ECT

[Sushirolls]

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Does any one know of ECT being performed solely in an Ambulatory Surgery Center? CMS has not placed ECT (CPT code 90870) on the list of approved procedures in an ASC, and they aren't making it a priority even with APA and ISEN-ECT requests to add it. This means medicare/medicaid are unlikely to be performed in an ASC for near future. So have any of you heard of colleagues, or are active yourself, in performing privately insured ECT in an ASC?

Further more, please educate me on how exactly anesthesiology billing works. A different thread on here mentioned '4 base units + 1 time unit' for ECT.

 

[Mman]

Does any one know of ECT being performed solely in an Ambulatory Surgery Center? CMS has not placed ECT (CPT code 90870) on the list of approved procedures in an ASC, and they aren't making it a priority even with APA and ISEN-ECT requests to add it. This means medicare/medicaid are unlikely to be performed in an ASC for near future. So have any of you heard of colleagues, or are active yourself, in performing privately insured ECT in an ASC?

Further more, please educate me on how exactly anesthesiology billing works. A different thread on here mentioned '4 base units + 1 time unit' for ECT.

what would a discussion of anesthesia billing have to do with ECT at an ambulatory surgery center?

why are you asking? I ask because if you don't already know how it works it seems unrelated to your original inquiry. But anyways (the super short and uncomplicated answer is) we get paid for how long a procedure takes as well as what the procedure is.

 

[ambiturner]

I have never heard of ECT in a surgicenter, everyone I’ve ever done it on was a psych inpatient.

Anesthesia billing has ‘base’ units, which is based on the complexity of the procedure, and then time units based on length of the procedure, usually a unit every 15 minutes. So an ECT is not a complex anesthetic (4 is a low base unit) and short (1 time unit).

 

[Sushirolls]

There is an anesthesiologist who may be partnering with me. We are in very early exploration stages of viability of this dream, so whether it ends up being employed, partner, or separate business entities I need some foundation education on the matter. Will also help if I opt to approach a free standing psych hospital, which I really hope to avoid, that already has an attitude of stomping on physicians.

Anesthesiology billing has everything to do with ECT in ASC. People need to get paid. Typically medicare rules over us all, and if the private insurances blindly follow too, then ASC ECT is a dead end. I can't build something up that's good for me only to have something bad for Anesthesiology, and then gone. This is a special population, and consistent, stability in providers is very important with ECT delivery.

My historic volumes were 10% or less inpatient, with 90% plus outpatient.

 

[nimbus]

I have never heard of ECT in a surgicenter, everyone I’ve ever done it on was a psych inpatient.

Anesthesia billing has ‘base’ units, which is based on the complexity of the procedure, and then time units based on length of the procedure, usually a unit every 15 minutes. So an ECT is not a complex anesthetic (4 is a low base unit) and short (1 time unit).

Outpatient ECT is very common.

 

[Sushirolls]

I have never heard of ECT in a surgicenter, everyone I’ve ever done it on was a psych inpatient.

Anesthesia billing has ‘base’ units, which is based on the complexity of the procedure, and then time units based on length of the procedure, usually a unit every 15 minutes. So an ECT is not a complex anesthetic (4 is a low base unit) and short (1 time unit).

What is the range of base units? 1-20? Did CMS or some one else determine base units? What if there are patient complexities, such as 100yo pt with ample CV health history, is that the same base unit as the 30yo no medical history patient who only has depression?
Are all time units in increments of 15 minutes?
Is the time unit only for start of induction to arousal? or Are different markers used for considers start and end? Such as patient entry to room? Patient exodus from room? Point of time out?

 

[Sushirolls]

what would a discussion of anesthesia billing have to do with ECT at an ambulatory surgery center?

why are you asking? I ask because if you don't already know how it works it seems unrelated to your original inquiry. But anyways (the super short and uncomplicated answer is) we get paid for how long a procedure takes as well as what the procedure is.

The issue means CMS doesn't pay for the facility fee in ASC. Not sure but also might not even pay for professional fee if done anyways in an ASC. This is a big part of the question, if any of you have seen it done in ASC, which could infer Psychiatrist/Anesthesiologist/Facility fee being reimbursed at least in private insurance arena.

