# medical direction vs medical supervisio-code anesthesia



## khill (Jun 10, 2014)

I code anesthesia and have never had this question posed to me before. what is the difference between med direction and med supervision? also, isn't there a way to bill for time only when no ane agents were administered but the case requires a qualified provider to step in if the patient cannot maintain their airway? i'm stumped!!!
Thanks:


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## dwaldman (Jun 11, 2014)

Below is from the CMS Internet only manual that describes medical direction vs. medical supervision. I searched for airway management in regards to your other question because I was not aware of the answer and below I copy and pasted what I found from an Internet search.

http://www.cms.gov/Regulations-and-...12.html?DLPage=1&DLSort=0&DLSortDir=ascending


B. Payment at Personally Performed Rate  
The Part B Contractor must determine the fee schedule payment, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time if:  
? The physician personally performed the entire anesthesia service alone;  
? The physician is involved with one anesthesia case with a resident, the physician is a teaching physician as defined in ?100, and the service is furnished on or after January 1, 1996;  
? The physician is involved in the training of physician residents in a single anesthesia case, two concurrent anesthesia cases involving residents or a single anesthesia case involving a resident that is concurrent to another case paid under the medical direction rules.  The physician meets the teaching physician criteria in ?100.1.4 and the service is furnished on or after January 1, 2010;   
? The physician is continuously involved in a single case involving a student nurse anesthetist;  
? The physician is continuously involved in one anesthesia case involving a CRNA (or AA) and the service was furnished prior to January 1, 1998.  If the physician is involved with a single case with a CRNA (or AA) and the service was furnished on or after January 1, 1998, carriers may pay the physician service and the CRNA (or AA) service in accordance with the medical direction payment policy; or  
? The physician and the CRNA (or AA) are involved in one anesthesia case and the services of each are found to be medically necessary.  Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers.  The physician reports the ?AA? modifier and the CRNA reports the ?QZ? modifier for a nonmedically directed case.  
C. Payment at the Medically Directed Rate  The Part B Contractor determines payment for the physician?s medical direction service furnished on or after January 1, 1998, on the basis of 50 percent of the allowance for the service performed by the physician alone.  Medical direction occurs if the physician medically directs qualified individuals in two, three, or four concurrent cases and the physician performs the following activities.  
? Performs a pre-anesthetic examination and evaluation;  
? Prescribes the anesthesia plan;  
? Personally participates in the most demanding procedures in the anesthesia plan, including induction and emergence;  
? Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;  
? Monitors the course of anesthesia administration at frequent intervals;  
? Remains physically present and available for immediate diagnosis and treatment of emergencies; and  
? Provides indicated-post-anesthesia care.  
Prior to January 1, 1999, the physician was required to participate in the most demanding procedures of the anesthesia plan, including induction and emergence.  
For medical direction services furnished on or after January 1, 1999, the physician must participate only in the most demanding procedures of the anesthesia plan, including, if applicable, induction and emergence.  Also for medical direction services furnished on or after January 1, 1999, the physician must document in the medical record that he or she performed the pre-anesthetic examination and evaluation.  Physicians must also document that they provided indicated post-anesthesia care, were present during some portion of the anesthesia monitoring, and were present during the most demanding procedures, including induction and emergence, where indicated.  
For services furnished on or after January 1, 1994, the physician can medically direct two, three, or four concurrent procedures involving qualified individuals, all of whom could be CRNAs, AAs, interns, residents or combinations of these individuals.  The medical direction rules apply to cases involving student nurse anesthetists if the physician directs two concurrent cases, each of which involves a student nurse anesthetist, or the physician directs one case involving a student nurse anesthetist and another involving a CRNA, AA, intern or resident.  
For services furnished on or after January 1, 2010, the medical direction rules do not apply to a single resident case that is concurrent to another anesthesia case paid under the medical direction rules or to two concurrent anesthesia cases involving residents.  
If anesthesiologists are in a group practice, one physician member may provide the pre- anesthesia examination and evaluation while another fulfills the other criteria.  Similarly, one physician member of the group may provide post-anesthesia care while another member of the group furnishes the other component parts of the anesthesia service.  However, the medical record must indicate that the services were furnished by physicians and identify the physicians who furnished them.  
A physician who is concurrently directing the administration of anesthesia to not more than four surgical patients cannot ordinarily be involved in furnishing additional services to other patients.  However, addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic, rather than continuous, monitoring of an obstetrical patient does not substantially diminish the 
scope of control exercised by the physician in directing the administration of anesthesia to surgical patients.  It does not constitute a separate service for the purpose of determining whether the medical direction criteria are met.  Further, while directing concurrent anesthesia procedures, a physician may receive patients entering the operating suite for the next surgery, check or discharge patients in the recovery room, or handle scheduling matters without affecting fee schedule payment.  
However, if the physician leaves the immediate area of the operating suite for other than short durations or devotes extensive time to an emergency case or is otherwise not available to respond to the immediate needs of the surgical patients, the physician?s services to the surgical patients are supervisory in nature.  Carriers may not make payment under the fee schedule.  
See ?50.J for a definition of concurrent anesthesia procedures.  
D. Payment at Medically Supervised Rate  The Part B Contractor may allow only three base units per procedure when the anesthesiologist is involved in furnishing more than four procedures concurrently or is performing other services while directing the concurrent procedures.  An additional time unit may be recognized if the physician can document he or she was present at induction

AD - Medical Supervision by a physician; more than 4 concurrent anesthesia procedures; 

_________________________________________________________
: What's the CPT code for airway management? 

A: Beyond intubation (31500) and ventilator management (94002-94003), there are no specific codes in CPT for airway management. 

CPT generally describes "provider" services, such as physicians, and generally doesn't provide codes that describe hospital employee services, such as respiratory therapists providing overall airway management for patients. 

Ray Cathey, PA-C, MHA, FAHC, CHCC, is the president/owner of Medical Management Dimensions in Stockton, Calif.


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## khill (Jun 16, 2014)

*ane info*

Thanks True Blue!
I'm gonna try to scrape together some money to go to the confernce in Orlando. I appreciate your checking these things out for me and i will look into the link you posted. The more knowledge the better!


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