Billing for time while on bypass

[periopdoc]

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Recently, a issue of billing for time while on pump has come up in my group and I want to get some input on it.

For those of you who step out while the patient is on pump, do you continue to bill for time? I am not looking for a debate of whether it is right to leave while on pump (we have had that discussion), just wondering if you subtract that time from your billing or not.

My take on it is that whether I am in the room or not, I am tied up with that patient and cannot provide care for another patient. Therefore, I believe that billing for that time is not fraudulent. Granted, there needs to be some geographic limit (I can't go workout or something), but I do not have a problem with billing for the time.

-pod

 

[imfrankie]

Recently, a issue of billing for time while on pump has come up in my group and I want to get some input on it.

For those of you who step out while the patient is on pump, do you continue to bill for time? I am not looking for a debate of whether it is right to leave while on pump (we have had that discussion), just wondering if you subtract that time from your billing or not.

My take on it is that whether I am in the room or not, I am tied up with that patient and cannot provide care for another patient. Therefore, I believe that billing for that time is not fraudulent. Granted, there needs to be some geographic limit (I can't go workout or something), but I do not have a problem with billing for the time.

-pod

Your approach seems reasonable to me. This will become increasingly true, in my estimation, as we further extend our reach with the emerging communications' systems.

 

[proman]

It seems to me that if you aren't physically present it should be discontinuous time. An exception may be if your state has a perfusionist practice act (like mine does) which delegates the administration of anesthetic agents while on CPB under direction of an anesthesiologist. With that wording, I think it would appropriate to have continuous time. I wouldn't step out, perfusionists need to be supervised (and the surgeon can't start a vasopressin or nitro drip for you).

 

[sevoflurane]

We bill for continuous time.

I'm not out of the OR the entire time either. I check up on perfusion, look and interpret all labs while on bypass, perhaps start an insulin infusion, glance at the foley to ascertain u/o while on bypass, start a vasopressor towards the end of bypass, look at the field and their grafts/anastomosis/ooziness, etc.
All in all, I pop in several times while on CPB. Other times I just kick back and chit chat with our surgeons and our CVOR team (good people over here).
If I get asked for something quick like an epidural, I punt it off and state that I'm tied up with my patient.... which is not stretching the truth in any sense of the word.

 

[sevoflurane]

Granted, there needs to be some geographic limit (I can't go workout or something), but I do not have a problem with billing for the time.

-pod

Our team knows how to find me lickidy split. I'm 2 doors down in the lounge. I can be reached in person or by phone in less than 30 seconds. I don't feel comfortable going down to starbucks and having a 5 minute conversation with someone I know in the hospital. As a rule, I stay close to the CVOR and don't venture very far.

I had an attending go to his office during residency (4-5 minute walk).... too far for my comfort zone. Always loved it, cuz I'd often get to come off by myself.

 

[urge]

Recently, a issue of billing for time while on pump has come up in my group and I want to get some input on it.

For those of you who step out while the patient is on pump, do you continue to bill for time? I am not looking for a debate of whether it is right to leave while on pump (we have had that discussion), just wondering if you subtract that time from your billing or not.

My take on it is that whether I am in the room or not, I am tied up with that patient and cannot provide care for another patient. Therefore, I believe that billing for that time is not fraudulent. Granted, there needs to be some geographic limit (I can't go workout or something), but I do not have a problem with billing for the time.

-pod

I have heard about this "ok to leave if you are not billing for the time". However, I have yet to hear about anyone not billing for it. Seems to me like an urban legend.

If I were paying you cash I would want you in the room the whole time.

 

[imfrankie]

I have heard about this "ok to leave if you are not billing for the time". However, I have yet to hear about anyone not billing for it. Seems to me like an urban legend.

If I were paying you cash I would want you in the room the whole time.

Please stay in the room for me too...please

 

[seinfeld]

I think better on an empty bladder.CPB is about the only time during a 5 hour stint that i get out and use the bathroom.

 

[Consigliere]

I don't do hearts which is actually the best route to go.

 

[periopdoc]

Interesting. A lot of I think, I want, you should, we should. But only opinions. I am really curious if there is any guidance on this issue other than opinions.

When asked, our billing company provided us with an editorial arguing for uninterupted anesthesia presence during CPB, and giving this as proof of the industry standard. My take on it is, if there is a large enough population of anesthesiologists leaving while on CPB to justify an editorial, then the claim that it is industry standard to have uninterrupted anesthesia presence is without merit.

Of course determinations of fraud and legitimate billing are not based on "standard of care" arguments which is why I am looking for some sort of definitive answer.

- pod