# Deducting Time for Lines & Blocks A Key Clarification of the Rule



## mhart (May 3, 2011)

Checking if anyone has read any news concerning anesthesiologist billing of lines and blocks. I came across this Billing and Compliance Alert that offers clarification on the ASA's 2007 rule regarding the billing of anesthesia time in conjunction with an invasive line or post-op pain The alert states: "In a March 17, 2011 letter to healthcare attorney David Vaughn, the AMA (in consultation with the ASA) advised that there are two circumstances in which time spent placing invasive lines or post-op pain blocks while in the OR, but prior to induction of the primary anesthetic, would NOT need to be deducted from total anesthesia time. Those circumstances are as follows:
- Where a medically directing anesthesiologist places the line or post-op pain block, the
time does not need to be deducted since the CRNA is providing ongoing anesthesia service
during such placement.
- Where an anesthesiologist is providing ongoing anesthesia care, and one of his/her
partners (a separate anesthesiologist) comes into the OR only to place the line or post-op pain block, no anesthesia time needs to be deducted since the patient has uninterrupted anesthesia care from the anesthesiologist who is handling the case. (The AMA noted that it expected such a case involving 2 anesthesiologists to be rare.)"
Does this now mean that a directing anesthesiologist can bill for a post-op pain block (after anesthesia care begins but before induction) without deducting time spent on the block?

Any help with understanding this alert would be appreciated!


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## dwaldman (May 3, 2011)

Below in the Medicare Claims Processing Manual Chp 12 they state the physician can still be providing "medical direction" for a case and remove himself  at an appropriate time to adminstered an epidural for another patient. They don't go in detail about the line placement and time or blocks for the same patient who anesthesia is provided that I could find. But....

I think the Alert that you have is really a good explanation from the AMA. I believe that it could be clarified further----but reading it a couple times makes sense if you are dealing with the same example they are giving. Maybe another forum member could expand on their points.

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

Page 122-123

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.

F. Payment for Medical and Surgical Services Furnished in Addition to Anesthesia Procedure
Payment may be made under the fee schedule for specific medical and surgical services furnished by the anesthesiologist as long as these services are reasonable and medically necessary or provided that other rebundling provisions (see §30 and Chapter 23) do not preclude separate payment. These services may be furnished in conjunction with the anesthesia procedure to the patient or may be furnished as single services, e.g., during the day of or the day before the anesthesia service. These services include the insertion of a Swan Ganz catheter, the insertion of central venous pressure lines, emergency intubation, and critical care visits.


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## mhart (May 4, 2011)

Thank you for your insight on this matter. I am not sure how much weight can be given to this alert, but it offers another person's interpretation to an ongoing discussion.


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