I am skeptical, but impressed if its true. I wet tapped my 3rd epidural as a ca2 and had at least one more in my first 100. Now, 10 years out, its about 1 in 300.

 

[norwood]

Your department is ok with you not billing? Most of the ebp's I have done have been for neurology so of course I bill.

That's a good point - I'm usually mopping up for ER if I am doing one, and IMHO intentionally putting a 17g hole in the dura makes PDPH less a complication than an expected effect. If the pt needs a Percocet for the pain, they have to pay for it...

Agree that if it were my (or my department's) complication, I'd try not to bill.

 

[BobBarker]

Doesn't seem too unusual. I have never had one either.

 

[Consigliere]

IMHO intentionally putting a 17g hole in the dura..."

Unless you're a complete d!ck, I don't think any one of us INTENTIONALLY puts a 17 gauge rent in the dural membrane.

 

[norwood]

I don't think any one of us INTENTIONALLY puts a 17 gauge rent in the dural membrane.

We don't. ER sometimes uses large bore needles for LP. I guess a spinal needle interferes with opening pressure measurement or something?

 

[Consigliere]

A 17 gauge needle for an LP!?! Jeez, and I thought a 20 gauge was barbaric...

 

[pjl]

Yes bill.
Is the patient going to waive rights to sue you if something goes wrong?

I am now at 2 dural punctures, my very first one, and my totally healthy, fit, slim 400th nurse patient who taught me to not be cocky about that rate of dural punctures. Now I am another few hundred later, just waiting to be humbled again.

With regards to LPs, try filling 10 mL worth of test tubes one slow drip at a time without the patient moving using a 22 guage (or 20 I guess) plus the opening pressure measurement will take forever to get to the top. They use 18 guage here in ED.

 

[kazuma]

I'm knocking on wood because I know I'll get a wet tap sooner or later.

Your department is ok with you not billing? Most of the ebp's I have done have been for neurology so of course I bill.

I've only done a few blood patches and my attendings have said to not bill for them. I write procedure notes for documentation but they are listed in the original encounter and I don't believe the coders bill for it unless it is in another encounter.

Like you mentioned if it was a BP from a neurology or ED lumbar puncture, I would definitely bill for it.


Does anyone bill for replacing a spotty epidural?

 

[kazuma]

Anybody else make it thru their 1st 70 epidurals without a wet tap?! I am skeptical, but impressed if its true. I wet tapped my 3rd epidural as a ca2 and had at least one more in my first 100. Now, 10 years out, its about 1 in 300.

I didn't think it was that unusual, but I just logged into the ACGME site and I've done 65 without a wet tap. On the other hand, I had a colleague that had two wet taps in one night. I've been told that if you have never had a wet tap then you haven't done enough epidurals. I'm sure I will sooner or later.

BTW, how many of you guys just thread the catheter and run a spinal catheter if you get a wet tap?

 

[BobBarker]

You can't bill for replacing an epidural.

 

[BLADEMDA]

We never bill a patient for a blood patch if one of our providers caused the wet tap. We do bill for blood patches due to post dural puncture headaches caused by ER, radiology, etc.

I don't think complications should be billed for by the provider/group who caused said complication. But, with a wet tap rate less than one percent this is a non issue.

 

[Arch Guillotti]

Bill them.

 

[pgg]

I wonder how long it'll be before it's impossible to bill anyone for treatment of any complication. Isn't that the whole objective of bundled payments?

If I had any say in the matter, I wouldn't bill for a EBP done to treat a wet tap done by an anesthesiologist in my group. For a PDPH from a diagnostic LP - yes, bill. Similar to paying the dentist for fixing damage done to healthy teeth during a routine DL.

 

[Mr Wizard]

We don't. ER sometimes uses large bore needles for LP. I guess a spinal needle interferes with opening pressure measurement or something?

That's what some neurologists and EM physicians will tell you. It's not true. There are some pretty good studies showing that opening pressure and CSF flow is just as good, if not better, with pencil-point needles. Not very many legitimate reasons to use quinkes any longer.

I take some sprottes with me down to the ED when they call for assistance with LPs

 

[Mman]

Anybody else make it thru their 1st 70 epidurals without a wet tap?! I am skeptical, but impressed if its true. I wet tapped my 3rd epidural as a ca2 and had at least one more in my first 100. Now, 10 years out, its about 1 in 300.

I went about 600-800 before getting my first wet tap and thought I was invincible. Then once after my first few thousand I had 2 consecutive ones. That was kinda humbling.

 

[stonemd]

We put large needles thru dura regularly for spinal drains
Btw how will us prevent we taps? Maybe reduce the incidence
U can use fluoro, us, ct and still get a rare wet tap when dura is adherent to the for afor a

 

[pgg]

I went about 600-800 before getting my first wet tap and thought I was invincible. Then once after my first few thousand I had 2 consecutive ones. That was kinda humbling.

I wet tapped my first ever epidural attempt as a resident. Went about 5 years before my next. Last year I had two wet taps ... in the same patient, different levels, about 45 seconds apart. Third attempt was good.

 

[BLADEMDA]

no matter how good you are, or think you are, an epidural wet tap can happen to you. My own personal data is somewhere between 1 out of 600 to 1 out of 800.

 

[Guillemot]

I'd be in favor of not billing for a blood patch if it were due to a tap I did, but Id bill for a blood patch if someone else wet tapped the patient then consulted me to fix it.

 

[pjl]

How about for post spinal for C/S? Then do you bill?
Why not give them the epidural free too if you mess it up and wet tap them?
Or how about for shoddy blocks from an epidural?

Guaranteeing your work against a known (albeit small rate) complication is what we are talking about when we don't charge for blood patches, which leads me to wonder where should a line be drawn?