It is important for all anesthesia organizations to understand billing for medical direction. The anesthesiologist medically directs the CRNA or AA when he or she directs one, two, three or four concurrent cases performed by a CRNA or AA. The anesthesiologist may not medically direct more than four concurrent cases.
The Centers for Medicare and Medicaid Services (CMS) seven requirements expect the attending anesthesiologist to perform and document the following:
Perform a pre-anesthesia examination and evaluation
The anesthesiologist must perform and document a pre-anesthesia evaluation and exam prior to surgery or any procedure that requires anesthesia. The anesthesiologist must document this on the anesthesia record. The evaluation must document the patient?s condition such as age, mental status or any physical comorbidities that mays affect the anesthetic. This should include a review of the medical record. The anesthesiologist must also assign an ASA Physical status on the record.
Prescribe the anesthesia plan
According to the pre-anesthesia evaluation the anesthesiologist will determine a plan for the procedure. This is a key feature of Billing for Medical Direction. The anesthesia plan is discussed, prescribed and documented with the anesthesiologist medically directing the case when the evaluation was performed by a nurse practitioner or CRNA. Anesthesia providers may change the plan at any time during the procedure if medically necessary. Changes are documented in the anesthesia record.
Personally, participate in the most demanding aspects of the anesthesia plan, including, if applicable, induction and emergence
The anesthesiologist must document presence and availability throughout the procedure including, if applicable induction and emergence. The signatures must occur at the time of these events. Pre-signing of the record is not acceptable. A MAC or regional anesthetic has no period of induction or emergence. This is one of the steps most likely overlooked when billing for medical direction.