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November 2013 - Newsletter

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The November 2013 NYSORA

In this issue:

A Letter from Your Editor

Dear NYSORA newsletter reader,

NYSORA is currently working on a number of exciting educational projects. For instance, on popular demand, the first of NYSORA's Boutique Ultrasound guided nerve blocks and vascular access workshops is planned for December 7-8, 2013 in New York.

Please refer to the program brochure for additional information and future dates. These workshops will be presented by NYSORA's team in New York for consistency of teaching and are planned as most intensive, jump start programs for colleagues who would like to get the most of a weekend -long workshop.

The 2014 will be particularly busy with educational outreach programs in Asia and Latin America. The 8th Annual NYSORA Asia (K2 Mission) in February 2014 will be particularly interesting as it will cater to the needs of Nepalese anesthesiologists who have been inviting NYSORA educational marines for several years now. The NYSORA's international team will deliver educational program and connect with the local colleagues in Nepal, followed by the traditional academic retreat. The K2 mission will end with a program in Kuala Lumpur

Long in planning, NYSORA finally rolls out its first Latin American Symposium in beautiful Florianapolis, Brazil. In cooperation with the RAPM leaders in Latin America, this Symposium has been structured as one of the strongest to date with an aim to connect colleagues throughout Latin America with some of the very top international NYSORA faculty. Dr. Carlos Bolini shares his vision of the NYSORA Latin America Symposium in his interesting interview in this issue of the Newsletter.

Finally, NYSORA features its first "Inspire Seminar", aimed at providing clinicians with an interactive learning environment, continuous professional development (CPD) and the opportunity to network with the opinion leaders in the field of regional anesthesia. The Inspire seminars will be CME-credited academic retreats for small groups of clinicians seeking the most authoritative information on the practice and trends in regional anesthesia. Delegates to these seminars are not expected to be highly specialized in the field - being passionate and having a desire to interact and exchange ideas is all that's needed. The Inspire program is designed with flexibility to accommodate a wide range of goals and knowledge levels such that delegates can navigate to just about any level desired – from the basic to the advanced techniques. They will be able to brainstorm their ideas, develop preliminary research protocols, or simply interact with NYSORA's highly selected faculty. In keeping with the Inspire philosophy, topics off the beaten path may be included, such as a leadership course, financial planning, photography, film history, among others.

A faculty of trend setting authors of peer-reviewed papers and top quality textbooks has been selected. However, in the give-and-take exchanges, the faculty will also be able to brainstorm and use the delegates as a sounding board for their own ideas. The ultimate goal of the Inspire seminars is for the delegates to return to their homes equipped with the most up-to-date knowledge and clinical practice protocols, and with inspiration to make a difference in their clinical practices.

We look forward to catching up with you in December.

Sincerely Yours,

Tim Peters 

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NYSORA's Boutique Workshops


The first module of NYSORA's Boutique Ultrasound guided nerve blocks and vascular access workshops starts this year on December 7-8, 2013 in New York City, NY.

Delegates attending NYSORA boutique wokshops will be taught standardized techniques and protocols endorsed by 26 participating NYSORA key opinion leaders worldwide. Faculty selected for teh workshops are some of the best instructors and clinicians, recognized for their expertise in regional anesthesia. They will adhere to a NYSORA format that offers the clearest possible instruction.

The Delegates will receive:

1. NYSORA boutique workshop materials, including a DVD, posters, and a standard NYSORA textbook.

2. New skills are learned in an organized manner. The didactic courses are immediately followed by hands-on sessions, instructor assisted scanning, nerve block simulations, hand eye coordination sessions, injection monitoring sessions, and a pre and post knowledge assessment test.

All sessions and sequences are taught based on a NYSORA format that has proven to offer the utmost educational value during the 2 day package.

Make sure to reserve your spot if you want to jumpstart the use of ultrasound in your practice as the attendance will be strictly limited!




