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Stone AB, Zorrilla Vaca A, Lirk P, Gerner P, Vlassakov K. Anesthesia start time documentation accuracy where peripheral nerve block is the primary anesthetic. Reg Anesth Pain Med 2024:rapm-2024-105292. [PMID: 38642928 DOI: 10.1136/rapm-2024-105292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/30/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION When used as the primary anesthetic, nerve blocks are not billed as separate procedures. In this scenario, the anesthesia start (AStart) time should include the block procedural time. We measured how often AStart time was documented before the nerve block was placed in the preoperative area, and compared cases where a block team performed the nerve block and cases where the intraoperative anesthesia attending supervised the nerve block. We hypothesized that the involvement of a regional anesthesia team would lead to more accurate documentation of AStart. We also estimated the lost revenue due to inaccurate start time documentation. METHODS The study population were patients undergoing surgery with a peripheral nerve block as the primary anesthetic. For this analysis, AStart occurring less than 10 min before the in-operating room time was defined as potentially inaccurate. Lost potential revenue was estimated by taking the difference between the documented time of local anesthetic administration and the documented AStart time. RESULTS A total of 745 cases were analyzed. Overall, 439 cases (58%) cases were identified as having potentially inaccurate start times. There were higher rates of inaccurate AStart documentation by the block team (316/482, 65.5%) compared with blocks supervised by the in-room anesthesia attendings (123/263, 46.7%, p<0.001). Overall, the estimated loss in billable revenue during the study period was a total of $70 265. CONCLUSIONS The performance of primary regional anesthesia procedure by a block team increased the incidence of inaccurate documentation and uncaptured potential revenue. There is need for education about accurate nerve block documentation for anesthesiologists, especially when separate teams are used.
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Affiliation(s)
- Alexander B Stone
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Andrés Zorrilla Vaca
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Philipp Gerner
- Harvard Medical School, Boston, Massachusetts, USA
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kamen Vlassakov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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May KA, Craven JM, Wright C, Tran B. Regional anesthesia and the acute pain service: compliance and controversies. Curr Opin Anaesthesiol 2022; 35:224-229. [PMID: 35125395 DOI: 10.1097/aco.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aims of this article are three-fold: first, to describe the necessary elements that result in accurate and compliant billing practice; second, to discuss billing in the context of new blocks and liposomal bupivacaine; and third, to gain a better understanding of compliance law. RECENT FINDINGS Regional anesthesia techniques provide an appealing alternative to opioid medication for pain management. However, these techniques also increase the cost of care. As new peripheral and fascial plane blocks emerge, proper coding has become more complex. SUMMARY Familiarity with documentation, billing, and compliance requirements can help maintain proper reimbursement rates, as well as limit potential downstream consequences. Most importantly this can help increase the viability and success of an acute pain service.
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Affiliation(s)
- Keith A May
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jack M Craven
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Crystal Wright
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryant Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
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Webb CAJ, Kim TE. Establishing an Acute Pain Service in Private Practice and Updates on Regional Anesthesia Billing. Anesthesiol Clin 2018; 36:333-344. [PMID: 30092932 DOI: 10.1016/j.anclin.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics. Standardization of regional anesthesia procedures and billing practices can promote consistent outcomes and efficiency.
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Affiliation(s)
- Christopher A J Webb
- Department of Anesthesiology and Perioperative Medicine, Kaiser Permanente South San Francisco Medical Center, 1200 El Camino Real, South San Francisco, CA 94080, USA; Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, 521 Parnassus Avenue, San Francisco, CA 94143, USA
| | - T Edward Kim
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Kim TE, Ganaway T, Harrison TK, Howard SK, Shum C, Kuo A, Mariano ER. Implementation of clinical practice changes by experienced anesthesiologists after simulation-based ultrasound-guided regional anesthesia training. Korean J Anesthesiol 2017; 70:318-326. [PMID: 28580083 PMCID: PMC5453894 DOI: 10.4097/kjae.2017.70.3.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background Anesthesiologists who have finished formal training and want to learn ultrasound-guided regional anesthesia (UGRA) commonly attend 1 day workshops. However, it is unclear whether participation actually changes clinical practice. We assessed change implementation after completion of a 1 day simulation-based UGRA workshop. Methods Practicing anesthesiologists who participated in a 1 day UGRA course from January 2012 through May 2014 were surveyed. The course consisted of clinical observation of UGRA procedures, didactic lectures, ultrasound scanning, hands-on perineural catheter placement, and mannequin simulation. The primary outcome was the average number of UGRA blocks per month reported at follow-up versus baseline. Secondary outcomes included preference for ultrasound as the nerve localization technique, ratings of UGRA teaching methods, and obstacles to performing UGRA. Results Survey data from 46 course participants (60% response rate) were included for analysis. Participants were (median [10th–90th percentile]) 50 (37–63) years old, had been in practice for 17 (5–30) years, and were surveyed 27 (10–34) months after their UGRA training. Participants reported performing 24 (4–90) blocks per month at follow-up compared to 10 (2–24) blocks at baseline (P < 0.001). Compared to baseline, more participants at follow-up preferred ultrasound for nerve localization. The major obstacle to implementing UGRA in clinical practice was time pressure. Conclusions Participation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Toni Ganaway
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alex Kuo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Mariano ER, Walters TL, Kim TE, Kain ZN. Why the Perioperative Surgical Home Makes Sense for Veterans Affairs Health Care. Anesth Analg 2015; 120:1163-1166. [DOI: 10.1213/ane.0000000000000712] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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