 

[Mman]

What is the range of base units? 1-20? Did CMS or some one else determine base units? What if there are patient complexities, such as 100yo pt with ample CV health history, is that the same base unit as the 30yo no medical history patient who only has depression?
Are all time units in increments of 15 minutes?
Is the time unit only for start of induction to arousal? or Are different markers used for considers start and end? Such as patient entry to room? Patient exodus from room? Point of time out?

I suggest you sit down with the anesthesiologist you want to partner with and discuss it. This forum isn't the place for an in depth discussion on how to bill and collect for anesthesia services.

As for location, AFAIK the professional fees are reimbursed on the basis of the procedure and not where it was done. When we submit an anesthesia record it doesn't mention if it was done at our outpatient center or inpatient hospital. Facility fees are always determined by the setting a procedure is done in which is why hospital based pain clinics generate massive charges compared to similar outpatient facilities.

 

[nimbus]

Base units range from 3-30. There are lots of modifiers and addons. Some payers pay them and others don’t. Your anesthesiologist friend should be intimately familiar with all of this. Why not just ask them?

 

[Sushirolls]

I will talk with the Anesthesiologist friend, but this person hasn't done ECT in some time. It was a secondary topic, and also of benefit to other on here who probably have no idea how Anesthesiology does their billing. Information for residents and students to better understand bureaucracy behind the future paycheck.

The main question was to see if there are others out there who are already doing ECT in an ASC, that isn't hospital affiliated or using a hospital code.

When bills are submitted to their insurance company they have a standard set of facility codes they need to be submitted with it, to reflect the "point of service." For instance 11 is outpatient office, 21 is inpatient hospital, 24 is ASC, 31 is SNF, 34 Hospice, 50 FQHC, 17 walk in retail, 12 Home, 4 Homeless shelter, etc, etc

 

[narcotics999]

I will talk with the Anesthesiologist friend, but this person hasn't done ECT in some time. It was a secondary topic, and also of benefit to other on here who probably have no idea how Anesthesiology does their billing. Information for residents and students to better understand bureaucracy behind the future paycheck.

The main question was to see if there are others out there who are already doing ECT in an ASC, that isn't hospital affiliated or using a hospital code.

When bills are submitted to their insurance company they have a standard set of facility codes they need to be submitted with it, to reflect the "point of service." For instance 11 is outpatient office, 21 is inpatient hospital, 24 is ASC, 31 is SNF, 34 Hospice, 50 FQHC, 17 walk in retail, 12 Home, 4 Homeless shelter, etc, etc

It is not uncommon that anesthesiologist has not done ECT for a while, just because there aren't many cases. It is not difficult and we can pick up quickly.

 

[Sushirolls]

It is not uncommon that anesthesiologist has not done ECT for a while, just because there aren't many cases. It is not difficult and we can pick up quickly.

Absolutely, this is my usual expectation for anesthesiology. Comes back quickly for y'all.

 

[deleted171991]

Absolutely, this is my usual expectation for anesthesiology. Comes back quickly for y'all.

It's basically anesthesia 101, plus 15 minutes of reading before the first day. So any idiot can do it, no offense.

 

[IMGASMD]

Did a less than 5 min research on the inter web with the aid of Dr. Google.

Base unit 4 + 1 time unit.
CPT 00104.

Pretty sweet if can do 10-15 patients in a day, even with very poor rates.

Sign me up!

 

[Sushirolls]

Did a less than 5 min research on the inter web with the aid of Dr. Google.

Base unit 4 + 1 time unit.
CPT 00104.

Pretty sweet if can do 10-15 patients in a day, even with very poor rates.

Sign me up!

Good to know that could be sentiment. If things come together as I hope, don't want an unhappy anesthesiologist bailing on me later.

 

[IMGASMD]

Good to know that could be sentiment. If things come together as I hope, don't want an unhappy anesthesiologist bailing on me later.

I hope you’re in a big market.
Cannot do this gig for long if no constant patient population.