the 100% directionless thread

[rmabrey]

As I understand it normal IV solutions (saline,D5W,LR etc), antibiotics and TPN dont qualify for SCT billing. Doesnt matter if a pump was used or not.

Good to know. Doesnt matter anyway cause the pump isnt being used and its going BLS. So they just lost a few thousand more

 

[Jim37F]

So me and my partner are bringing a 5150 into a psych facility, I ring the doorbell, tell them over the intercom who we're bringing in and they say it'll be just a minute. About a minute later someone opens the door and instead of a staffer letting us in, it's another staff member leaving for the night, apparently no clue we're just outside the door waiting to come in. She cracks the door, sees me, and jumps about a foot in the air trying (not very successfully) to muffle a scream, so unexpected it apparently was to run into us lol

 

[Akulahawk]

As I understand it normal IV solutions (saline,D5W,LR etc), antibiotics and TPN dont qualify for SCT billing. Doesnt matter if a pump was used or not.

If an EMT can monitor that fluid, then it's NOT an SCT billable item. If a Paramedic can monitor the fluid, then it's possibly billable as an ALS item. If a regular (non-CCT) Paramedic can't monitor it, then it probably is an SCT billable item. As a Paramedic in Sacramento, I can't monitor antibiotics, TPN, blood/blood products, most pressors, or IV NTG, for instance. I've never heard of an IV fluid simply because a pump was used/required.

It's also possible that SCT billing is very regional and based upon what EMT, EMT-II/Advanced EMT, and Paramedic personnel can do in that region. Since I don't do billing, that's my (somewhat) educated guess.

 

[rmabrey]

Well either way it isnt the dispatchers decision to make. He has this idea that the more money the company makes the more we make.

I know better, and part of being a good patient advocate IMO is avoiding sticking the patient with an unnecessary ALS/SCT charge (pumps are ALS for us).

 

[Wheel]

Well, ideally, no moving or towards Texas/Southern New Mexico, but Colorado would be workable.

I would look towards one of the good Texas services. That's my plan at the moment.

 

[shfd739]

If an EMT can monitor that fluid, then it's NOT an SCT billable item. If a Paramedic can monitor the fluid, then it's possibly billable as an ALS item. If a regular (non-CCT) Paramedic can't monitor it, then it probably is an SCT billable item. As a Paramedic in Sacramento, I can't monitor antibiotics, TPN, blood/blood products, most pressors, or IV NTG, for instance. I've never heard of an IV fluid simply because a pump was used/required.

It's also possible that SCT billing is very regional and based upon what EMT, EMT-II/Advanced EMT, and Paramedic personnel can do in that region. Since I don't do billing, that's my (somewhat) educated guess.

Region probably has something to do with it. FWIW Ive understood that its based off what Medicare will recognize and reimburse as SCT.

For us:

Saline lock only basic can ride and it bills BLS.

Normal fluids (saline,D5W,LR) intermediate/paramedic has to ride. This includes antibiotics and TPN. If the facility is willing to send their pump or switch to dial a flow an ALS crew will take. If not we'll send a CCT unit with a pump. Still bills as an ALS trip

Other meds, blood products, pressors etc go with CCT unit and bills SCT.

 

[VFlutter]

The Doctor talking about my 600+ pound patient...

D:"He weighs more than two silverback Gorillas, more than a baby Hippo, this guy weighs more than a blue whale fetus"
Me: "How do you know all that?"
D: "I just made that :censored::censored::censored::censored: up, but you get the point. The dude is huge"

 

[chaz90]

The Doctor talking about my 600+ pound patient...

D:"He weighs more than two silverback Gorillas, more than a baby Hippo, this guy weighs more than a blue whale fetus"
Me: "How do you know all that?"
D: "I just made that :censored::censored::censored::censored: up, but you get the point. The dude is huge"

My roommate and I went to visit her young horse a couple months ago. We were talking about the horse's size, and suddenly realized a frequently calling local patient weighs as much as the horse did at that time. Really puts things in perspective when you're looking at an animal that size and realize there's a human you're expected to treat that weighs as much. It makes you wonder how many of our pre-hospital treatments are even effective at that point. BVM? Not likely you can form a tight enough seal to ventilate with the weight of the chest wall. IV medications or fluid? Ha, I honestly don't even know if our bariatric IO could reach bone on some of these patients! The code (unsurprisingly poor outcome) I worked on a 700 lb patient remains a...cherished... EMS memory.

