Interested in people's thought on the need for sedation in cervical MB RFN. IV sedation? PO sedation ? None?
If PO sedation - what and when?
If PO sedation - what and when?
a little valium or Ativan.1 per every few years if they had too much screaming with local only.
Routine use is bad for everyone except the anes company.
One of the frequents on this forum got sued for a cervical RF when the patient did not say that she had eaten that morning. She claimed to be NPO she had a little Benadryl and versed then aspirated and died a few days later.
I'm assuming NJpain means you practice in the great garden state as do I. My precert department is telling me that no insurance (except some Medicaid plans ironically) will cover cs for any pain management procedure. I've been doing everything with po sedation..Valium mainly.Interested in people's thought on the need for sedation in cervical MB RFN. IV sedation? PO sedation ? None?
If PO sedation - what and when?
I'm assuming NJpain means you practice in the great garden state as do I. My precert department is telling me that no insurance (except some Medicaid plans ironically) will cover cs for any pain management procedure. I've been doing everything with po sedation..Valium mainly.
none. use 25g tho, what size r all of you using?Interested in people's thought on the need for sedation in cervical MB RFN. IV sedation? PO sedation ? None?
If PO sedation - what and when?
They only cover it in the clinic??True no one "needs" conscious sedation for most of what we do. This is just more fodder to push everything towards office based practice. I think in a short time period many insurances will not cover spine injections in an asc setting..where I am horizon and Aetna definitely don't cover it and some of the others are following suit..been doing Valium or xanax for rfa without an issue
No..they don't cover it at all. I can't speak for hospital employees but this is my world as a private practice doc. So if they don't cover it then the argument can be made that you don't need to do it in an asc in the first place.They only cover it in the clinic??
Legal or not that's what we doIf insurance doesn't cover it, is it legal to offer a cash pay option just for the sedation?
Nice. Don't see why not. What pay scale do u use?Legal or not that's what we do
ABN?I would think cash pay no problem if insurance doesn't pay and they sign an ABN. The issue may be if insurance bundles the sedation with the procedure code...
Are most willing to sign the ABN? I understand that you wont proceed without it but my sense is that my patient population will skip the procedure if there is a hint that it will cost them anything. Rural/blue collar population. The dog gets his ACL done for cash. The pickup truck gets it chrome tail pipes for cash. But pay for healthcare, NO.Pretty much all RF's have an iv and I'd guess 99% patients want some sedation. Their choice. Maybe I just have wimpy patients. Most just a little midazolam. Add a little fentanyl if needed. It calms them and that way I don't have a moving target. I'm anesthesia trained so I perhaps feel more comfortable with giving sedation than other specialties. No one gets "knocked out". No one is making money on iv sedation. If its paid, its around $40 in the office, and $11 bucks if at a facility. The billing service hasn't told me that I'm not getting paid....but then again I'm bringing billing in house as they don't tell me much...
I'm using more ABNs now as more and more commercial insurances are not providing/performing predetermination/authorization for RF. We just get a letter or the office staff are told over the phone....no authorization required and pre-d not performed.
Pretty much all RF's have an iv and I'd guess 99% patients want some sedation. Their choice. Maybe I just have wimpy patients. Most just a little midazolam. Add a little fentanyl if needed. It calms them and that way I don't have a moving target. I'm anesthesia trained so I perhaps feel more comfortable with giving sedation than other specialties. No one gets "knocked out". No one is making money on iv sedation. If its paid, its around $40 in the office, and $11 bucks if at a facility. The billing service hasn't told me that I'm not getting paid....but then again I'm bringing billing in house as they don't tell me much...
I'm using more ABNs now as more and more commercial insurances are not providing/performing predetermination/authorization for RF. We just get a letter or the office staff are told over the phone....no authorization required and pre-d not performed.
I also put ivs in most procedures. Lumbar mbbs and lesi only if sedation. Of course it is the young healthy guys getting an epidural who like to vagal the most on me so not totally logical.
I am a solo doc in an office with no one but a dentist across the hall. Have an extremely low tolerance for risk for my patients and litigation. If a bad outcome and no iv will be plenty of docs willing to say I should have performed in asc.
I think it is a little of the art of medicine as well. I treat the procedure seriously and patients therefore take it that way. My procedure suite has a separate pre/post iv room with two lazyboys and my MAs have a special “iv certificate”. It is seemless and doesn’t hold me up one bit.
On the other hand after 50k+ cases I have never opened my crash cart...
I also put ivs in most procedures. Lumbar mbbs and lesi only if sedation. Of course it is the young healthy guys getting an epidural who like to vagal the most on me so not totally logical.
I am a solo doc in an office with no one but a dentist across the hall. Have an extremely low tolerance for risk for my patients and litigation. If a bad outcome and no iv will be plenty of docs willing to say I should have performed in asc.
I think it is a little of the art of medicine as well. I treat the procedure seriously and patients therefore take it that way. My procedure suite has a separate pre/post iv room with two lazyboys and my MAs have a special “iv certificate”. It is seemless and doesn’t hold me up one bit.
On the other hand after 50k+ cases I have never opened my crash cart...
Last I read, IV fentanyl and IV midazolam fo have risks that extend beyond the 5 min of deep sedation one gets. The elimination half life for both fentanyl and midazolam is roughly 3 hours, so patients have over half their meds for at least 2 hours after they go home.Easier to titrate fentanyl and versed IV than having to guess how much P.O. Valium/Xanax a patient needs. A heck of a lot faster onset too. But I do agree with you, it is an extra chore/expense that you won’t get paid for....
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Last I read, IV fentanyl and IV midazolam fo have risks that extend beyond the 5 min of deep sedation one gets. The elimination half life for both fentanyl and midazolam is roughly 3 hours, so patients have over half their meds for at least 2 hours after they go home.
More than enough time to grab a couple of percs or a 12 ouncer...