IV start service

[pmichaelmd]

If it's not in your contract then I would be telling them to go fly a kite if they tried to call after hours or on weekends

Would be tempting but I would not underestimate the power of goodwill from admin for such acts. During the height of the pandemic, when other services were taking pay cuts and getting fired, we lost nothing due to our volunteerism.

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[DocVapor]

Would be tempting but I would not underestimate the power of goodwill from admin for such acts. During the height of the pandemic, when other services were taking pay cuts and getting fired, we lost nothing due to our volunteerism.

At that moment in time, sure

It won't be remembered.

 

[pmichaelmd]

At that moment in time, sure

It won't be remembered.

Sad, but probably true. But we have held steady within our system since 2006 so maybe it will hold for a bit longer.

 

[DocVapor]

Sad, but probably true. But we have held steady within our system since 2006 so maybe it will hold for a bit longer.

I hope your group can prove me wrong!

 

[GassYous]

We get called quite frequently. If the floor/SSU/ICU/L&D nurse can’t get access, during business hours, they will call the IV team (several RNs who are trained to place PICC and midlines) who often “can’t find anything.” We are then the last line. Def not in our contracts and we don’t mind helping when free and available, but it can get irritating to be called in overnight or on weekend call to do peripheral IVs. The surgeons sometimes get called for central lines if we aren’t available but they have gotten smart and simply say they are too busy.

What started as a courtesy has become an expectation. I don’t mind during usual work hours and it does keep our value at the forefront with admin because not every anesthesia group would agree to help like this. And, although salaried, we are well-compensated.

Same for intubations in the ICU or on the floor. Our intensivists by and large don’t intubate or do lines. We also get called by nephrology to place Vas caths.
Small to medium sized community hospital system here.

NOPE

 

[OptionOffense]

IV teams make sense. Placing IVs on hospital inpatients is a nursing duty so having a team of nurses who are good at it saves everyone else like IR or us who are too well paid and too busy from wasting time doing floor IVs/central lines/piccs just for access.

Its not wasting time. It's taking care of your patient. I got called to do an Iv on the floor. i did. I did a preanesthesia eval, wrote a procedure note and sent a bill for it. DONE. I was happy to do it

 

[vector2]

Its not wasting time. It's taking care of your patient. I got called to do an Iv on the floor. i did. I did a preanesthesia eval, wrote a procedure note and sent a bill for it. DONE. I was happy to do it

Lol "my patient" ? A random pt on the medicine ward who the floor nurse is too lazy to stick at 7pm on a Saturday is not my patient.

And doing a pre-eval or filing a 99251 for your "consult" or anything outside of the actual procedure note is a fking farce

 

[Arch Guillotti]

Lol "my patient" ? A random pt on the medicine ward who the floor nurse is too lazy to stick at 7pm on a Saturday is not my patient.

And doing a pre-eval or filing a 99251 for your "consult" or anything outside of the actual procedure note is a fking farce

Although I have started many lines that I want nothing to do with, I have to agree with this 100%.

 

[deleted875186]

Can’t you bill for an ultrasound guided peripheral IV if you save an image.

 

[coffeebythelake]

Can’t you bill for an ultrasound guided peripheral IV if you save an image.

None of this is worth the time or effort involved.

 

[Arch Guillotti]

None of this is worth the time or effort involved.

This times infinity plus one.

 

[OptionOffense]

Lol "my patient" ? A random pt on the medicine ward who the floor nurse is too lazy to stick at 7pm on a Saturday is not my patient.

And doing a pre-eval or filing a 99251 for your "consult" or anything outside of the actual procedure note is a fking farce

Youre calling an Anesthesiologist to put in your IV. I come, take my time, use the ultrasound put the iv in pain free with a smile. That is worth 45 mins of anesthesia time plus the cost of the ultrasound. 400 dollars. Thanks.

 

[vector2]

Youre calling an Anesthesiologist to put in your IV. I come, take my time, use the ultrasound put the iv in pain free with a smile. That is worth 45 mins of anesthesia time plus the cost of the ultrasound. 400 dollars. Thanks.

45 min? Just when you thought the farce couldn't get any bigger...

 

[Arch Guillotti]

Youre calling an Anesthesiologist to put in your IV. I come, take my time, use the ultrasound put the iv in pain free with a smile. That is worth 45 mins of anesthesia time plus the cost of the ultrasound. 400 dollars. Thanks.

Who is paying $400 for an IV?

 

[deleted875186]

Who is paying $400 for an IV?

Maybe if you put the big tegaderm on it and dress it nicely, maybe put one of those alcohol antiseptic caps in the end ….

 

[OptionOffense]

45 min? Just when you thought the farce couldn't get any bigger...

I have to find the u/s, read the chart, gather my equipment, drag the u/s machine on the elevator, talk to the subject, set the machine up, do the actual procecdure (10 mins or so), dress the iv, clean the u/s machine, clean off the mess, drag the machine back, then call the primary team saying I put the iv in for them which they were supposed to do in the 1st place. 400 dollars. Life isnt free. Thank you again.

 

[vector2]

I have to find the u/s, read the chart, gather my equipment, drag the u/s machine on the elevator, talk to the subject, set the machine up, do the actual procecdure (10 mins or so), dress the iv, clean the u/s machine, clean off the mess, drag the machine back, then call the primary team saying I put the iv in for them which they were supposed to do in the 1st place. 400 dollars. Life isnt free. Thank you again.

