Wiki 7 steps to Anesthesia medical direction

[Dawn Shanahan]

I need to get some clarification on step 3; CMS states 3. Personally participate in the most demanding procedures in the anesthesia plan, including (if applicable) induction and emergence. However I also read in and article by Marcella Bucknam on this website that the anesthesiologist MUST be int he room and must participate in induction and emergence when those are elements of the service provided. My providers want to know where CMS states they have to be in the room? Can anyone help me with this?

 

[SharonCollachi]

Here is what you may be looking for: Noridian Medicare (my MAC), states the following: Medical Direction: The physician... would perform the following... 3. Personally participates in anesthesia procedures, including induction and emergence.

Some points for discussion: If induction and emergence are not the most demanding procedure in the anesthesia plan, then what is the most demanding?

Medicare states: The physician must document in the medical record that he or she performed the pre-anesthetic examination and evaluation. Physicians must also document that they provided indicated post-anesthesia care, were present during some portion of the anesthesia monitoring, and were present during the most demanding procedures in the anesthesia plan, including induction and emergence, where indicated.

Also: If anesthesiologists are in a group practice, one physician member may provide the pre- anesthesia examination and evaluation while another fulfills the other criteria. Similarly, one physician member of the group may provide post-anesthesia care while another member of the group furnishes the other component parts of the anesthesia service. However, the medical record must indicate that the services were furnished by physicians and identify the physicians who furnished them. (same link as previous)

Another consideration that factors very heavily with our state medical board is, "What is the accepted standard of practice?" So even if something is not written down somewhere as being what you have to do, if they can show that it is the accepted standard of practice throughout the industry, and NOT doing it is contraindicated to the patient's well-being, then, in effect, that IS the "law" you have to obey.

Do your doctors want to defend themselves in either a malpractice case from a patient, or an independent accusation from the medical board, where they have to explain why they did not think it was necessary for them to be present during the most dangerous portions of the anesthesia plan?