Nerve Blocks/Medical Direction

[DMBUGA34]

Does placing a nerve block (adductor, interscalene) while supervising rooms violate medical direction? Our billing company is telling us we can no longer place blocks unless we're completely free. What's everyone doing?

---

Members don't see this ad.

 

[nimbus]

Does placing a nerve block (adductor, interscalene) while supervising rooms violate medical direction? Our billing company is telling us we can no longer place blocks unless we're completely free. What's everyone doing?

That sounds ridiculous. Isn't that the whole point of supervision? To launch cases with lines, blocks and induction while concurrently supervising other rooms. I imagine 100% of supervision practices do this.

 

[DMBUGA34]

I guess our billing company is taking a very strict definition of medical direction. Regional blocks (non-labor) are not listed under services we can provide while directing anesthesia. Has anyone else had to deal with this? It does sound ridiculous to me.

"Medical Direction of Anesthesia Services

Medical direction occurs when an anesthesiologist is involved in two, three or four concurrent anesthesia procedures or a single anesthesia procedure with a qualified anesthetist. For each anesthesia procedure, the anesthesiologist must do the following seven services:

• Perform a pre-anesthetic examination and evaluation;
  
  
• Prescribe the anesthesia plan;
  
  
• Personally participate in the most demanding procedures of the anesthesia plan including, if applicable, induction and emergence;
  
  
• Ensure that any procedure in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
  
  
• Monitor the course of anesthesia administration at frequent intervals;
  
  
• Remain physically present and available for immediate diagnosis and treatment of emergencies; and
  
  
• Provide the indicated post anesthesia care.
  

If one or more of the above services are not performed by the anesthesiologist, the service is not considered medical direction.

Ordinarily, anesthesiologist should not furnish additional services to other patients while concurrently directing the administration of anesthesia. The anesthesiologist can, however, provide any of the following services to other patients while medically directing the administration of anesthesia without affecting their ability to administer medical direction.

• Addressing an emergency of short duration in the immediate area.
  
  
• Administering an epidural or caudal anesthetic to ease labor pain.
  
  
• Periodic rather than continuous monitoring of an obstetrical patient.
  
  
• Receiving patients entering the operating suite for the next surgery.
  
  
• Checking on or discharging patients from the post anesthesia care unit.
  
  
• Coordinating scheduling matters."
  

 

[OB1🤙]

If you can do an epidural you can do a frigging PNB

 

[facted]

We routinely preform blocks while covering a second room, and this is perfectly acceptable from a billing perspective. How is this any different from intubating a second case while covering your first room?

As long as you are immediately available geographically, you are fine.

We use ABC as our biller and this has never come up..

 

[deleted162650]

A block is part of the "anesthesia procedure" you are providing for the patient which it clearly states you can do up to 4 at a time. The rules (to me) read that you should not be doing blocks for other patients while supervising 4 rooms already.

Your billing company is a bunch of buffoons. Time for a new billing company.

 

[BLADEMDA]

A block is part of the "anesthesia procedure" you are providing for the patient which it clearly states you can do up to 4 at a time. The rules (to me) read that you should not be doing blocks for other patients while supervising 4 rooms already.

Your billing company is a bunch of buffoons. Time for a new billing company.

ABC is the largest billing company for anesthesia in the USA. They said it was perfectly "legal" to do nerve blocks while supervising 4 rooms. End of discussion.

 

[DMBUGA34]

ABC is the largest billing company for anesthesia in the USA. They said it was perfectly "legal" to do nerve blocks while supervising 4 rooms.

Where have they said this?

 

[Arch Guillotti]

I think they are getting mixed up with blocks for chronic pain like a steroid injection.

 

[nimbus]

Did your billing company just hire a new high school kid and put him in charge? And said high school student pulled this interpretation out of his ass. Reminds me of JCAHO inspectors.

 

[Mman]

I guess our billing company is taking a very strict definition of medical direction. Regional blocks (non-labor) are not listed under services we can provide while directing anesthesia. Has anyone else had to deal with this? It does sound ridiculous to me.

• 
  
• Personally participate in the most demanding procedures of the anesthesia plan including, if applicable, induction and emergence;

I bolded the part applicable to a nerve block. The regional block is part of the anesthesia plan. Just because it isn't in the OR and isn't timed doesn't mean it isn't a part. CMS pays for you to do it while still medically directing other ORs and no private payer will ever say no to it.

You need a new billing company.

 

[nimbus]

I guess our billing company is taking a very strict definition of medical direction. Regional blocks (non-labor) are not listed under services we can provide while directing anesthesia. Has anyone else had to deal with this? It does sound ridiculous to me.

"Medical Direction of Anesthesia Services

Medical direction occurs when an anesthesiologist is involved in two, three or four concurrent anesthesia procedures or a single anesthesia procedure with a qualified anesthetist. For each anesthesia procedure, the anesthesiologist must do the following seven services:

• Perform a pre-anesthetic examination and evaluation;
  
  
• Prescribe the anesthesia plan;
  
  
• Personally participate in the most demanding procedures of the anesthesia plan including, if applicable, induction and emergence;
  
  
• Ensure that any procedure in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
  
  
• Monitor the course of anesthesia administration at frequent intervals;
  
  
• Remain physically present and available for immediate diagnosis and treatment of emergencies; and
  
  
• Provide the indicated post anesthesia care.

If one or more of the above services are not performed by the anesthesiologist, the service is not considered medical direction.

It's reasonable to interpret this to mean the anesthesiologist must be the one performing the block.

"Personally participate in the most demanding procedures of the anesthesia plan including, if applicable, induction and emergence;"

 

[Noyac]

Never mind.

 

[OB1🤙]

Bumping this because ABC is apparently telling us that doing nerve blocks (but not epidurals) breaks medical direction which is the dumbest thing I've ever heard. Which is saying a lot... What are your situations out there? Are you all getting paid to do blocks as part of medically directed cases?

 

[Aether2000]

Tell your billing company the standard of care and common practice across the entire US is that anesthesiologists do regional blocks while supervising cases, and that the billing company is way out of line.

 

[AdmiralChz]

We do it while supervising ALL THE TIME. We don’t even give it a second thought. We do our own billing, and we’ve had zero issues.

 

[dannyboy1]

The standard pain note that we fill out for billing at my shop does not have the time the block was placed. So I don’t know how the billing company would even know if you were “free” or not....