Billing for contrast

[giddyup]

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Do y'all bill for the contrast itself when doing ESIs etc? At my old job we always did. Omnipaque with code Q9966 for amount used and Q9966-JW for amount wasted. Always gets paid. Adds up to about 20 bucks for a 50mL vial. My new job I'm starting says to not bill for contrast and cites this:

Thoughts?

 

[RoloTomassi]

I do, just amount used. It's in my billing template so no extra work on my end, worse case they don't pay it.

 

[BobBarker]

Yes I don’t waste any, just bill amount used. It pays.

 

[giddyup]

Yes I don’t waste any, just bill amount used. It pays.

so you re-use your vials? we typically use a 50mL vial, use 10 and bill for it, and waste 40 and bill for it using the JW code so each patient has their own vial.

 

[so55b]

so you re-use your vials? we typically use a 50mL vial, use 10 and bill for it, and waste 40 and bill for it using the JW code so each patient has their own vial.

why not use 10cc vials?

 

[giddyup]

why not use 10cc vials?

apparently my clinic cant get them from their current supplier, only the 50s 🤷‍♀️

 

[BobBarker]

Yea, I just use the same vial until kit is fully depleted. We did the same at the hospital and at the other two clinics I was affiliated with.

 

[SSdoc33]

apparently my clinic cant get them from their current supplier, only the 50s 🤷‍♀️

same

 

[SSdoc33]

Yea, I just use the same vial until kit is fully depleted. We did the same at the hospital and at the other two clinics I was affiliated with.

if i ware in PP i'd do the same, but this is frowned upon. we have a thread about it here somewhere

 

[gdub25]

Why would it be frowned upon, they are multi use vials. 50mL vials would be really expensive, seems like our 10ml vials are $12 or something like that. Also, 10mL used for one patient!?

 

[RoloTomassi]

Every medication is supposed to be new vial opened for each case but I don't know anyone who follows that in real life, incredibly wasteful

 

[MD87]

Why would it be frowned upon, they are multi use vials. 50mL vials would be really expensive, seems like our 10ml vials are $12 or something like that. Also, 10mL used for one patient!?

They are not multi use. Specifically says single use on the bottle. May not be rational, but that’s what it says on the bottle.

 

[gdub25]

Hmm, I did not realize it says single use one the bottle and will have to look into that but I don't think it would make a difference even if it did. We had to look into the regulations regarding how drugs are drawn up and single use vs multi use vials when we built our ASC. I didn't have a third party that did the licensing or policies/procedures paperwork, I did it all myself because I wanted to know for sure what we could and could not do and the why behind it. There is language in the regulations that state medication vials can be split up for use across multiple patients but the medication has to be drawn up in a drug room or in the operating room prior to any patient being in the room. The medication may then be stored and used throughout the day according to the manufacturer's standards of each particular drug. I just tried to grab a screenshot of the code but the manual is 100s of pages and I haven't found it. I'll ask my ASC admin, she'll probably know right where it is.

 

[GoBeers]

for single-use vials, i use throughout the day and then discard the remainder at the end of day

 

[BobBarker]

for single-use vials, i use throughout the day and then discard the remainder at the end of day

Yes, that is what we did at the hospital.

 

[Ducttape]

Why would it be frowned upon, they are multi use vials. 50mL vials would be really expensive, seems like our 10ml vials are $12 or something like that. Also, 10mL used for one patient!?

you need to make sure that they say "multi use" vials.

some of the vials have 50 ml and are not multi use. different stopper, different preservatives.

(fwiw, radiology generally uses 50 ml vials for CT scans)

Hmm, I did not realize it says single use one the bottle and will have to look into that but I don't think it would make a difference even if it did. We had to look into the regulations regarding how drugs are drawn up and single use vs multi use vials when we built our ASC. I didn't have a third party that did the licensing or policies/procedures paperwork, I did it all myself because I wanted to know for sure what we could and could not do and the why behind it. There is language in the regulations that state medication vials can be split up for use across multiple patients but the medication has to be drawn up in a drug room or in the operating room prior to any patient being in the room. The medication may then be stored and used throughout the day according to the manufacturer's standards of each particular drug. I just tried to grab a screenshot of the code but the manual is 100s of pages and I haven't found it. I'll ask my ASC admin, she'll probably know right where it is.

may depend on your state.

in this state, being drawn up in a drug room is not as simple as "in another room". it has meant under a hood by a pharmacist.

we did this during covid supply chain. in patient pharmacy would draw up and split each 10 ml vial in to 3 ml aliquots sterilely, under a hood, and a courier would get them based on the schedule, as they could only be stored in our fridge for 24 hours.

 

[NVO]

may depend on your state.

in this state, being drawn up in a drug room is not as simple as "in another room". it has meant under a hood by a pharmacist.

we did this during covid supply chain. in patient pharmacy would draw up and split each 10 ml vial in to 3 ml aliquots sterilely, under a hood, and a courier would get them based on the schedule, as they could only be stored in our fridge for 24 hours.

This is funny cause we tried getting pharmacy to portion out our drugs and they said no because the OR air circulation is actually better than their hoods so we might as well do it ourselves. Not sure how much of this is true vs them being lazy, or how pharmaceutical hoods compare to the ORs (new air every 3min)

 

[gdub25]

you need to make sure that they say "multi use" vials.

some of the vials have 50 ml and are not multi use. different stopper, different preservatives.

(fwiw, radiology generally uses 50 ml vials for CT scans)


may depend on your state.

in this state, being drawn up in a drug room is not as simple as "in another room". it has meant under a hood by a pharmacist.

we did this during covid supply chain. in patient pharmacy would draw up and split each 10 ml vial in to 3 ml aliquots sterilely, under a hood, and a courier would get them based on the schedule, as they could only be stored in our fridge for 24 hours.

I can't speak to every state requirement, and perhaps they are different, but the regulation I'm speaking of is set forth by CMS and is in the HFAP accrediting body handbook that is several hundred pages long that I have. The joint commission and AAAHC have similar guidelines. I suppose states could have separate regulations that are more strict but in my experience I have not come across this when setting up surgery centers in different states.