fastosprintini

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ok, i 'd like to get the input /advice from all those who actually work in an ambulatory surgicenter(asc).
ours has 3 rooms, we have a mix of ortho, ophto, general etc but lately the ortho guys have hired and sucessfully brought in young, skilled and agressive (in a positive way) orthopods with a subsequent increase in business .
they just love it when i do regional blocks in addition to the general that is provided by our crna's , but we don't seem to be able to reap a real benefit (moneywise, that is) yet. how is your practice set up , how do you bill for regional and are you able to do away entirely with general ?
appreciate your opinion, fasto
 

militarymd

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We do perioperative blocks along with GA for our orthopedic surgeons.


Depending on which state and which insurance company you are billing, you can get up to 12 or 15 units per block......that's more than the fee for the GA.


As long as the block is for post op pain control and not for the case itself...so you still need to do the GA.

You need to have a good meeting with your billing company and review the cpt/asa codes for the blocks.
 

fastosprintini

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militarymd said:
We do perioperative blocks along with GA for our orthopedic surgeons.


Depending on which state and which insurance company you are billing, you can get up to 12 or 15 units per block......that's more than the fee for the GA.


As long as the block is for post op pain control and not for the case itself...so you still need to do the GA.

You need to have a good meeting with your billing company and review the cpt/asa codes for the blocks.

thank you for the reply, in addition, i'd like to know what kind of blocks you do regularly- as in worthwhile the effort.
we do consistently interscalenes for shoulders but are not to sure about the benefit of other techniques...
any opinions? fasto
 

militarymd

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fastosprintini said:
thank you for the reply, in addition, i'd like to know what kind of blocks you do regularly- as in worthwhile the effort.
we do consistently interscalenes for shoulders but are not to sure about the benefit of other techniques...
any opinions? fasto
ISB for shoulders and elbow procedures

axillary/ infraclavicular blocks for elbow and hand procedures


femoral for knee stuff (acl/tka)

Popliteal fossa and lateral sciatic nerve block for foot and ankle procedures.
 

fastosprintini

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militarymd said:
ISB for shoulders and elbow procedures

axillary/ infraclavicular blocks for elbow and hand procedures


femoral for knee stuff (acl/tka)

Popliteal fossa and lateral sciatic nerve block for foot and ankle procedures.


nice! so you say there is no benefit to attempt a pure regional technique(with sedation) as we cannot bill for it unless it is an additional , post-op analgesia technique....?
 

militarymd

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fastosprintini said:
nice! so you say there is no benefit to attempt a pure regional technique(with sedation) as we cannot bill for it unless it is an additional , post-op analgesia technique....?
If the regional technique is the sole anesthetic...you cannot bill for it....now if you place the block for post op pain...than that pretty much doubles your compensation.
 

threepeas

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militarymd said:
If the regional technique is the sole anesthetic...you cannot bill for it....now if you place the block for post op pain...than that pretty much doubles your compensation.
why is that?
 

ecCA1

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Mil,

Do you think there will be some kind of reduction in fees or a changing of perspective by insurance companies in the next few years re: post-op pain blocks? Will they continue to pay effectively double for block+GA?
 

Noyac

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ecCA1 said:
Mil,

Do you think there will be some kind of reduction in fees or a changing of perspective by insurance companies in the next few years re: post-op pain blocks? Will they continue to pay effectively double for block+GA?
YEs there will be some sort of change. There always is.

Fast, you can do the block and sedate them with propofol, ketafol, what ever and just document that there was a period of loss of consciousness which would make it a general and just keep them lightly sedated for the majority of the case.
 

nimbus

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This is ethically shaky ground.

I have seen many examples of patients getting multiple anesthetics when one will do, especially regional or plexus blocks+GA. If you have a slow surgeon or an inaccessible airway, it is understandable. Otherwise we are putting our financial interests ahead of the interests of our patient and exposing them to unnecessary risk solely for our own financial benefit. For example, I have seen people give intrathecal morphine, then a GA for a 50-60min TKR on healthy patients. WTF??? If you are going to stick the spine anyway, how hard is it to add 1.6 ml of bupiv and skip the GA???

IMHO, Femoral+GA for ACL repair is ok, ISB+GA for clavicle resection or rotator cuff repair is ok, infraclavicular block+GA for hand case is NOT ok. Just pick one, IFCB or GA, whichever is most appropriate for the patient and procedure.

The payers set up this senseless system but we need to stick to the high road.
 

The_Sensei

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nimbus said:
The payers set up this senseless system but we need to stick to the high road.

Most of my patients don't want to "see or hear anything" ergo the GA in addition to the block.
 

nimbus

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The_Sensei said:
Most of my patients don't want to "see or hear anything" ergo the GA in addition to the block.
Most of my patients say the same thing. I tell them that I will be sitting next to them the entire case, that they should inform me if they see, hear or feel anything that makes them uncomfortable, and that I will make them sleepier if necessary. Most of my patients accept this. I do routinely run propofol infusions for noisy total joints or if the patient requests deep sedation.