Wiki billing when no drugs are given

[jayne]

We have had several occasions lately where our CRNA has been in the OR monitoring the patient, but no anesthesia was actually given. In most of these cases, he was "stand-by", in case the patient did require anesthesia. In all of the cases, he was monitoring the patient's vitals through the entire procedure. Is this still considered MAC, since no drugs were given? Some of these are medicare. Would appreciate any help. Thanks!

 

[Michele Hannon]

Several payers have documented definitions of "stand-by" anesthesia. The following is the definition provided by Anthem:
Standby anesthesia service is when the anesthesiologist would be immediately available if a clinical need should arise but the anesthesiologist may be elsewhere performing other duties. Stand-by anesthesia is considered medically necessary when a procedure, which does not normally require anesthesia services, has a significant potential for catastrophic complications or potential for the need of other intervention that would require immediate availability of general anesthesia.

Medicare does no pay for "stand-by" anesthesia:
http://www.medicarenhic.com/providers/pubs/AnesthesiaBillingGuide.pdf See page 12

Medicare and the ASA also have very clearly defined MAC anesthesia and the requirements necessary to bill for it.
This all being said........anesthesia providers get reimbursed for services deemed medically necessary by the payer.