Patient calls for procedures

[lobelsteve]

A few times per day the nurses get calls from patients who want to come in and have a procedure repeated.
If less than a year, I tell them to schedule it. If more than a year I get an OV to determine what is going on.
I am told from admin that it is needed for insurance precert. What is everyone else doing?

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[SSdoc33]

A few times per day the nurses get calls from patients who want to come in and have a procedure repeated.
If less than a year, I tell them to schedule it. If more than a year I get an OV to determine what is going on.
I am told from admin that it is needed for insurance precert. What is everyone else doing?

Case-dependent

If they dont need auth or if it joint or a year from RF, ill just book em for the shot. Authorization necessity is variable in my area

If i can get them right in, i do. No arbitrary timeline

 

[pmrmd]

Same. Need for prior auth dictates everything.

 

[Analgesia108]

Will c them in office, update chart & schedule

 

[Agast]

Only primary Medicare patients can call for a repeat injection, if it’s been within 2 months of me examining them and suggesting that procedure. Otherwise needs an exam to make sure it’s still the same problem. And even then you still get people who say “actually now it’s on the other side.” Since the allotment of injections per area is so stingy I really don’t want to waste a treatment on wrong site.

 

[stsa84]

If they haven't been seen in > 3 months, I have them come in for a quick office visit to make sure the procedure still makes sense with their reported pain. If < 3 months, I'll schedule it.

 

[mid|ine]

We have everyone follow up about 8 weeks after any procedure and document response, and if appropriate place an order to repeat in the future . These orders expire after 6 months and another f/u would be required.

 

[GlowInTheDark]

Most procedures follow up within 2-4 weeks. If they need repeat within 6 months will usually schedule, otherwise will be office visit first. What they think is wrong with themselves frequently different after a few months.

 

[SSdoc33]

smh. dont know what you are all doing. i guess there is more than 1 way to skin a cat

have your ESIs f/u in 3 months. that way, if it wears off, you can book another one if needed. you wont catch them in the "im still feeling good phase". same with RF where you may need to book an SIJ afterwards

some mbb f/u can be done over the phone

does the LOL with severe stenosis really need an office f/u? why cant she just call if she wants another injection

does the patient you sent to PT really need to f/u if he/she is feeling better?

the office f/u is the least efficient use of our time. we should be spending our time on new patients and shots. i used to see everyone in f/u, but those can really be minimized. if you are struggling for volume, i guess you could see everyone at more frequent intervals. you wont be doing all that much for them, though....

 

[kstarm]

What do you do with outside referrals? e.g: Patient referred from neurosurgery has 6 months of complete relief following ESI calls clinic to repeat injection as he is having same symptoms, concordant imaging, etc. They go back to neurosurg, you set them up for a visit in your clinic (as you have technically seen them for the previous procedure) , or do you just set them up for repeat injection?

 

[mid|ine]

the office f/u is the least efficient use of our time. we should be spending our time on new patients and shots. i used to see everyone in f/u, but those can really be minimized. if you are struggling for volume, i guess you could see everyone at more frequent intervals. you wont be doing all that much for them, though....

I have my NPs see routine f/u. I would say its a waste of time to be handling these things over the phone and not billing for your time.

 

[SSdoc33]

I have my NPs see routine f/u. I would say its a waste of time to be handling these things over the phone and not billing for your time.

who says im not billing for it? telehealth visits still getting paid from pandemic in my area

 

[Ducttape]

Case dependent. Most people request follow ups every 3-6 months apart, and I accommodate them.

No fault - just ask for auth.

Medicaid and option plans have to be seen within 1 month. So they have to make an appponyment.

Private plans - depends on the plan. I generally ask to see them if it has been longer than 6 months, unless it is for an MBB.

 

[Drd105]

Only primary Medicare patients can call for a repeat injection, if it’s been within 2 months of me examining them and suggesting that procedure. Otherwise needs an exam to make sure it’s still the same problem. And even then you still get people who say “actually now it’s on the other side.” Since the allotment of injections per area is so stingy I really don’t want to waste a treatment on wrong site.

I do exactly this- it has to be in my prior note that I said they can call within 2 mos

 

[DrMDAware]

smh. dont know what you are all doing. i guess there is more than 1 way to skin a cat

have your ESIs f/u in 3 months. that way, if it wears off, you can book another one if needed. you wont catch them in the "im still feeling good phase". same with RF where you may need to book an SIJ afterwards

some mbb f/u can be done over the phone

does the LOL with severe stenosis really need an office f/u? why cant she just call if she wants another injection

does the patient you sent to PT really need to f/u if he/she is feeling better?

the office f/u is the least efficient use of our time. we should be spending our time on new patients and shots. i used to see everyone in f/u, but those can really be minimized. if you are struggling for volume, i guess you could see everyone at more frequent intervals. you wont be doing all that much for them, though....

I’d suggest that a medial branch follow up is still a level four visit. In addition, I understand the epidural guidelines to be 50% relief for two weeks. Therefore, if I am waiting three months and patients are still in pain they would likely go somewhere else. Therefore, I follow up in three weeks after an epidural.

 

[TIVAndy]

So many variables and headaches, especially screening for anticoagulation, educating, prior auth. These are sine reasons i have them come in for OV unless discussed recently and pt decided to hold off for some reason

 

[Taus]

Case by case basis. If patient is certain it is exact same problem/side, and reasonable timeframe for a repeat procedure that provided a good response previously, I just have my staff book it. They can confirm blood thinners/allergies at that time. If that clinical info confirming appropriate to repeat can’t be confirmed with a brief portal or phone conversation with my assistant, and then a follow up is scheduled. To book the repeat procedure takes under a minute for me to review the chart and dictate a brief note for indication for repeat for insurance authorization where needed. I am booked out over a month, and already come in early or stay late most days for urgent or VIP add-ons. In my opinion, it is not reasonable to make the repeat procedure patient wait a month to be seen to then book the procedure. Would be the perfect situation for a mid-level to see this patient, but not in the cards in my situation.

Overall, this keeps my procedure schedule full, clinic open for new or urgent problems, and patients happy.