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Anesthesia Coding Alert

Guideline Help:

Georgia Sets the Bar for Clarifying Medical Direction

Published on Wed Jul 20, 2005

A few simple answers can make coding medical direction a whole lot easier

If you have trouble interpreting the rules of medical direction for your anesthesiologists, guidelines from the Georgia Society of Anesthesiologists (GSA) might help. Here's their stance regarding what constitutes an emergency of short duration:
 
"We agree that [the duties CMS states the medically directing anesthesiologist may perform concurrently] are reasonable, consistent with sound medical practice, and would not cause the medically directing anesthesiologist to be in violation of [CMS'] rules for medical direction. As long as the medically directing anesthesiologist 'remains physically present and available for immediate diagnosis and treatment of emergencies,' we would agree that the following procedures would be an illustrative but not exclusive list of allowed interventions:  

  • Placement of a Swan-Ganz catheter, central line or arterial line
     
  • Placement of an epidural catheter for post-operative analgesia or in preparation for subsequent surgery (for a 'to follow' case)
     
  • Placement of other peripheral nerve blocks prior to subsequent surgery, to include brachial plexus blocks, ankle blocks, femoral nerve blocks, etc."

    Codes for these procedures can include:

  • 93503 - Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes

  • 36555-36569 for central venous catheter insertion

  • 36620-36625 - Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous; or ... cutdown

  • 64400-64530 for a diagnostic or therapeutic nerve block to various somatic or sympathetic nerves.

    GSA worked with the state's Medicare carrier to compile the list of common medical-direction questions and answers (published as part of an article titled "Answers to Common Questions Regarding HCFA's Rules for Medical Direction" in the summer 1999 GSA Newsletter). Since then, carriers in other states have considered whether to follow the Georgia guidelines, so it helps to know your carrier's opinion.

    "Compliance with regard to medical direction is one of the biggest issues we face today in regard to billing," says Donna Howe, CPC, of Anesthesiology Associates of Eastern Connecticut in Manchester. Having some guidelines such as the ones from Georgia can help your group determine when services truly qualify as medical direction.

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