Nursing sedation for in-office procedures

[HyperSonic]

Is anybody doing nursing sedation for in-office procedures (not ASC)?
Is it cost-effective/profitable at all?
How do you bill for that?

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[Doctodd]

yea nurses can give propofol all the time.....as long as there is a dr in the same county, nurses should go for it

 

[HyperSonic]

yea nurses can give propofol all the time.....as long as there is a dr in the same county, nurses should go for it

I’m not sure if it’s a sarcasm or an attack to nurses, but it’s definitely not what I have asked.

 

[GoBeers]

We do nursing sedation in office. You bill 99152 and J codes for meds. In regards to profitability, that just depends on how many cases you can squeeze in and how much you are paying the nurses. For us I think we make roughly 30 dollars profit per case by end of average procedure day?

 

[lobelsteve]

Should not be done often enough for routine procedures to be profitable or safe.

 

[drusso]

Is anybody doing nursing sedation for in-office procedures (not ASC)?
Is it cost-effective/profitable at all?
How do you bill for that?

We do it. We're an accredited office-based surgery (OBS) practice but no juice on the SOS like HOPD or ASC.

Office-Based Surgery Centers | AAAHC

Office-based surgery (OBS) practices operate with the same high standard of care as ASCs. Keeping in mind OBS practices have special considerations ranging from size and staffing, areas of specialty, and state requirements, the approach from AAAHC reflects this reality. See how we can help your...

www.aaahc.org

Many insurances and Medicare don't cover it so we do it for cash: $299.95. Buy two sedations and get one free.

 

[Ducttape]

Just a comment on wording.

It is not nursing sedation.

It is moderate sedation or physician directed sedation.

You the doctor are performing the sedation with nursing assistance.

 

[lobelsteve]

We do it. We're an accredited office-based surgery (OBS) practice but no juice on the SOS like HOPD or ASC.

Office-Based Surgery Centers | AAAHC

Office-based surgery (OBS) practices operate with the same high standard of care as ASCs. Keeping in mind OBS practices have special considerations ranging from size and staffing, areas of specialty, and state requirements, the approach from AAAHC reflects this reality. See how we can help your...

www.aaahc.org

Many insurances and Medicare don't cover it so we do it for cash: $299.95. Buy two sedations and get one free.

Can I just pay the fee for sedation and not get any shots? Asking for a friend. JK, I have no friends.

 

[MitchLevi]

Sedation for routine spine procedures should not be allowed unless there are extreme circumstances like a pt is somehow physically unable to swallow 1-2 Valium tablets, or the pt is completely out of control (which means no shots for you).

 

[Ferrismonk]

We do in-office conscious sedation. Legally, you the doctor is giving the sedation and the RN is assisting you by actually injecting the meds. There are sedation codes based on time. To get paid you must do at least 10 minutes sedation time.

Conscious sedation was profitable in the past and currently with commercial insurances, but the actual practice profitability depends a lot on your payor mix and how often you use sedation. If this is something you're really interested in, consider a part time or per diem RN to give the sedation and put all your sedation cases back to back on the same day.

Can I just pay the fee for sedation and not get any shots? Asking for a friend. JK, I have no friends.

Funny you mentioned this. My current practice used to give sedation to almost everyone for many many years and I've been fighting this culture since I started here. I've made significant progress, but obviously a culture shift can be slow.

I've definitely felt that some patients were coming in just for the sedation and not the procedure. They would do just fine during the procedure but complain loudly afterwards. "But why didn't I go to sleep?" "I usually get a great nap!" "That's the only time I get some rest!"

When other docs argued that it's fine to continue heavy sedation on these patients, I suggested we just charge the patient $100, give them some Dilaudid IV, then send them home after 20 minutes. It would save on the cost of supplies. Not everyone appreciated my take, but it made them stop and think.

 

[Agast]

Just a comment on wording.

It is not nursing sedation.

It is moderate sedation or physician directed sedation.

You the doctor are performing the sedation with nursing assistance.

To piggy back on that, I would not try this if your background is not anesthesiology.

 

[RoloTomassi]

If you're going to do it, don't forget 99513 if it's 23+ minutes from the time they first inject to the time you take eyes off them.

But, it's really not that profitable. More profitable to just do PO and turn over the room faster, no IV or RN payroll

 

[drusso]

To piggy back on that, I would not try this if your background is not anesthesiology.

Why?

 

[bedrock]

Why?

Non anesthesia physicians should not be giving propofol.

Propofol: the drug that killed Michael Jackson - Harvard Health

The manslaughter trial of Michael Jackson’s personal physician, Dr. Conrad Murray, focused a lot of attention on a powerful anesthetic agent called propofol. Propofol is sometimes called the “m...

www.health.harvard.edu

 

[thecentral09]

We do it. We're an accredited office-based surgery (OBS) practice but no juice on the SOS like HOPD or ASC.

Office-Based Surgery Centers | AAAHC

Office-based surgery (OBS) practices operate with the same high standard of care as ASCs. Keeping in mind OBS practices have special considerations ranging from size and staffing, areas of specialty, and state requirements, the approach from AAAHC reflects this reality. See how we can help your...

www.aaahc.org

Many insurances and Medicare don't cover it so we do it for cash: $299.95. Buy two sedations and get one free.

I was just looking into this the other day. How cumbersome and expensive is the process to get your site accredited?

 

[Doctodd]

we did propofol on everyone in 2004.....but it was in office and there was no reimbursement. It paid for itself in saving us time by not talking to the patients becuase they were asleep for the 3 minutes it took to do the procedure. I dont sedate at all anymore.....Xanax PO if they are nervous.

 

[drusso]

I was just looking into this the other day. How cumbersome and expensive is the process to get your site accredited?

It's very cumbersome and expensive and you get no vig on the SOS like if you owned an ASC or were HOPD.

 

[IAmTheOne1]

99152 for 2mg of midazolam IV pays like $55 or so - definitely profitable but is it worth it?. That being said, the LCD for facets says conscious sedation (and MAC) are not routinely reimbursable and frequent reporting together "may trigger focused medical review." Not worth it to do it for medicare patients due to audit risk.

 

[drrosenrosen]

We have pts sign an ABN and charge cash price, $100. Partners use it more than I do. I mostly only use it for kypho, SCS, and RFA

 

[guytakingboards]

Funny you mentioned this. My current practice used to give sedation to almost everyone for many many years and I've been fighting this culture since I started here. I've made significant progress, but obviously a culture shift can be slow.

I've definitely felt that some patients were coming in just for the sedation and not the procedure. They would do just fine during the procedure but complain loudly afterwards. "But why didn't I go to sleep?" "I usually get a great nap!" "That's the only time I get some rest!"

When other docs argued that it's fine to continue heavy sedation on these patients, I suggested we just charge the patient $100, give them some Dilaudid IV, then send them home after 20 minutes. It would save on the cost of supplies. Not everyone appreciated my take, but it made them stop and think.

Lol, my radiology group offers sedation for MRI's and we definitely see similar things happen. Patient's rave to their doc about their MRI experience so we in turn get even more referrals for sedations.

I'll walk over to do the pre-sedation assessment and always hear "oh, my headache came back" or "My [insert body part] pain recurred". I'll look in their imaging jacket and find they've had 5-6 MRI's in the last year, 1 the prior month, all with sedation. Those are the ones that need a higher dose and then have the gall to tell me during the post-sedation assessment "doc i didn't feel anything from the sedation". To which I reply "so you're saying we could give you nothing during the MRI and it'd have the same effect...." Oh the look of sheer terror at that point.