 

[Tigger]

bruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswinbruinswin

BRUINS WIN!!

 

[RocketMedic]

Today, I finally realized the secret of EMS orientation. You don't have to be good, smart, or right. You literally just have to do exactly what your FTO wants to see. Do not worry about patient care- that is not a phase-one problem. "There to learn our way." Parrot mode engaged.

Sad, right?

 

[chaz90]

Today, I finally realized the secret of EMS orientation. You don't have to be good, smart, or right. You literally just have to do exactly what your FTO wants to see. Do not worry about patient care- that is not a phase-one problem. "There to learn our way." Parrot mode engaged.

Sad, right?

But get through the nonsense to the point where you're allowed to have an opinion. Every FTO thinks they're right about everything in comparison to the trainee. When you're out, you can make the decisions you want to make without being second guessed by a nanny over your shoulder. Learn to play the game and show them how well you can follow directions, then get out there and do the right thing.

 

[NomadicMedic]

Today, I finally realized the secret of EMS orientation. You don't have to be good, smart, or right. You literally just have to do exactly what your FTO wants to see. Do not worry about patient care- that is not a phase-one problem. "There to learn our way." Parrot mode engaged.

Sad, right?

I just had this same discussion with a friend of mine. He's going through the same thing. It sucks, but I told him the same thing I said to you. "FTO time eventually ends. Then you go out on your own and do it right."

 

[RocketMedic]

Glad to be home tonight lol...I heard the EMSA crew across the street at West Midway tear off into Mustang and really kind of miss it. I guess I'm just "meh" right now...

 

[RocketMedic]

I just had this same discussion with a friend of mine. He's going through the same thing. It sucks, but I told him the same thing I said to you. "FTO time eventually ends. Then you go out on your own and do it right."

Thats whats frustrating- you're being graded on your decision-making, but aren't allowed to make decisions.

 

[NomadicMedic]

In many places you're also being graded on how you "fit in". In the discussion I had with my friend, comparing his FTO process with mine here in Delaware, a common theme was the lack of an objective evaluation.

There's no good answer for that. Just try to play the game.

 

[Akulahawk]

In many places you're also being graded on how you "fit in". In the discussion I had with my friend, comparing his FTO process with mine here in Delaware, a common theme was the lack of an objective evaluation.

There's no good answer for that. Just try to play the game.

And at some really small places, whether you're a threat to the structure in place and/or whether you're going to take away people's overtime...

 

[NomadicMedic]

And at some really small places, whether you're a threat to the structure in place and/or whether you're going to take away people's overtime...

True. Resistant to change = EMS.

 

[shfd739]

See that's all sad that FTO time is like that.

I'm an FTO here and all Im looking for is that you have the monkey skills (iv, intubation etc.)down, you're catching onto our protocols and you arent gonna kill someone. If your way works then rock on. I might make a suggestion to help but won't hold your way against you if it works. We'll discuss some of the new research regarding treatments such as oxygen; and Ill probably break out my capnography power point if someone doesn't understand capnography.

Oh and Im gonna make sure you know the important policies and dumb idiosyncrasies of this area.

The sooner I get you cleared the sooner you get a shift and we quit being pestered to work overtime lol.

 

[Jim37F]

So I actually got to help put a traction splint for the very first time since EMT school on a Pt this morning. On an Inter Facility Transfer too

 

[Household6]

I had a (rural) EMR call late last night, a 35yo female removed her inner labias with a razor blade, then called 911 when she couldn't stop the bleeding..

My preceptor responded with ALS and transported her. I'll see him tonight, hopefully he'll tell me how she is.