Why can't we bill for multiple anesthetics...?

[sigrhoillusion]

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I'll never understand this.

We are legally only allowed to bill for one anesthetic (well technically you can bill for anything, but are only going to get paid for one.)

MY issue is that for a knee replacement let's say you provide a spinal for analgesia because that's all you really need to get through the case. But then you put in an adductior nerve block for post-op pain control. But of course 99% of patients are going to get sedation as well. However, when it comes to billing you can only bill for the spinal for your anesthetic and then bill the block for post-op pain control, but you can't also bill for MAC for providing that fent/midaz/prop/precedex or whatever you use to put the patient "asleep" so they don't just blankly stare at the ceiling and listen to buzzsaws and whatever radio station the surgeon chooses that day...

So my question is why can't we bill for all three? I mean unless there is a contraindication to sedation (i.e. difficult airway) I feel like most patients if you told them they would be wide awake for their joint replacement would be kinda uneasy. I guess what I'm saying is it comes down to patient comfort and expectations. Because you know how many times you meet a patient in pre-op that day, and you tell them you're the anesthesiologists, and they perk up and they say "oh sweet! you're the one that's gonna make sure I'm alseep for the procedure." So you know if you told them, "welllllllll insurance won't pay me for your sedation so hope you're interested in watching me manage my stocks and listen to Pearl Jam for 2 hours..." they wouldn't be overly enthused.

In the end you decide to do the spinal, place the block and drip in a little of the magic milk and the patient wakes up 2 hours later and loves you forever (or until the go home and the block wears off...) . So yeah, technically we're providing an "unnecessary" medical service with teh sedation, but again for convenience and comfort we provide it cause that's what is expected. We take on all the risks of MAC (resp depression, conversion to general, anaphylaxis to drugs) but get none of the financial benefits. Am I missing something?

 

[sevoflurane]

I'll never understand this.

We are legally only allowed to bill for one anesthetic (well technically you can bill for anything, but are only going to get paid for one.)

MY issue is that for a knee replacement let's say you provide a spinal for analgesia because that's all you really need to get through the case. But then you put in an adductior nerve block for post-op pain control. But of course 99% of patients are going to get sedation as well. However, when it comes to billing you can only bill for the spinal for your anesthetic and then bill the block for post-op pain control, but you can't also bill for MAC for providing that fent/midaz/prop/precedex or whatever you use to put the patient "asleep" so they don't just blankly stare at the ceiling and listen to buzzsaws and whatever radio station the surgeon chooses that day...

So my question is why can't we bill for all three? I mean unless there is a contraindication to sedation (i.e. difficult airway) I feel like most patients if you told them they would be wide awake for their joint replacement would be kinda uneasy. I guess what I'm saying is it comes down to patient comfort and expectations. Because you know how many times you meet a patient in pre-op that day, and you tell them you're the anesthesiologists, and they perk up and they say "oh sweet! you're the one that's gonna make sure I'm alseep for the procedure." So you know if you told them, "welllllllll insurance won't pay me for your sedation so hope you're interested in watching me manage my stocks and listen to Pearl Jam for 2 hours..." they wouldn't be overly enthused.

In the end you decide to do the spinal, place the block and drip in a little of the magic milk and the patient wakes up 2 hours later and loves you forever (or until the go home and the block wears off...) . So yeah, technically we're providing an "unnecessary" medical service with teh sedation, but again for convenience and comfort we provide it cause that's what is expected. We take on all the risks of MAC (resp depression, conversion to general, anaphylaxis to drugs) but get none of the financial benefits. Am I missing something?

Can your patient respond to verbal communication during your "sedation"? Does your patient prefer to be sleeping? Any duramorph in your spinal?

If you put your patient to sleep with propofol or an inhaled agent, it's still considered GA.
AW management does not factor in this equation and you can bill for both. ACB + PF DM is superior to either one alone.

 

[urge]

I'll never understand this.

We are legally only allowed to bill for one anesthetic (well technically you can bill for anything, but are only going to get paid for one.)

MY issue is that for a knee replacement let's say you provide a spinal for analgesia because that's all you really need to get through the case. But then you put in an adductior nerve block for post-op pain control. But of course 99% of patients are going to get sedation as well. However, when it comes to billing you can only bill for the spinal for your anesthetic and then bill the block for post-op pain control, but you can't also bill for MAC for providing that fent/midaz/prop/precedex or whatever you use to put the patient "asleep" so they don't just blankly stare at the ceiling and listen to buzzsaws and whatever radio station the surgeon chooses that day...

