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
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