For more information visit the event website

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NYSORA announces Inspire Seminars


During these busy times it is increasingly difficult to balance the challenges of day to day working life with the need for continuing education and vacation time. With this in mind NYSORA announces Inspire Seminars.

The Inspire program aims to strike a balance between education and leisure for busy clinicians. Delegates can use this opportunity to bring back value to their clinical or academic practices by earning CME credits in the morning hours, and then spending an ample amount of down-time or quality time after the sessions. The seminars are hosted in some of the most unique locations worldwide, allowing a wide array of activities while providing an ideal environment for brainstorming away from the everyday practice of medicine.

Delegates to these seminars are not expected to be highly specialized in the field – being passionate and having a desire to interact and exchange ideas is all that’s needed. The Inspire program is designed with flexibility to accommodate a wide range of goals and knowledge levels such that delegates can navigate to just about any level desired – from the basic to the advanced techniques. They will be able to brainstorm their ideas, develop preliminary research protocols, or simply interact with NYSORA’s highly selected faculty. In keeping with the Inspire philosophy, topics off the beaten path may be included, such as a leadership course, financial planning, photography, film history, among others.

A faculty of trend setting authors of peer-reviewed papers and top quality textbooks has been selected. However, in the give-and-take exchanges, the faculty will also be able to brainstorm and use the delegates as a sounding board for their own ideas.

The destination for the first seminar is the Landings Resort on the beautiful north coast of St Lucia. Here you can be as energetic or as laid back as you wish. Activities include, snorkeling, scuba diving, deep sea fishing and sailing, or alternatively try a treatment at the luxurious on-site Soleil Spa.

The Landings St Lucia offers 80 spacious luxury Caribbean villa suites, with one, two or three bedrooms, with either a harbor view or St Lucia beachfront view. The resort is only five years old and was constructed using the best materials and high quality fittings and fixtures. Each luxury villa suite has been designed for comfort and equipped for your convenience. The most outstanding quality of The Landings accommodations is the sheer space enjoyed by guests.

For more information and to reserve your place on this seminar please visit the Inspire website



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Basic Tips on Reporting Perioperative Peripheral Nerve Blocks


If a regional anesthetic technique is performed for postoperative analgesia, providers can bill for regional anesthetic technique as a separate service from the anesthetic. In order to report pain management blocks, clear documentation is required to help distinguish between anesthetic and analgesia.

Medical necessity for postoperative pain management must be documented by the requesting physician. Normal postoperative pain management including management of intravenous patient controlled analgesia is considered part of the surgical global package.

Perioperative nerve blocks can be reported when the anesthesia for the surgical procedure is not dependent on the efficacy of the regional anesthetic technique and the time spent on peri-operative placement of the block must be separated and not included in the reported anesthesia time.

Some of the major factors that one needs to keep in mind when documenting are:

                Name of block performed

                Approach used

                Patient condition

                Indications for block

                Patient position

                Needle design, technique, depth of insertion

                Local anesthetic used

                Dose

                Monitoring/narrative of event/description of motor response

                Patient vital signs following procedure

You also need to ensure that payors whose contract with your ASC specifically excludes PNB reimbursement are not to be billed and Medicare should not be billed separately for peripheral nerve blocks related to surgery as it only reimburses for PNBs that are for chronic pain control.

Documentation is considered incomplete when post operative pain block is dictated within the operative report and no separate procedure note for the block is provided, post operative pain procedure report includes no information of post operative pain management, incomplete statements are made which do not have physician order and anesthesia type is not specified with clear documentation relating to post operative pain control.

To code for pain the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care are taken into consideration. But as a secondary diagnosis postoperative pain can be coded. However, a code cannot be assigned if the pain is routine or after surgery.

About Author

David William is a coding and billing expert who is well versed with the changes that are occuring in the healthcare industry. He usually writes on topics like compliance and reimbursement, and how to familiarize ourself with physician practice billing services to save time, be compliant and code efficiently and effectively.

More resources are available here: Anesthesia Coding Alert

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Needle and Injection Monitoring During Nerve Block Placement
 

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