Anesthesia Coding Alert

Answer: Usually, when an anesthesiologist is concurrently providing medical direction, they cannot provide additional services to other patients — although there are some exceptions.

Key: While an anesthesiologist who is concurrently providing medical direction cannot typically provide additional services to other patients, the Centers for Medicare & Medicaid Services (CMS) has identified several services as permissible exceptions to the medical direction rules, meaning that the anesthesiologist is allowed to perform these services while still medically directing other cases.

For example, consider labor epidurals. A physician can medically direct a case and leave the area to administer an epidural to ease labor pain, as long as they are still close enough to return if needed, which will depend on the facility layout.

Exceptions also exist for receiving the next surgical patient, checking or discharging patients in the recovery room, handling scheduling matters, addressing an emergency of short duration in the immediate area, and periodically monitoring an obstetrical patient.

Some Medicare Administrative Contractors (MACs) have allowed arterial line placement or acute postoperative pain management blocks in the immediate area. However, chronic pain management interventions would not be an exception.

Caveat: Thorough documentation of any care you’re reporting as an exception to medical direction is critical to receiving and retaining payment.