Consents and Billing

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SouthPod7

SouthPod7

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Happy belated St. Patrick's Day!

So, the clipboard nurses at my job approached me and told me that I need to start consenting for EVERY billable office procedure. Including 11721/11055, in office wound debridement's (regardless of size or depth of debridements), application of wound vacs, short leg casts, custom orthotics etc. Not for E&M, just office procedures. They are making the argument that it cannot be billed to insurance if there is no consent.

Does anyone else who work in Florida heard about this? I'm trying to figure out more but I'm curious if this is a change to the Medicare LCD that encompasses Florida? I cannot fathom having to go through the trouble to consent every single nail patient every day for every debridement.
 
SouthPod7 said:
Happy belated St. Patrick's Day!

So, the clipboard nurses at my job approached me and told me that I need to start consenting for EVERY billable office procedure. Including 11721/11055, in office wound debridement's (regardless of size or depth of debridements), application of wound vacs, short leg casts, custom orthotics etc. Not for E&M, just office procedures. They are making the argument that it cannot be billed to insurance if there is no consent.

Does anyone else who work in Florida heard about this? I'm trying to figure out more but I'm curious if this is a change to the Medicare LCD that encompasses Florida? I cannot fathom having to go through the trouble to consent every single nail patient every day for every debridement.
Click to expand...
NO
 
SouthPod7 said:
Happy belated St. Patrick's Day!

So, the clipboard nurses at my job approached me and told me that I need to start consenting for EVERY billable office procedure. Including 11721/11055, in office wound debridement's (regardless of size or depth of debridements), application of wound vacs, short leg casts, custom orthotics etc. Not for E&M, just office procedures. They are making the argument that it cannot be billed to insurance if there is no consent.

Does anyone else who work in Florida heard about this? I'm trying to figure out more but I'm curious if this is a change to the Medicare LCD that encompasses Florida? I cannot fathom having to go through the trouble to consent every single nail patient every day for every debridement.
Click to expand...
Its only going to get worse. They are going to take everything from you. All your meds. Your individual sterile packed instruments that you have locked up will now need to be kept in an alternate room. If you need a #15 blade you will have to step out of the room to get one. No longer any phenol, antibiotic ointment (even if pre packaged), or anything useful will be kept in the room after the next round of clip board tactics. Need a silver nitrate stick right now/this instant? Well guess what. Youre going to have to take your gloves off and get up to go get one in the central supply.

But the patient is totally going to be 100% more safe now.

I have my staff have them sign a consent while rooming for any obvious procedure that needs done. If they are there for wound care they sign a wound care consent before Im even in the room. I also make my staff sit in the room with me because they need to be my "runner" to get simple supplies that was not anticipated. It has cut my production down significantly.
 
I predict omni cells are next for me.
 
It can be billed without. Are you talking about in the hospital clinic, hospital floor consults? ECF/LTAC? Private office? If you are private, you can take your work elsewhere, but you're probably SOL if you're their employee.

No, it's not required anywhere. Consent can be verbal. You would be wise to do consents on office or ER or inpatient people who are sedated, peds, dementia/AMS/disabled, etc since they cannot comprehend and/or consent verbally. Obviously you want consents for all OR stuff due to the sedation.

Regardless of what is actually required or smart, you will come to realize that in a hospital owned/run place, they can make whatever stupid policy they wish. When I was in IHS, I had Med Rec sometimes coming to me a year or so after procedures asking me to change right/left to wound debride or matrixectomy consents (very smart to change a legal document a year after without pt knowledge, I declined). You just get to enjoy their stupidity and be that much happier when you get out. 😀

There is a similar thread that would help you...
forums.studentdoctor.net

Consents for Injections?

For surgeries and procedures such as a matrixectomy, I think we all should get a written consent from the patient. But for a steroid injection, do you get a written consent?
forums.studentdoctor.net forums.studentdoctor.net
 
I probably posted this in the other thread but we don’t even get written consent for matrixectomies. You need to tell the clipboard nurses “no,” when it comes to consenting wounds and toenail clippings. It’s not a legal requirement for them to bill/get reimbursed and informed consent does not have to be written/signed.
 
The true answer is YES written consent can be required for all “procedures”. This is dependent on your hospitals definition of procedure and their accreditation. If the accreditation is through jcaho, they will hold you to the hospitals definition of “procedure” and if that potentially includes any of the things you do in clinic, well then full documentation of universal protocol is required. If signed consent is not on file, timeout is not documented, prep dry time is not documented, etc then it could be a strike against certification next jcaho audit.

