Post op note, MD vs CRNA

[caligas]

Any compliance gurus here that have wrestled with whether CMS allows the postop note to be done only by the CRNA without an MD signature?

I found multiple sources that seem conflicting

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[rick roller pump]

I would put them in as a resident and they did not require a co-signature. I believe CRNAs would as well.

 

[coffeebythelake]

Any compliance gurus here that have wrestled with whether CMS allows the postop note to be done only by the CRNA without an MD signature?

I found multiple sources that seem conflicting

I assume that if a bonafide postop assessment was made it doesn't matter who on the anesthesia team did it.

 

[caligas]

to clarify the issue we have a consultant for the hospital telling us that it has to be an MD so I’m trying to shoot that down

 

[Dr. Rude]

to clarify the issue we have a consultant for the hospital telling us that it has to be an MD so I’m trying to shoot that down

You need to make sure that you are differentiating between compliance for billing purposes and compliance with state law an compliance with hospital bylaws.

 

[TheLoneWolf]

to clarify the issue we have a consultant for the hospital telling us that it has to be an MD so I’m trying to shoot that down

Why not just have the CRNAs do the postop note and have you cosign it?

 

[TheLoneWolf]

I would put them in as a resident and they did not require a co-signature. I believe CRNAs would as well.

Absolutely hated being postcall in residency and rounding on 30+ patients across multiple floors asking if they had N/V or pain issues. Even if something was found, we would have to contact the primary team to have them address the issue. Place was inefficient.

Even worse place was a trauma center we rotated at which had paper charts. Would have to find and wrangle the patient binder from whoever had it to place a postop note. Yuck.

Attendings never cosigned the postop notes.

 

[caligas]

Why not just have the CRNAs do the postop note and have you cosign it?

I think that’s where we are heading

 

[Urzuz]

Absolutely hated being postcall in residency and rounding on 30+ patients across multiple floors asking if they had N/V or pain issues. Even if something was found, we would have to contact the primary team to have them address the issue. Place was inefficient.

Even worse place was a trauma center we rotated at which had paper charts. Would have to find and wrangle the patient binder from whoever had it to place a postop note. Yuck.

Attendings never cosigned the postop notes.

You guys had to round on every post anesthesia patient, regardless of procedure and whether there were anesthetic/surgical complications? I guess I can see some value in that, but the time to value ratio seems completely skewed to it being much more of a waste of time than anything else.

 

[TheLoneWolf]

You guys had to round on every post anesthesia patient, regardless of procedure and whether there were anesthetic/surgical complications? I guess I can see some value in that, but the time to value ratio seems completely skewed to it being much more of a waste of time than anything else.

Was a PP group that the residents rotated with. They explained it was for billing purposes.

 

[nimbus]

Was a PP group that the residents rotated with. They explained it was for billing purposes.

Unless it’s a postop pain management note, an anesthesia postop note is part of the anesthetic and you don’t get anything for it.

 

[rick roller pump]

I have a template that imports the vitals and says all the stuff is normal. Obviously I would write more if there is some post op complication such as pain or hemodynamic issues but 90% of patients I just click 1 button and it takes 5 seconds.

 

[nimbus]

You guys had to round on every post anesthesia patient, regardless of procedure and whether there were anesthetic/surgical complications? I guess I can see some value in that, but the time to value ratio seems completely skewed to it being much more of a waste of time than anything else.

We just check their pacu record on Epic. If there are no complications noted, we just click the generic postop note and sign it.

 

[nimbus]

I have a template that imports the vitals and says all the stuff is normal. Obviously I would write more if there is some post op complication such as pain or hemodynamic issues but 90% of patients I just click 1 button and it takes 5 seconds.

Same.

 

[Dr. Rude]

Absolutely hated being postcall in residency and rounding on 30+ patients across multiple floors asking if they had N/V or pain issues. Even if something was found, we would have to contact the primary team to have them address the issue. Place was inefficient.

Even worse place was a trauma center we rotated at which had paper charts. Would have to find and wrangle the patient binder from whoever had it to place a postop note. Yuck.

Attendings never cosigned the postop notes.

total BS waste of a resident's time. Not that I give a **** about a resident's time, but this is garbage. 99% of anesthesia complications will manifest in the PACU. The other 1% I guarantee will find you.

