Anesthesia Coding Alert

Here are two sets of rules to keep in mind for getting surefire reimbursement on your anesthesia claims and to stay on the right side of the federal authorities at the same time.

Rule: According to Section 415.110 of the Code of Federal Regulations, the conditions under which anesthesiologists can be reimbursed by Medicare for "medically directing" one through four concurrent anesthesia services can be summarized as follows:

For each patient, the anesthesiologist must fulfill seven conditions in the performance of the anesthesia service. These involve:

1. Performs a pre-anesthetic examination and evaluation

2. Prescribes the anesthesia plan

3. Personally participates in the most demanding procedures of the anesthesia plan, including induction and emergence

4. Ensures that any procedures in the anesthesia plan that he does not perform are performed by a qualified individual

5. Monitors the course of anesthesia administration at frequent intervals

6. Remains physically present and available for immediate diagnosis and treatment of emergencies

7. Provides indicated postanesthesia care.

This set of requirements is patterned closely after the ASA's own definition of "medical direction" that is part of the ASA's "Guidelines for the Ethical Practice of Anesthesiology."

While "medically directing," the anesthesiologist may not perform any other services so that adherence to the activities listed above can be ensured.

Despite this apparent prohibition, Medicare, through its Medicare Carriers Manual, has listed several activities, most of short duration, that an anesthesiologist may be involved in while "medically directing":

1. address an emergency of short duration in the immediate area

2. administer an epidural or caudal anesthetic to ease labor pain

3. provide periodic, rather than continuous, monitoring of an obstetrical patient

4. receive patients entering the operating suite for the next surgery

5. check or discharge patients in the recovery room

6. handle scheduling matters.

Note: Some states also allow other exceptions, such as placing arterial lines. Check with your carrier before filing your claim.

Resource: You can find the ASA "Guidelines for the Ethical Practice of Anesthesiology" at http://www.asahq.org/publicationsAndServices/standards/10.pdf.