# medical direction vs medical supervisio



## 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,
coderquest


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## Michele Hannon (Jun 10, 2014)

Medicare allows a physician to medically direct up to four anesthesia cases when: the seven steps of medical direction are met (see link).http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1324CP.pdf
The physician may not perform any other services while directing a single or concurrent case(s) excluding those services listed as exceptions under the medical direction guidelines.
Medical Supervision is when an anesthesiologist is responsible for 5 or more anesthesia cases happening concurrently. Medical Supervision must also be billed if a medically directing anesthesiologist cannot fulfill the seven steps of medical direction. Anesthesiologist payment is reduced to three base units per procedure when supervising. An additional (1) time unit may be billed if there is documentation of physician presence at induction.

Are you familiar with running a concurrency report? A concurrency report allows you to be absolutely sure that providers are in only one place at any given time. 

Medicare does not pay for "stand-by" anesthesia. A quick search found that Anthem does recognize "stand-by". http://www.anthem.com/medicalpolicies/guidelines/gl_pw_a050123.htm
It is recommended to research your payer policy.


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## khill (Jun 10, 2014)

*Concurrency*

I do run concurrency each day and my system tabulates and applies the modifiers based on those numbers. I just have the CRNAs and MDAs asking me what the difference is and I tried to explain... I'm not sure they believe what I'm telling them so I wanted to clarify.
They also think they should be paid for stand-by when the surgeon uses local only but I'm not sure that's billable. I would LOVE to attend a workshop that covers ALL THINGS ANESTHESIA!! Even though I've been coding it for years I'm having a lot of questions pop up.
thanks for your answer - not familiar with this forum and would like to use it more regularly....


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## LeslieJ (Jun 10, 2014)

Hi Khill,

You asked, or I wouldn't put this link here. This is going to sound like an ad, please forgive me - unless someone asked, I wouldn't even put this up here.  Michelle Hannon gave you some excellent links, but if you want more information, there's a way you can get it.

DecisionHealth puts on an annual 2-day anesthesia conference - on all things anesthesia! To be fair, I'm a speaker with them and one of my topics is going to be on medical direction, what it means, how it works, the whole bit - and I'll include a handy-dandy cheat sheet along with direct, black & white links from CMS & other places where you can find solid information to show your docs.  

Ask your docs to send you so you can have the answers they need -even bring one along.  Kelly Dennis will be there, as well as Dr. Pam Upadya and a bunch of others.  If you want to spend some time with the pain management team, they're awesome too - Marvel Hammer, Judi Blaszczyk & some others, sometimes they let you go to both tracks so you can get the most out of the time you're there.

Anyhow, you can find information that you need by going here:  http://www.decisionhealth.com/anesthesia/index.html. 

Leslie J


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## khill (Jun 11, 2014)

I will check with my hospital and see if they might help with the cost. maybe my supervisor will want to attend too, if so that might help!! 
I appreciate the info sooooo much. I would love to eventually learn enough to gain a specialty credential in anesthesia!


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