documenting blocks

[Multifidus]

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I perform blocks for post-op analgesia. I have to do them in the OR. I have been documenting anesthesia start time as when I enter the room. I also provide a picture from the US machine on a block note. Couple of q's:

1. Should I not be documenting anesthesia start time as when I enter the room, but rather from the time my block ends?

2. Does providing a picture of the ultrasound image really matter in terms of billing?

 

[epidural man]

I perform blocks for post-op analgesia. I have to do them in the OR. I have been documenting anesthesia start time as when I enter the room. I also provide a picture from the US machine on a block note. Couple of q's:

1. Should I not be documenting anesthesia start time as when I enter the room, but rather from the time my block ends?

2. Does providing a picture of the ultrasound image really matter in terms of billing?

1. No idea..

2. Yes - can't code for ultrasound without a hard copy of the picture documenting it in the chart. Note should indicate that a copy of the ultrasound pic is in the chart.

 

[periopdoc]

You cannot bill anesthesia time and procedures at the same time unless the procedure is done after induction. You could delay your anesthesia start time until after the block/ art line/ etc is in place. Since there can be a fair amount of billable time between the patient entering the OR and the start of the procedure, I list the time into the OR as my start time then I document start time and end time of my procedure and subtract that time from my overall billed time. The time adds up.

- pod

 

[RussianJoo]

don't know much about billing, but where i'm rotating they do the blocks pre-op, document them on the anesthesia record but leave the time of the block blank, and check the general anesthesia box on the record not the regional box. This way they bill for the block as post-op pain control and bill the OR time as general anesthesia.

 

[IN2B8R]

I perform blocks for post-op analgesia. I have to do them in the OR. I have been documenting anesthesia start time as when I enter the room. I also provide a picture from the US machine on a block note. Couple of q's:

1. Should I not be documenting anesthesia start time as when I enter the room, but rather from the time my block ends?

2. Does providing a picture of the ultrasound image really matter in terms of billing?

Block time needs to be explicitly documented on your anesthesia billing sheet. Anesthesia start time should be separate and after the block time. A submission of the picutre is not "required," at least in my neck of the woods (our U/S machine archives all pictures).... But, obviously, it would not hurt to have it. You do have to document your block procedure note on your anesthesia record for medicolegal and billing purposes.

 

[IN2B8R]

don't know much about billing, but where i'm rotating they do the blocks pre-op, document them on the anesthesia record but leave the time of the block blank, and check the general anesthesia box on the record not the regional box. This way they bill for the block as post-op pain control and bill the OR time as general anesthesia.

When you get into private practice, you will check a "block for post-op pain" box, then document on your billing sheet that the "surgeon requested block for post-op pain."

 

[climbingak]

PNB are a large part of my practice. Billing can be difficult as some insurance companies won't want to pay you for it. Although not all of the following are required, I think each of these will help distinguish the block done for post op pain as a separate procedure from the anesthetic:
1. Block done in a different area than the anesthesia
2. Block done by different provider than the one doing the anesthesia
3. Block time is documented and does not coincide with anesthesia time
4. Ultrasound picture is time stamped with a time that fits within your stated block time
5. I don't even mention the block on my anesthesia record. I just mark general or TIVA or whatever.
6. I have a separate block note which contains the procedure code, a diagnosis code (shoulder pain, post op pain), a referring surgeon, a statement that the block was done at the request of the surgeon for post op pain control, a separate time out
7. I attach an ultrasound picture to my block note
8. To bill for ultrasound it is important to document a. relevant anatomy identified b. local anesthetic spread visualized c. vascular puncture avoided

My block note has a lot of check boxes and only takes me a minute or less to complete. The more you can separate the block from the anesthetic, the better chance of getting paid.