# time guidelines qx



## elisaarb (Dec 28, 2011)

inquiry regarding correct billing...when submitting claims for anesthsiologist medically directing up to four rooms..billing for crna (qx) charge: what is the correct time to put as start time for crna?  when the dr starts or when the crna actually takes over?


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## dwaldman (Dec 28, 2011)

If the documentation supports the physician met the medical direction criteria for the cases he was involved in he could report with the start and end times from the anesthesia record is my understanding.

http://www.cms.gov/manuals/downloads/clm104c12.pdf

Page 120

 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.


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## RonMcK3 (Dec 29, 2011)

This answers re the anesthesiologist's time. Can you answer OP's query re what start/stop times to show for each CMA being supervised by the anesthesiologist?

Thanks,


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## dwaldman (Dec 29, 2011)

My point was if the physician is meeting the medical direction criteria and they are going to report medical direction for four separate cases for the anesthesiologist with QK and each CRNA is going to report QX for those four cases. The start and end times from each of those cases would be reported based on the start and end times upon the anesthesia record. There would be 50/50 split in payment for the medically directing anesthesiologist and the CRNA per case.


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## RonMcK3 (Dec 30, 2011)

Thanks,


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