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The hospital system I was with for 5 years required the surgeon's office to schedule surgery with a request for a block for post op analgesia, therefore documentation was never an issue. However there appears to be a myriad of practices in the many surgery centers where I now administer anesthesia including-
1. No surgeon scheduling of a block, no verbal or written request for a block, but it is "understood" that certain procedures will be accompanied with a post op pain block.
2. Surgeon schedules the procedure that typically gets pain blocks as "choice" but neither asks for nor schedules a block.
3. Surgeon schedules the procedure that typically gets pain blocks as "Regional" but neither asks for nor schedules a block.
4. Surgeons schedules the procedure as "MAC with pain block", and does not want general anesthesia.
5. Surgeon verbally asks for a pain block but with no documentation anywhere from the surgeon of this.
The ASA has addressed this to a certain degree: Statement on Reporting Postoperative Pain Procedures in Conjunction with Anesthesia
however, some of the scheduling and lack of documentation by the surgeon or their scheduling office may prove problematic given that some insurers require documentation by the surgeon of the request for post operative pain blocks, ostensibly (according to CMS) because they do not have the skills to provide such post operative pain control measures (since the primary responsibility for post op pain control is by the surgeon according to CMS). For instance scheduling a procedure as MAC with pain block does not meet the requirements to be able to use the pain block as post operative pain because the pain block was actually the primary intraoperative anesthetic. Similarly, scheduling "Regional" indicates regional anesthesia for surgery, not for post operative pain. The situation where the surgeon neither documents nor schedules nor requests a post op pain block does not seem to meet the documentation requirements.
Thoughts?
1. No surgeon scheduling of a block, no verbal or written request for a block, but it is "understood" that certain procedures will be accompanied with a post op pain block.
2. Surgeon schedules the procedure that typically gets pain blocks as "choice" but neither asks for nor schedules a block.
3. Surgeon schedules the procedure that typically gets pain blocks as "Regional" but neither asks for nor schedules a block.
4. Surgeons schedules the procedure as "MAC with pain block", and does not want general anesthesia.
5. Surgeon verbally asks for a pain block but with no documentation anywhere from the surgeon of this.
The ASA has addressed this to a certain degree: Statement on Reporting Postoperative Pain Procedures in Conjunction with Anesthesia
however, some of the scheduling and lack of documentation by the surgeon or their scheduling office may prove problematic given that some insurers require documentation by the surgeon of the request for post operative pain blocks, ostensibly (according to CMS) because they do not have the skills to provide such post operative pain control measures (since the primary responsibility for post op pain control is by the surgeon according to CMS). For instance scheduling a procedure as MAC with pain block does not meet the requirements to be able to use the pain block as post operative pain because the pain block was actually the primary intraoperative anesthetic. Similarly, scheduling "Regional" indicates regional anesthesia for surgery, not for post operative pain. The situation where the surgeon neither documents nor schedules nor requests a post op pain block does not seem to meet the documentation requirements.
Thoughts?
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