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Comment on Tuesday's email - rendering and billing for services outside our specialty

December 1, 2016
In response to Tuesday's email -

Comment from one of our MDs - 


I can answer that question.  No. 
The core residency is the physical medicine and rehabilitation.  The secondary qualification is in pain medicine with an anesthesiology group. This means that he has learned how to do pain management procedures from anesthesiologist who are the pioneers in this field. 

Therefore this person has no knowledge of anesthesia administration as defined by the American Society of anesthesiology nor does he have any chance of being board-certified in that field. I myself am board-certified in anesthesiology for the secondary board certification and pain management.

As any physician, he can bill for sedation using a benzodiazepine, however his question really involves whether he can administer propofol and bill the same way as an anesthesiologist does. The answer to that is no, it falls outside the scope of his license. 

As a sidenote Jennifer I think you have the most informative legal/medical newsletter I've ever seen. Your writing style is also very fluid and a pleasure to read as well as informative. I typically save most of them and refer to them periodically.

Dr. S

Response - 

Thank you for the response and the sidenote - it is always nice to know you are reading!  As an aside of my own - we do post the newsletters on our website in case you do not want to save them but would like to refer back. 

I agree with your comments, Dr. S, from an exposure standpoint in our clustered community in Downstate NY.  But, I respond with a challenge - would your opinion be the same if this doctor were practicing in a rural environment with no anesthesiologists available for referral? What about our country doctors that come out trained in Internal Medicine and end up performing half their careers dabbling in what us urbanites would define as other specialties?  From my non-medical, legal standpoint, technically under the MD or DO license you are qualified to perform any area of medicine. I am not familiar with DEA regulations that may prohibit certain prescribing or substance utilization depending on specialty, but I would not be surprised if that existed, as I am aware of government enforced restrictions for use of certain substances by certain practitioners (after investigation and charges, whether by OPMC, Bureau of Narcotics or other agency).  

I do agree that while the licensing department maintains an MD or DO has an unrestricted license, we all know in NY that an internist cannot open a practice anymore with dermatology or cardiology referenced in the practice name, or get themselves credentialed with a payor for services outside their board certification.  While we're on the topic, without board certification in certain specialties, we're all aware in NY you cannot even participate with certain payors. 

So, I see your point and, of course, cannot say I disagree.  But with so many of our topics, I do think its worth mentioning the circumstances may set the conclusion a bit.  Certainly from a malpractice standpoint a lack of training/specializing may be the noose around the neck.  


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