 

[GassYous]

Absolutely hated being postcall in residency and rounding on 30+ patients across multiple floors asking if they had N/V or pain issues. Even if something was found, we would have to contact the primary team to have them address the issue. Place was inefficient.

Even worse place was a trauma center we rotated at which had paper charts. Would have to find and wrangle the patient binder from whoever had it to place a postop note. Yuck.

Attendings never cosigned the postop notes.

Well it's not billable unless you did a block or something so what's the point

 

[TheLoneWolf]

Well it's not billable unless you did a block or something so what's the point

I dunno. Though im pretty sure they were making something off these postop notes as they militantly enforced them.

This same group refused to set up a preop clinic that the hospital asked for to cut down on day of surgery cancelations and shut down their in hospital pain clinic as "they couldn't spare a single member to work outside of the OR".

Made us do inane scutwork as the 24 hr on-call residents like write out the next days assignments by hand on a white board for 40+ assignments in between the evening and night cases.

Anytime the PD tried to intervene, they would not so subtly remind them that they have the lions share of big cases that the resident need to log in order to graduate.

 

[nimbus]

I dunno. Though im pretty sure they were making something off these postop notes as they militantly enforced them.

This same group refused to set up a preop clinic that the hospital asked for to cut down on day of surgery cancelations and shut down their in hospital pain clinic as "they couldn't spare a single member to work outside of the OR".

Made us do inane scutwork as the 24 hr on-call residents like write out the next days assignments by hand on a white board for 40+ assignments in between the evening and night cases.

Anytime the PD tried to intervene, they would not so subtly remind them that they have the lions share of big cases that the resident need to log in order to graduate.

The merits of a physician staffed preop clinic are debatable. We have a nurse staffed screening clinic that will bring questionable charts to us for review.

Still I hope nobody from your program went to work for them.

 

[PpfSuxTube]

Absolutely hated being postcall in residency and rounding on 30+ patients across multiple floors asking if they had N/V or pain issues. Even if something was found, we would have to contact the primary team to have them address the issue.

Why would you do any of this?
When they're aldrete 9, they're not our problem anymore

 

[TheLoneWolf]

The merits of a physician staffed preop clinic are debatable. We have a nurse staffed screening clinic that will bring questionable charts to us for review.

Still I hope nobody from your program went to work for them.

We are a large program...they may have a resident sign with them every year, rest tend to stay local and work for the other locsl groups as we resented the abusive behavior endured in residency.

Same thing continues if you sign with them, juniors always cover the most unpalatable rooms and surgeons for a couple years until you make partner.

 

[TheLoneWolf]

Why would you do any of this?
When they're aldrete 9, they're not our problem anymore

Again, don't know. The groups senior partners had a meeting with the residents and mentioned something about CMS and ASA documentation requirements must include a postop note in order to collect the full amount billed. Sounded pretty convincing to me as a fresh CA1

 

[Gern Blansten]

Again, don't know. The groups senior partners had a meeting with the residents and mentioned something about CMS and ASA documentation requirements must include a postop note in order to collect the full amount billed. Sounded pretty convincing to me as a fresh CA1

It’s one of the seven components required to bill for medical direction, isn’t it?

 

[Shimmy8]

Post anesthesia eval is part of the 7 steps yes. But I never understood why because we don’t do it for patients sent home?

In residency the rounding pain team handled it. Was miserable.

Now in PP we use our PACU sign out as that post op note.

 

[GassYous]

Post anesthesia eval is part of the 7 steps yes. But I never understood why because we don’t do it for patients sent home?

In residency the rounding pain team handled it. Was miserable.

Now in PP we use our PACU sign out as that post op note.

I just put a note a minute after the pacu note

 

[chessknt]

Absolutely hated being postcall in residency and rounding on 30+ patients across multiple floors asking if they had N/V or pain issues. Even if something was found, we would have to contact the primary team to have them address the issue. Place was inefficient.

Even worse place was a trauma center we rotated at which had paper charts. Would have to find and wrangle the patient binder from whoever had it to place a postop note. Yuck.

Attendings never cosigned the postop notes.

????? The anesthesia attendings where I work put this in on patients in the pacu who aren't even responsive yet, beat the surgeons to the brief op note every time. It's the dumbest note in the chart. Why the hell would you wait until they go to the floor?