Consents and Billing

[SouthPod7]

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.

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[Shiyuan]

I work in FL. What the crap lol I call BS

 

[heybrother]

Somewhere out there is a forum for clipboard nurses and someone at Dyk's hospital has been talking to someone at your hospital.

 

[air bud]

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.

NO

 

[DYK343]

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.

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.

 

[DYK343]

I predict omni cells are next for me.

 

[Feli]

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...

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

 

[dtrack22]

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.

 

[PeaJay]

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.

 

[air bud]

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.

Lol we have different definitions of the wild west in medicine......potato potato

 

[PeaJay]

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 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?

 

[PeaJay]

Lol we have different definitions of the wild west in medicine......potato potato

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.

 

[mdtomdrevenue]

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.

 

[DYK343]

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.

 

[Scrantonicity]

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.

Man, next time I'm having a bad day I'll remind myself, "at least I still have ethyl chloride in my rooms"

 

[Feli]

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.

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.

 

[dtrack22]

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.

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…

 

[NatCh]

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.

My room is a ticking time bomb.

 

[heybrother]

...windows. damn.

 

[DYK343]

My room is a ticking time bomb. View attachment 353387

That lysol can might explode being so close to that window. Too much sun.


I want your view....

 

[NatCh]

That lysol can might explode being so close to that window. Too much sun.


I want your view....

I moved the Lysol to a better location in case the clipboard nurses visit. Safety first!

 

[Shiyuan]

Looks like you can have a battle in that sized room.

 

[SouthPod7]

I think that one office room is larger than all 4 office rooms I have combined.

 

[DYK343]

I moved the Lysol to a better location in case the clipboard nurses visit. Safety first!

View attachment 353390

Much safer. Trip hazards are not real hazards but exploding lysol cans are.

That office is glorious.....

 

[NatCh]

Wide angle lens setting makes the room look a bit larger than it really is.

 

[GreenHousePub]

Perfect drawer position so patients can steal everything they can fit in their pockets

 

[NatCh]

Perfect drawer position so patients can steal everything they can fit in their pockets

Oooh, good call. I moved the carts to a better location in case any patients get sticky fingers. What would I do without you guys?

 

[Podstar]

Oooh, good call. I moved the carts to a better location in case any patients get sticky fingers. What would I do without you guys?

View attachment 353454View attachment 353455View attachment 353456

Lmao

 

[DYK343]

You moved the lysol bottle back to that window I can see it

 

[dtrack22]

You moved the lysol bottle back to that window I can see it

Can’t wait till @NatCh gets sued for some patient drinking the Lysol and getting injured. He’ll wish he had clipboard nurses then…

 

[DYK343]

Can’t wait till @NatCh gets sued for some patient drinking the Lysol and getting injured. He’ll wish he had clipboard nurses then…

GIven that a certain person high up in our recent politics have considered drinking bleach its honestly a possiblity...