You can do whatever semi-fraudulent thing you like, but you are not performing a service that requires more than the 36400 for the IV placement and the 76937 for the use of the ultrasound. Lugging your U/S across the hospital is not billable anesthesia or consult time.

 

[Hork Bajir]

Got a call for IV placement on a floor patient at 2AM last night. Inspired by this thread, I told them that I would be happy to help… just transport The patient down to the OR holding room, get me an ultrasound and IV supplies including lidocaine drawn up and ready at the bedside, and call me when I can come do the procedure. Somehow all of a sudden they didn’t need my help anymore…

 

[coffeebythelake]

Got a call for IV placement on a floor patient at 2AM last night. Inspired by this thread, I told them that I would be happy to help… just transport The patient down to the OR holding room, get me an ultrasound and IV supplies including lidocaine drawn up and ready at the bedside, and call me when I can come do the procedure. Somehow all of a sudden they didn’t need my help anymore…

😺
Nice

 

[kidthor]

If the hospital is getting massive facility fees to compensate for this exact type of thing, we ought to be able to directly bill the hospital for a part of said fees as well. So maybe the 400 cited above plus 600 in facility fees to make it $1000. That seems fair for physician level service. Do you think a law firm partner will accept any less for an hour of emergency work at 2am on Saturday night?

 

[DrAmir0078]

Sounds familiar in my Country, they call us as the last resort or stop. It is apparently a contagious situation. Quite few, we find good veins and that make us mad too.
But, the great debate which is an endless story regarding CV line placement, it is a hidden war between vascular team and Anesthesia team, it happens to have official statement from the Ministry of health of who is responsible for CV lines, and whenever the person in charge replaced or got under pressure from big shot academic vascular surgeons, he would change the regulations.
Back in the US, when I was an ER tech, they call us almost every day from the floors to perform USGIVs, even if they are trained the Nurses and they won't bother Anesthesia. I had never seen a resident in Anesthesia do an IV, only ER techs were the last stop too

 

[pmichaelmd]

Got a call for IV placement on a floor patient at 2AM last night. Inspired by this thread, I told them that I would be happy to help… just transport The patient down to the OR holding room, get me an ultrasound and IV supplies including lidocaine drawn up and ready at the bedside, and call me when I can come do the procedure. Somehow all of a sudden they didn’t need my help anymore…

We often do the same thing, especially during busy work hours and we are supervising one to 3 or one to 4. If they can supply a nurse, the patient, and all the needed supplies to the block holding area, I’m happy to quickly place a line. If they want or need the line badly enough, they comply.

 

[The Duck Knows]

If the hospital is getting massive facility fees to compensate for this exact type of thing, we ought to be able to directly bill the hospital for a part of said fees as well. So maybe the 400 cited above plus 600 in facility fees to make it $1000. That seems fair for physician level service. Do you think a law firm partner will accept any less for an hour of emergency work at 2am on Saturday night?

I see more similarities than differences when comparing to IR placing an NG tube. Nobody questions it because they get sent down to IR and use expensive imaging to guide them, and it’s a necessary procedure made difficult by the patient’s anatomy.

 

[Mman]

I see more similarities than differences when comparing to IR placing an NG tube. Nobody questions it because they get sent down to IR and use expensive imaging to guide them, and it’s a necessary procedure made difficult by the patient’s anatomy.

except you can't bill the hospital for the procedure and the reimbursement from CMS or a private payor is minimal. You can make as big a production as you want out of it.

 

[Ashers]

What service were you on as an anesthesia resident where you were called to do a central line on a floor patient?

General OR overnight call. Seemed like a lot of the hospital would call us for lines. It sucked. As the 1st call resident, I fielded the calls.

 

[norski]

I place pivs for every single patient I encounter at my home hospital. Placed around 20000 during my career, bedside nursing and anesthesia. I'm decent.

The thing is, I hate doing them, and so it angers me every time I get called by the ICU, floor or ER, as these people really should be as good as I am, but they're lazy AF. I've started placing 16gs out of spite (and because there's room), usually inside two minutes of veinous whispering, alcohol wipes and rubber bands.

I do hate being called at home after midnight, so I've stopped trying to get any sleep on call nights until after ABx rounds at midnight, and then relying on getting another call within six hours. Gets me up bright and ready for sitting four hour abdominoplasties and boob jobs on post call day.

In Norway, anesthesia is the only game in town for any airways, a lines or central lines, so we're well and thoroughly f***ed. I did know this entering the line of work, but I never imagined how much my former colleagues actually sucked at very simple procedures.

 

[Mman]

The thing is, I hate doing them, and so it angers me every time I get called by the ICU, floor or ER, as these people really should be as good as I am, but they're lazy AF.

I do dislike the people that should be good at procedures but just get in the habit of calling for help because someone else will do it for them if it is at all "difficult".

 

[lunaire]

We used to do this in my old hospital -- patient would get transported to preop holding, then one of the anesthesiologist will insert an ultrasound guided midline or PIV.

This is totally not financially worth it, no matter how you bill for it. If you are doing this service for the hospital, make sure you are getting something back; a stipend, goodwill, less sass from the floor nurses, etc... Usually better to get IR to line the floor patients.