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thatmom06

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Reply with quote  #1 
Hi everyone,

I'm looking for help from those of you that have used the Fleisher protocol when terminating the episode at home didn't work.  It sounds like the sedation phase needs to happen at the hospital since it requires IV fluids and meds.  Since it is deep sleep that ends an episode and they just kick you out when you go to the ER as soon as they can, do you get admitted for the sedation period?  Does your doctor provide you with orders to get admitted once you are seen in the ER?  How does that work?

Thank you!

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Jennifer
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ginny

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Reply with quote  #2 
Hi Jennifer.  To be admitted you would need to be diagnosed with something that has a medical code. Different codes will allow for different admissions.  Each condition will have limits on it-- number of days to be admitted, meds covered.   

I don't think anyone would be covered for sedation but sedation would be included in a covered diagnosis-- as long as sedation is approved under that condition code.



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wynnak

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Reply with quote  #3 
As the sedation for the brain “reset” is usually a long period, the ER would not keep you for that. It would have to be admission.
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Peacelj65

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Reply with quote  #4 
Our 26 years old’s experience with this phase always requires admission. The ER tries to quick hydrate and sedate and then sends her home. Within a few hours she is back at ER. The cycle for her typically takes 3-4 days to subside. Sometimes longer depending on how many times the dang ER sends her home. It’s so frustrating.
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thatmom06

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Reply with quote  #5 
It really is frustrating. This last trip to the ER they were nice and let him sleep for two hours.

So CVS does have a medical code and he has been diagnosed with it. Does anyone know if sedation is covered under this diagnosis, and if so, for how long of an admission? He has been admitted before but only because of his history with intestinal malrotation. The admission did not include sedation, only imaging to confirm that he wasn't twisting or obstructing.

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Jennifer
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ginny

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Reply with quote  #6 

There is a code for CVS.  The hospital and doctors have the codes to use and they might not use the CVS code but instead another (dehydration, bleeding, suspicion of something, elevated enzymes) that will allow admission.  I don't have a book with coding but like with lab tests, there might be something on the web. 

Sleeping for a couple of hours is usually in the observation area and for us, the observation area was not covered as completely as an inpatient admission nor was the 24 hours adequate to end the cycle.

Try CMS.gov and then also your own insurance company web page.


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ginny CVSA Moderator
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