Sedation

[Yo GabbaPentin]

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I’m well aware that moderate sedation charge is no longer covered by Medicare for ESI, SI, etc. Every other clinic in our area still doing it. Is anyone having patients just sign ABN and charging for this? Are you eating the cost and just doing in anyways? Or have you cut it out entirely? And by moderate sedation I am talking about like 2 mg versed. Many of our patients demand it routinely.

 

[Ferrismonk]

FYI, it's legally okay with SI (for now).

We do ABN and collect ahead of time if the patient insists.

 

[bedrock]

I’m well aware that moderate sedation charge is no longer covered by Medicare for ESI, SI, etc. Every other clinic in our area still doing it. Is anyone having patients just sign ABN and charging for this? Are you eating the cost and just doing in anyways? Or have you cut it out entirely? And by moderate sedation I am talking about like 2 mg versed. Many of our patients demand it routinely.

I explain that sedation is no longer covered and quote the month. Then I blame the government, which is true.

I offer Medicare patients the same anestheia choices I give all my patients 1- local only and drive themselves or 2-Xanax + driver, 3- IV sedation + driver+ must fast for sedation.

So the Medicare can still get PO Xanax without an extra charge. If they want IV sedation, I tell them they can have it——-for the same cash price that other commercial patients have been paying for years out of pocket($200). About 3/4 of the Medicare that wanted sedation instead choose Xanax and 1/4 pay cash for IV sedation after signing ABN.

It’s not that much money for the service they get. But ironic that they pay more for the IV sedation than my professional fee to do the actual procedure in our ASC!!

I also find it amusing when the Medicare patient suddenly changes their tune about how critical is their need for IV sedation……when they’re not getting it for free!

 

[lobelsteve]

Just saying.....(again and again)

https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/FactFinder_2018_02_Conscious.pdf

For the frequently performed spinal procedures mentioned, default use of conscious sedation does not add a clear health/outcome benefit. The use of sedation may increase the risk of rare but catastrophic neurologic complications. Use of moderate sedation also adds to health care costs. While it seems that when given the option, patients with anxiety are more likely to elect the use of sedation, only a very small percentage of patients report dissatisfaction if sedation is simply not offered. When sedation is used, it does not predict patient satisfaction. If “significant anxiety” or vasovagal reaction is a concern for a particular patient, conscious sedation can be considered. Physicians should be judicious in the safe use of sedation. Patients should be advised during informed consent that sedation is not necessary, but elective. The physician and patient need to weigh the risks and benefits of procedural harm with any potential advantage attributed to intravenous sedation. Providing patient educational material regarding sedation can assist patients in making informed decisions. If the physician performing the procedure decides to administer and supervise the sedation, they should be trained and qualified to do so. In these situations, a separate healthcare provider is required to assist with the administration of the medications and monitoring of the patient.

 

[MD87]

I’m a little confused about an ABN. Isn’t this something that just states that Medicare MAY deny a service? Does this mean that you are submitting the sedation costs to Medicare and if they don’t pay you are charging the patient? Or are you not submitting the costs? I would imagine submitting to Medicare may lead to an audit. Thanks.

 

[lobelsteve]

I’m a little confused about an ABN. Isn’t this something that just states that Medicare MAY deny a service? Does this mean that you are submitting the sedation costs to Medicare and if they don’t pay you are charging the patient? Or are you not submitting the costs? I would imagine submitting to Medicare may lead to an audit. Thanks.

Makes patients financially responsible.

 

[drusso]

I’m well aware that moderate sedation charge is no longer covered by Medicare for ESI, SI, etc. Every other clinic in our area still doing it. Is anyone having patients just sign ABN and charging for this? Are you eating the cost and just doing in anyways? Or have you cut it out entirely? And by moderate sedation I am talking about like 2 mg versed. Many of our patients demand it routinely.

Have the patient sign an ABN and pay for the sedation or whatever on their credit card. Easy-peezy. I've been doing this for years. It works for everything: Sedation, regen, stellate for PTSD, etc.

 

[ED50]

How do you all dose xanax for these patients? I am more familiar with lorazepam.

 

[RoloTomassi]

How do you all dose xanax for these patients? I am more familiar with lorazepam.

1 mg Xanax ~ 2 mg lorazepam

 

[Laryngospasm]

Valium can help with spasm post procedure from uncomfortable positioning.

 

[lobelsteve]

How do you all dose xanax for these patients? I am more familiar with lorazepam.

Stick with the Ativan. Xanax is just dirty medication.

 

[sdnuser001]

Stick with the Ativan. Xanax is just dirty medication.

Why?

 

[DrMDAware]

Why?

Part of the “holy trinity” so might catch the DEA’s attention.

And higher theoretical use of addiction.

 

[Ligament]

Stick with the Ativan. Xanax is just dirty medication.

What dose of ativan do you use? What is the ativan equivalent of 1mg Xanax?

 

[epidural man]

I use Valium.

 

[lobelsteve]

What dose of ativan do you use? What is the ativan equivalent of 1mg Xanax?

1mg. 2 pills. One before coming to office and one optional on arrival.

 

[thecentral09]

So for you guys still doing IV sedation in the office?, Mainly for RFA’s which is still reimbursed, a few questions
1. Do you need an additional DEA license to hold liquid medication’s in your office?
2. How much are you reimburse to provide IV sedation for these procedures (stim trials, RFA, Kypho etc)
3 For someone starting up, what other suggestions would you have?

 

[drusso]

So for you guys still doing IV sedation in the office?, Mainly for RFA’s which is still reimbursed, a few questions
1. Do you need an additional DEA license to hold liquid medication’s in your office?
2. How much are you reimburse to provide IV sedation for these procedures (stim trials, RFA, Kypho etc)
3 For someone starting up, what other suggestions would you have?

1) Yes.
2) It stinks. Very low.
3) Check with your state and if you need or are strongly suggested to be accredited as an office-based surgical practice. There's no SOS/facility fee for this. It's just an unfunded mandate and burden for independent MD offices, but it will save your ass in case of a lawsuit or alleged complication. We use AAAAF.

Outpatient Accreditation Programs | Healthcare Standards | QUAD A

The Outpatient Procedural Facility Accreditation is for ambulatory facilities performing therapeutic & diagnostic procedures under sedation. Click to learn more.

www.quada.org