Anesthesia Coding Alert

Question: How does Medicare define "periodic monitoring" on medical-direction cases?


Connecticut Subscriber

Answer: Many coders believe that Medicare purposely leaves the "periodic monitoring" criterion of medical-direction guidelines vague so different medical practices can interpret it for themselves.

Failure to document frequent physician monitoring for medically directed cases is a high anesthesia risk area, according to information from the American Society of Anesthesiologists (ASA). The ASA's April 2001 newsletter said, "In many cases, documenting monitoring one or two times per hour will be adequate," which gives you a rule of thumb to follow.

Go to your state Medicare carrier's Web site and search for "periodic monitoring," or read whatever information it has posted about medical supervision and direction. Then work with your anesthesia team members to determine your specific definition of "frequent or periodic monitoring." Write it as an official policy, file the policy within the department and have it available for auditors if the need arises.

More advice: Some coders say you should establish a periodic monitoring policy but not put specific time frames in writing. Their reasoning is that if you have a policy stating that "periodic monitoring" means "every 15 minutes" and a physician checks on the patient after 20 minutes, your physician is not following policy -- when, in fact, the 20 minute check-in could be fine for that patient. Instead, discuss "periodic monitoring" within your group and agree to reasonable time frames, but don't include times in your policy.