The Health Care Financing Administration (HCFA) guidelines state that a medically directing anesthesiologist may perform other duties concurrently, such as performing periodic rather than continuous monitoring of an obstetrical patient, checking or discharging patients in Post Anesthesia Care Unit (PACU), and coordinating scheduling matters. Because of thisand because of the number of simultaneous cases that may require anesthesiaits common for a medically directing anesthesiologist to share time on a case with one or more other members of the same anesthesia-providing group.
Mryl Smith, coding manager with Healthpac Computers, a physician and hospital billing service in Savannah, GA, that mainly handles anesthesia and radiology claims, says that before a case can be considered medically directed, HCFA mandates that the anesthesiologist meet several criteria, sometimes called the seven rules of medical direction. The physician must:
1. perform a pre-anesthesia examination and evaluation;
2. prescribe the anesthesia plan;
3. personally participate in the most demanding
procedures of the anesthesia plan, including induc-
tion and emergence;
4. ensure that any procedures in the anesthesia plan
that he or she does not perform are performed by a qualified anesthetist;
5. monitor the course of anesthesia administration at
intervals;
6. remain physically present and available for immedi-
ate diagnosis and treatment of emergencies; and
7. provide indicated post-anesthesia care.
Once a case has been deemed medically directed, the question for many coders is: How should the shared services be billed? The answer: It depends on which member of the anesthesia team performs which services at which times.
Members of the Georgia Society of Anesthesiologists (GSA) wanted to be sure they were coding correctly, so they decided to go straight to the source. The Georgia Society of the American Society of Anesthesiologists (ASA) submitted a list of questions to Medicare to try and make sense of the OR rules, says Judy Chesin, president of the Georgia Anesthesia Administrators Association (GAAA). Were beginning to get answers back from HCFA, and the rules arent as vague as we originally thought. Having concrete answers to common situations makes it easier for us to code procedures right the first time, and speed up the reimbursement process.
The following questions and answers are based on information GSA developed with Cahaba Benefits Administrators, Georgias Medicare carrier. The information applies to anesthesia practices in Georgia and possibly other states with Cahaba Medicare. Chesin recommends that coders check with their local carriers for specific requirements in their state, and consider using the Georgia guidelines to clarify these issues with other Medicare carriers.
