Anesthesia Coding Alert

Administering labor epidural doesn't alter calculations

The ins and outs of medical direction -- reporting an anesthesiologist's involvement in several concurrent cases -- is an ongoing documentation checkpoint unique to anesthesia coders. Verify that cases are concurrent (overlapping) and ensure that the anesthesiologist meets -- and documents -- all of CMS' seven criteria for medical direction before reporting cases as medically directed:
 
Performs a pre-anesthetic examination and evaluation
Prescribes the anesthesia plan
Personally participates in the most demanding procedures of the anesthesia plan, including induction and emergence (if applicable; this criterion doesn't apply to MAC cases, says Kelly Dennis, CPC, of Perfect Office Solutions in Leesburg, Fla.)
Ensures that any procedures in the anesthesia plan that he does not perform are performed by a qualified individual
Monitors the course of anesthesia administration at frequent intervals
Remains physically present and available for immediate diagnosis and treatment of emergencies
Provides indicated postanesthesia care. The anesthesiologist may perform certain duties for other patients while medically directing cases, according to further information with the guidelines. The guidelines list six tasks of short duration that fall in this realm, including administering an epidural or caudal anesthetic to a labor patient. Because of this, the anesthesiologist can start the epidural without conflicting with cases he will report as medically directed -- if he's still available for the other cases.

"I always try to mention that the anesthesiologist will lose medical-direction status if he or she has problems with the labor epidural patient and is not available to the medically directed CRNA or CRNAs," Dennis says. "Remember, the rules state that the physician is performing periodic rather than continuous monitoring of an obstetric patient in order to comply with medical- direction guidelines."