I'm really not trying to be offensive but are you an attending or student?
None taken. Attending but in an ivory tower setting so always a student I suppose?
Just because a physician thinks something is "indicated" does not ensure it will be reimbursed.
That's not a physician's thinking it's indicated, as in insurance and reimbursement indication is present for local anesthetic around a nerve to a painful area. Worst case scenario you bill a TPI.
I've seen surgeries get canceled with the patient sitting in pre op because approval was denied. Now why a surgeon would bring someone in without approval is beyond me.
**** happens, and not to be offensive, but you've worked in some crappy places if you've seen multiples of that.
The most likely way you'll get reimbursed is if you talk to the surgeon, have them bring the patient in for a shoulder manipulation, do a pre op block, then have the patient go to PT later that day. Am I understanding that the surgeon wants a block one week prior to PT? If so I still don't have any idea why you'd do that.
I'm all about emptying a syringe and knob twisting, but in this scenario, there are a lot of indications for it. I'm not sure why you'd upcharge for a EUA when a simple block would do. The problem here really is if your only tool is an ISB, that's a higher risk procedure for the problem.
If we're talking shoulder surgery...personally...I would recommend a suprascapular here. Yes The shoulder is also innervated by the axillary nerve, and you are going to miss this whereas you would not with the ISB. However, I think on the whole you will still get excellent analgesia which is sufficient for rehabilitation, while avoiding the dangers as well as the profound motor loss of the ISB. (you will only lose the supra and infraspinatus.
The suprascap was my initial thought, but an axillary at the deltoid has some benefit too. There are some folks now that are trying radiofrequency ablation or cryoablation preoperatively prior to knee surgeries so that people can have preop/intraop/postop analgesia with minimal motor deficits. That's often a PA/NP/provider in an ortho clinic, as the mechanical aspects of these procedures aren't that challenging.
In this scenario, I have to applaud the OP for stepping outside their comfort zone and helping a patient out. Def not going to get rich and taking on some risk, but that surgeon and patient probably appreciated it. If the provider keeps asking and you aren't comfortable, maybe plug them in with a pain doc in the area that does pulsed RF or cryoablation, as that can be done a few weeks preoperatively, help with pre-hab and post-op PT. Better yet though, that's a sweet skill to have, and you could combine it as a PAT visit, a procedure visit, and avoid all this silliness with trying to bill in the usual anesthesia framework.