So my question is why can't we bill for all three? I mean unless there is a contraindication to sedation (i.e. difficult airway) I feel like most patients if you told them they would be wide awake for their joint replacement would be kinda uneasy. I guess what I'm saying is it comes down to patient comfort and expectations. Because you know how many times you meet a patient in pre-op that day, and you tell them you're the anesthesiologists, and they perk up and they say "oh sweet! you're the one that's gonna make sure I'm alseep for the procedure." So you know if you told them, "welllllllll insurance won't pay me for your sedation so hope you're interested in watching me manage my stocks and listen to Pearl Jam for 2 hours..." they wouldn't be overly enthused.

In the end you decide to do the spinal, place the block and drip in a little of the magic milk and the patient wakes up 2 hours later and loves you forever (or until the go home and the block wears off...) . So yeah, technically we're providing an "unnecessary" medical service with teh sedation, but again for convenience and comfort we provide it cause that's what is expected. We take on all the risks of MAC (resp depression, conversion to general, anaphylaxis to drugs) but get none of the financial benefits. Am I missing something?

I don't know of you are a crook or just a little delayed.

Stop trying to pad the bill. There is one anesthetic. The way you deliver it is your problem.

 

[deleted162650]

I'll never understand this.

We are legally only allowed to bill for one anesthetic (well technically you can bill for anything, but are only going to get paid for one.)

MY issue is that for a knee replacement let's say you provide a spinal for analgesia because that's all you really need to get through the case. But then you put in an adductior nerve block for post-op pain control. But of course 99% of patients are going to get sedation as well. However, when it comes to billing you can only bill for the spinal for your anesthetic and then bill the block for post-op pain control, but you can't also bill for MAC for providing that fent/midaz/prop/precedex or whatever you use to put the patient "asleep" so they don't just blankly stare at the ceiling and listen to buzzsaws and whatever radio station the surgeon chooses that day...

So my question is why can't we bill for all three? I mean unless there is a contraindication to sedation (i.e. difficult airway) I feel like most patients if you told them they would be wide awake for their joint replacement would be kinda uneasy. I guess what I'm saying is it comes down to patient comfort and expectations. Because you know how many times you meet a patient in pre-op that day, and you tell them you're the anesthesiologists, and they perk up and they say "oh sweet! you're the one that's gonna make sure I'm alseep for the procedure." So you know if you told them, "welllllllll insurance won't pay me for your sedation so hope you're interested in watching me manage my stocks and listen to Pearl Jam for 2 hours..." they wouldn't be overly enthused.

In the end you decide to do the spinal, place the block and drip in a little of the magic milk and the patient wakes up 2 hours later and loves you forever (or until the go home and the block wears off...) . So yeah, technically we're providing an "unnecessary" medical service with teh sedation, but again for convenience and comfort we provide it cause that's what is expected. We take on all the risks of MAC (resp depression, conversion to general, anaphylaxis to drugs) but get none of the financial benefits. Am I missing something?

 

[jwk]

This isn't rocket science. Yes, you're missing something.

 

[Consigliere]

One word: fraud.

 

[ZzzPlz]

If we have to adjust table height more than once, let's make it four anesthesia bills.

I kid I kid

 

[sigrhoillusion]

I don't know of you are a crook or just a little delayed.

Stop trying to pad the bill. There is one anesthetic. The way you deliver it is your problem.

Whoa whoa whoa... relax. I know how to bill and I know how to provide anesthesia. I'm just saying in the grand scheme of things when you bill for a case you can only choose one way of providing anesthesia, but technically we often provide several types. I guess what I wanted to express was how annoying it is when we have to document what anesthesia we provide we have to document one, even though we might provide several types for ultimate patient satisfaction.

 

[Consigliere]

Go Eagles!

 

[fakin' the funk]

Whoa whoa whoa... relax. I know how to bill and I know how to provide anesthesia. I'm just saying in the grand scheme of things when you bill for a case you can only choose one way of providing anesthesia, but technically we often provide several types. I guess what I wanted to express was how annoying it is when we have to document what anesthesia we provide we have to document one, even though we might provide several types for ultimate patient satisfaction.

YOU can provide just one. Enjoy