Outpatient Surgery Magazine - Subscribers

Helping Hand - Outpatient Surgery Magazine - July 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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do in an outpatient setting and that commercial insurances tend to pay very well for," says Marcia Van Alstine, RN, CNOR, CASC, the executive director at Semmes Murphey Surgery Center in Memphis, Tenn. But be forewarned: TLIFs are labor-intensive, time-consuming procedures that can take anywhere from 2 to 4 hours to perform, depending on the surgeon. Because of the time-intensive nature of the procedure, effective scheduling is key. As a general rule, you'll want to schedule TLIFs first thing in the morning and, even though this is a same-day procedure, prepare for the unlikely possibility that a patient may have to stay the night. "We always make TLIFs the first case of the day, we only schedule 1 per day and we book every procedure 2 weeks in advance to allow for our nurses to sign up for overnight shifts (2 RNs are required in the event of an overnight stay)," says Ms. Van Alstine. While the extra preparation is a must, the vast majority of Semmes's TLIF patients walk out the doors of the surgery center by 6:30 or 7:00 p.m. Again, unless you're already outfitted for MIS spine, this probably isn't the right procedure for your facility. At a minimum, your facility needs a Jackson table with a Wilson frame (surgery in prone posi- tion), a C-arm, a decent neuro microscope and a tubular retractor instrumentation. The latter was an easy one for Semmes because one of its physicians, Kevin T. Foley, MD, FAANS, invented a well-known tubular system: the METRx, a micro endoscopic discectomy system that features a series of sequential muscle dilation tubes. "So we were lucky in that we didn't have to buy anything extra there," says Ms. Van Alstine. Medicare doesn't currently reimburse for the procedure, but com- mercial payers do (see "Medicare Reimbursement" on page 37). Be extra careful your coding team is billing everything correctly. "Certain insurers will bundle the payment, so it's up to you to make 6 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9

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