Ultrasound procedures

[pjuer]

---

Members don't see this ad.

i don't believe your claim you invented ultrasound.

Didn't Al Gore invent ultrasound?

 

[101N]

Didn't Al Gore invent ultrasound?

Al Gore invented pants. I INVENTED ULTRASOUND.

There will be no further discussion of who invented US. Ok. Thank you and
proceed.

 

[drf]

why stop at 40cc?

generally speaking, the blocks that i did for anesthesia were of lower volume than 40 cc of 0.5%. if i remember correctly, scalenes were 10 cc, supraclaviculars were 20 cc, femorals were 20-30 cc.


i am a fan of ultrasound, but ultrasound does not "make" the block - the person and his skill doing the injection "makes" the block successful.

Were these with or without US?

 

[powermd]

This is anecdotal of course, but it seems to me that since I have started doing TPI's with ultrasound, they work better, and last a LOT longer.

What is often cool, is it seems that I can sometimes see the "abnormality" under ultrasound, and most times, when I start the injection into the usually more hyper echoic area (compared to the surrounding similar structures), they say - unprompted - "Oh Yeah...that's the spot."

Also, anectotally, I have found that a lot of the trigger point areas seem to be along the fascia right above the rib - and I never targeted this area before.

One thing I don't see under ultrasound, which was always cool doing them blind - is that twitch you get when you DO hit the right spot - probably because it is under the probe.

Right on.

 

[Ducttape]

Were these with or without US?

With US.

 

[drf]

With US.

I agree with much lower volumes when utilizing ultrasound.

I think the point of 40 ml 0.5% was to get enough spread when using anatomic or stim techniques.

In residency I remember each preop block using stim got pushed to the toxic dose limit. I do understand that this was partially due to being in residency. Im sure a PP anesthesiologist with 5-10 years of experience would be much better at stim/blind blocks.

The reason for high doses was if a block wasn't perfect after 20-30 minutes a furious surgeon would decide that none of his patients would ever get blocked again. For the first year or two of residency there was constant argument between surgeons and regional anesthesiologists. Surgeons would drop off the block list after one delayed start and it would take the anesthesiologists 6 months to convince them blocks were good for patients again.

No blocks was bad for resident learning. However for the last 4-5 years in the same place I haven't heard a single complaint from a surgeon. Now they are buddies with the regional folks. All appropriate patients get blocked. And the blocks always work. I haven't converted to GA in 5 years on a block case.

Edit to add: before US it was very common to do the block with a plan of GA. The block wouldn't set up until mid surgery. Now all these patients avoid GA because the blocks reliably work by the end of prep and drape even if done immediately before rolling back.

 

[NEPain]

Well, it started out as an interesting discussion. Can I ask some questions and make some comments?

I am really interested in US and this discussion showed it's utility, not to mention the appeal of offering patients radiation free treatment. BUT, I contacted our billing department to support my goal of buying an US unit (what, 20-30K?) and was told that NOBODY pays for ultrasound.

So are you doing the ultrasound for free or is there a way to bill extra for it? Is there a code I can send to my billing monsters to turn them around?

And YES, TPI's were the number one procedure in the closed claims study because of PTX. Number two was doing ESI's with local.

Thanks for any help getting past the Berlin Wall of our billing dept.

 

[lobelsteve]

Well, it started out as an interesting discussion. Can I ask some questions and make some comments?

I am really interested in US and this discussion showed it's utility, not to mention the appeal of offering patients radiation free treatment. BUT, I contacted our billing department to support my goal of buying an US unit (what, 20-30K?) and was told that NOBODY pays for ultrasound.

So are you doing the ultrasound for free or is there a way to bill extra for it? Is there a code I can send to my billing monsters to turn them around?

And YES, TPI's were the number one procedure in the closed claims study because of PTX. Number two was doing ESI's with local.

Thanks for any help getting past the Berlin Wall of our billing dept.

Codes will follow, but it pays 4x more than the injection, so your billing department is wrong. Very wrong. Everyone pays for it. For now.

 

[specepic]

Well, it started out as an interesting discussion. Can I ask some questions and make some comments?

I am really interested in US and this discussion showed it's utility, not to mention the appeal of offering patients radiation free treatment. BUT, I contacted our billing department to support my goal of buying an US unit (what, 20-30K?) and was told that NOBODY pays for ultrasound.

So are you doing the ultrasound for free or is there a way to bill extra for it? Is there a code I can send to my billing monsters to turn them around?

And YES, TPI's were the number one procedure in the closed claims study because of PTX. Number two was doing ESI's with local.

Thanks for any help getting past the Berlin Wall of our billing dept.

Depends on the procedure if it "pays". It won't 'pay' for a TFESI, facet, but it will for TPI, large joint, CTI, etc. Guidance code 76942.

 

[NEPain]

Very interesting. Thank you so much.

 

[drf]

Depends on the procedure if it "pays". It won't 'pay' for a TFESI, facet, but it will for TPI, large joint, CTI, etc. Guidance code 76942.

Agree. I got to see my clinic procedure code breakdown for last year. The wRVUs from US was not insignificant.

For now.

 

[epidural man]

....was told that NOBODY pays for ultrasound.

.

Really? That's hard to believe.

If you took the insurance company to small claims, I'd bet ya $5, you would win.

Ultrasound takes time and training, just like fluoro. It adds saftey and efficacy to the procedure. There is NO justification not to pay for it.

 

[sblau001]

It's nice to see that a post about US today doesn't get too contentious. I remember posting something about US about a year ago, and the thread was eventually moved into the private sphere after causing a big tumult. For years I've been a big believer in the capabilities of US. It's been used in veterinary medicine for quite some time, and believe it or not, has many similar uses in humans. Why wait for an MRI to tell me that someone has a bursitis or rotator cuff tear, when I can see it within minutes in my office? It is also being used extensively in the military, in part because of its ease of portability. I use US for joint injections, nerve blocks, tendon sheath injections, and yes, even TPI's. Not every TPI, but definitely when I'm injecting into the cervical or thoracic regions, or when injecting extremely close to a previous laminectomy site. While definitely inferior to fluoro for facet blocks, US can be helpful in patients who can not lie down on the table for whatever reason (as a 92 year old patient of mine presented last year). I am actually putting on the finishing touches to an article I have been writing describing an improved technique for US-guided thoracic TPI's, which describes using M-mode to verify that no PTX has occurred, providing additional benefit in case of litigation. Also, my experiences have been different than epidural man's, as sometimes a clear and obvious local twitch response can be seen beautifully under US.