# Anesthesia concurrency



## Kpope2565 (Jan 30, 2014)

Hello,
I am in need of some clarification.  
I have a case where it starts out with the Anesthesiologist along with an CRNA.
The Anesthesiologist is also in a second case with a SRNA.
During the second case, the SRNA leaves the room leaving the Anesthesiologist alone.
However, the first case has ended, so there is only one case going on.
The SRNA returns to the case after about 30-45 minutes. Once the SRNA returns, the Anesthesiologist starts another case.
My question is, what would the concurrency be for the 2nd case? At the beginning it was 02, in the middle it was 00 and at the end it was 02.
Thanks for any help you can give.


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## LeslieJ (Jan 30, 2014)

You have a case of broken medical direction.

You have an anesthesiologist medically directing a CRNA.  (1)
You have an anesthesiologist also medically directing/teaching an SRNA (2)

There are 2 concurrencies.

The SRNA leaves, and the anesthesiologist is now personally performing for case #2.  This means that medical direction has been broken for CRNA, case #1, regardless of _when_ the break occurred.  The times between the 2 cases overlapped.

For Case #1, the CPT/ASA code should have QZ as the CRNA was performing without medical direction OR, as the rules say, _one of the 7 steps was unable to be met_. 

Regardless of the fact that it ended prior to the SRNA leaving the room w/the anesthesiologist, the anesthesiologist's 2nd case began during or prior to the end of case #2 where medical direction broke by the anesthesiologist personally performing a case, unable to adhere to the 7 steps of medical direction.

For Case #2, the CPT/ASA code should have AA-GC modifier.


Leslie J


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## Kpope2565 (Jan 30, 2014)

*Anesthesia Concurrency*

Thank you Leslie!


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