VSS ANAESTHESIA, SEDATION AND ANALGESIA INVOICING POLICY

Background

This schedule provides guidelines as to when to invoice different components for sedation, anaesthesia or analgesia of patients.  Once implemented, previous invoicing habits and some product items will be removed from ezyVet.

Specifics

Medications

  • All medications used for the provision of anaesthesia, sedation or analgesia should be individually invoiced based on the volume used through ezyVet.
  • Where possible the nursing team or relevant staff member should apply these amounts as they are being administered to the patient.  This provides both an accurate medical record and accurate invoicing.
  • If a whole container of an item is used for a single patient, then the whole vial should be invoiced to that patient regardless of whether the whole amount was administered.  Any unused amounts should be disposed of appropriately.
  • Where relevant, the specific product used should be invoiced (this refers to using the specific brand/formula/delivery if there are multiple versions of the same drug).
  • If a constant rate infusion (CRI) is required, then the CRI administration schedule below should be used.

Sedation

  • A professional fee for sedation should be invoiced if sedation is performed
  • Sedation items relate to animals that have been given an injectable combination subcutaneously or intravenously as a single dose for chemical restraint

Anaesthesia

  • A professional fee for anaesthesia should be invoiced if anaesthesia is performed
  • The time periods for the procedures below refer to the procedure time as defined by the professional fee units tables, rather than the anticipated length of anaesthesia.
  • Definitions are provided for the various levels of anaesthesia below
    • Deep sedation or anaesthesia -  short procedure (replaces anaesthesia IV)
      • Short procedure (up to 15 minutes) with either induction of anaesthesia and intubation or twilight anaesthesia/sedation with a combination such as ketamine/alfaxalone/medetomidine
      • This item is also suitable if a patient requires significant chemical restraint for a single diagnostic procedure such as ultrasound.  If multiple diagnostic procedures are to be performed, then other anaesthesia levels should be used as indicated by time.
    • Anaesthesia level 1 (Replaces anaesthesia isofluorane 1 or similar)
      • Procedure/s 15-60 minutes
    • Anaesthesia level 2 (replaces anaesthesia isofluorane 2 or similar)
      • Procedure/s 60-120 minutes
    • Anaesthesia level 3 (replaces anaesthesia isofluorane 3 or similar)
      • Procedure/s 2 hours plus or complex anaesthesia including
        • Requiring multiple pressors
        • Thoracotomy
        • Adrenalectomy
        • Liver lobectomy
        • Rupture cholecystectomy
  • Time guidelines are for veterinarians work time (not total anaesthesia time) for an average specialist clinician.  A reference table will be provided.
  • If multiple procedures are performed under the same anaesthesia, then the times of the individual procedures should be added and the total time used to select the anaesthesia level.

Analgesia in hospital

  • Constant rate infusions should be invoiced with itemised medication use (in whole units/vials per patient).  CRI pump use is included in hospitalisation levels for standard and ICU.
  • Individual injections should be invoiced as individual injections through ezyVet with the relevant volume recorded.

Specialist Anaesthetist fee

  • If a specialist anaesthetist is directly administering the anaesthesia to a patient then the invoice should include
    • Specialist Anaesthesia 1 = for patients where a specialist anaesthetist is directly administering the anaesthesia of the patient and anaesthesia levels 1, 2 or 3 are indicated
    • Specialist Anaesthesia 2 = for patients where a specialist anaesthetist is directly administering the anaesthesia and anaesthesia level 4 is indicated

Fluids with anaesthesia

  • If a patient will be on fluids then this should also be reflected in the relevant hospitalisation rate (i.e. one that includes fluid therapy).

CRI schedule

CRI pump use is included in hospitalisation levels standard and ICU

Estimation

Estimates should include both the professional fee (sedation or anaesthesia) and an estimate for medications based on patient size.  Cost estimates will be based on high end body weight for the relevant range.

The ezyVet estimates should include

  • Premedication and induction estimate
    • 1 unit assumes acepromazine/methadone premedication for a 30kg dog along with alfaxalone induction
  • Intra operative medication estimate
    • 1 unit includes a range of 1 to 3 fentanyl 50ug vials, dopamine and ephidrine
  • Anaesthesia estimate
    • Dogs and cats both use the same levels based on time bands as above

Effective date - 13 February 2023

VSS
Veterinary
Hospital

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