I live in this world already. It is hard to be efficient and have comparable productivity to those living in the “Wild West” and having a two line documentation of a procedure.
 
PeaJay said:
The true answer is YES written consent can be required for all “procedures”. This is dependent on your hospitals definition of procedure and their accreditation. If the accreditation is through jcaho, they will hold you to the hospitals definition of “procedure” and if that potentially includes any of the things you do in clinic, well then full documentation of universal protocol is required. If signed consent is not on file, timeout is not documented, prep dry time is not documented, etc then it could be a strike against certification next jcaho audit.

I live in this world already. It is hard to be efficient and have comparable productivity to those living in the “Wild West” and having a two line documentation of a procedure.
Click to expand...
Lol we have different definitions of the wild west in medicine......potato potato
 
DYK343 said:
Its only going to get worse. They are going to take everything from you. All your meds. Your individual sterile packed instruments that you have locked up will now need to be kept in an alternate room. If you need a #15 blade you will have to step out of the room to get one. No longer any phenol, antibiotic ointment (even if pre packaged), or anything useful will be kept in the room after the next round of clip board tactics. Need a silver nitrate stick right now/this instant? Well guess what. Youre going to have to take your gloves off and get up to go get one in the central supply.

But the patient is totally going to be 100% more safe now.

I have my staff have them sign a consent while rooming for any obvious procedure that needs done. If they are there for wound care they sign a wound care consent before Im even in the room. I also make my staff sit in the room with me because they need to be my "runner" to get simple supplies that was not anticipated. It has cut my production down significantly.
Click to expand...

I feel the pain. Everything in the room has to be under lock and key. Absolutely no “chemicals” in room other than cleaning supplies. No medications/ointments/etc.

I have found a loop hole in that you can have an ongoing consent if the procedure is part of a series. This allows for one wound consent at start of care and one yearly “at risk foot care” consent yearly. This works well if they have guardians also, as I am sure all of you get written consent from poa/ guardian every time you touch the patient right?
 
air bud said:
Lol we have different definitions of the wild west in medicine......potato potato
Click to expand...
Lol. I am using the pencil pushers definition. They are on me about documentation all the time. They monitor compliance with written consents and dry time. I mean I get a percent compliance number quarterly.
 
Yes unfortunately consent before every procedure! Like the idea of the above regarding ongoing treatment consent. It is just getting harder and harder to manage the insurance reimbursement. Every year feels like a new set of rules.
 
Last edited by a moderator:
Clip Board nurses just came back through.
They want to take away my ethyl choride because its a spray and they believe I will accidently cause injury (eye, etc) with a spray medication.
They took it from my rooms.
They take everything.
 
DYK343 said:
Clip Board nurses just came back through.
They want to take away my ethyl choride because its a spray and they believe I will accidently cause injury (eye, etc) with a spray medication.
They took it from my rooms.
They take everything.
Click to expand...
Man, next time I'm having a bad day I'll remind myself, "at least I still have ethyl chloride in my rooms"
 
DYK343 said:
Clip Board nurses just came back through.
They want to take away my ethyl choride because its a spray and they believe I will accidently cause injury (eye, etc) with a spray medication.
They took it from my rooms.
They take everything.
Click to expand...
It is like prison guards... the adhesive on your met pads will be next!
Just take them on a hospital cafeteria coffee date or maybe slip them a set of arch supports, and maybe they stay gone for a few months and let you have your salicylic acid cream or betadine wipes not under lock and key? They will never overlook missing a consent for a MPJ inject or a patient's 6th wound debride in a row, though.
 
DYK343 said:
Clip Board nurses just came back through.
They want to take away my ethyl choride because its a spray and they believe I will accidently cause injury (eye, etc) with a spray medication.
They took it from my rooms.
They take everything.
Click to expand...

You should have taken their clipboard, hit one of them over the head with it, and then demanded they lose the clipboards now that they have been shown to cause injury…
 
DYK343 said:
Clip Board nurses just came back through.
They want to take away my ethyl choride because its a spray and they believe I will accidently cause injury (eye, etc) with a spray medication.
They took it from my rooms.
They take everything.
Click to expand...

My room is a ticking time bomb.
6CEE2A26-588F-4CAC-9F5E-48ABCD0D88CA.jpeg
 
Wide angle lens setting makes the room look a bit larger than it really is.
 
You moved the lysol bottle back to that window I can see it
 
dtrack22 said:
Can’t wait till @NatCh gets sued for some patient drinking the Lysol and getting injured. He’ll wish he had clipboard nurses then…
Click to expand...
GIven that a certain person high up in our recent politics have considered drinking bleach its honestly a possiblity...
 
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