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Anesthesia Services: General Information

Provider Qualifications

For Medicare purposes, anesthesia services may be provided by physicians, Certified Registered Nurse Anesthetists (CRNAs), or Anesthesiologist Assistants (AAs) under the medical supervision of a physician.

Provider Type
Instructions
Physician – Anesthesiologist
Physician is defined as a doctor of medicine who is legally authorized to practice in the State in which he/she performs services. The issuance of a license by a State to practice constitutes legal authorization. If the State licensing law limits the scope of practice of a particular type of medical practitioner, only the services within these limitations are covered.
Anesthesiologist Assistants &
Certified Registered Nurse Anesthetists
For payment purposes, qualified anesthetists are Anesthesiologist Assistants (AAs) and Certified Registered Nurse Anesthetists (CRNAs).

An AA is a person who:
  • Is permitted by state law to administer anesthesia
  • Has successfully completed a six (6) year program for Anesthesiologists Assistants of which two (2) years consist of specialized academic and clinical training in anesthesia.

A CRNA is a registered nurse who is licensed by the state in which the nurse practices and who:
  • Is currently certified by the Council on Certification of Nurse Anesthetists or
  • The Council on Recertification of Nurse Anesthetists or
  • Has graduated within the past 18 months from a nurse anesthesia program meeting the standards of the Council of Accreditation of Nurse Anesthesia Educational Programs and awaits initial certification.

CRNAs and AAs may submit claims to Medicare directly for their services or have payment made to an employer or an entity under which they have a contract. This could be a hospital, physician or Ambulatory Surgical Center.

Note: Locum Tenens arrangements do not apply to CRNAs and AAs.

Key Terms

Term
Definition
Group Practice
 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. Only one member of the group would bill for the entire anesthesia service

Note: The medical record must indicate the services furnished and identify the physicians who furnished them.
Concurrent Medical Direction
CRNAs/AAs providing anesthesia services under the medical direction of an anesthesiologist must have uninterrupted immediate availability of an anesthesiologist at all times.

When a medically directing anesthesiologist provides temporary relief to another anesthesia provider, the need for uninterrupted immediate availability may be met by any of the following strategies:
  • A second anesthesiologist, not medically directing more than three concurrent procedures, may assume temporary medical direction responsibility for the relieving anesthesiologist
    • The transfer of responsibility from one physician to another should be documented in the medical record
  • Policy and procedure may require that the relieved provider remain in the immediate area and be available to immediately return to his/her case in the event the relieving anesthesiologist is required elsewhere
    • Adequate mechanisms for communication among staff must be in place
  • Policy and procedure requires that a specified anesthesiologist (e.g., O.R. Director) remain available at all times to provide substitute medical direction services for anesthesiologist(s) providing relief to anesthesia providers
    • This individual must not personally have ongoing medical direction responsibilities that would preclude temporarily assuming responsibility for additional case(s)
Personally Performed
The following criteria apply to anesthesia services that are personally performed:
  • The physician personally performed the entire anesthesia service alone;
  • The physician is a teaching physician and is involved with one anesthesia case with a resident;
  • The physician is continuously involved in a single case involving a student nurse anesthetist; or
  • The physician and the non medically directed CRNA (or AA) are involved in one anesthesia case and the services of each are found to be medically necessary
Medical Direction
Medical direction occurs if the physician medically directs qualified individuals in two, three, or four concurrent cases and the physician performs the following activities:
  • Performs a pre-anesthesia examination and evaluation
  • Prescribes the anesthesia plan
    • Personally participates in the most demanding procedures of the anesthesia plan, including induction and emergence, if applicable
    • Ensures that any procedures in the anesthesia plan that he/she does not perform are performed by a qualified anesthetist
  • Monitors the course of anesthesia administration at frequent intervals
    • Remains physically present and available for immediate diagnosis and treatment of emergencies; and Provides indicated post-anesthesia care
  • Medically directs not more than 4 concurrent procedures involving CRNAs, AAs, interns or residents
  • Medically directs not more than 2 concurrent cases,  each of involves a student nurse anesthetist, or the physician directs one case involving a student nurse anesthetist and another involving a CRNA, AA, intern or resident
For medical direction services, the physician must document in the medical record that he or she performed the pre-anesthetic exam 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, including induction and emergence, if applicable
Medically Supervised
When an anesthesiologist is involved in rendering more than four procedures concurrently or is performing other services, while directing the concurrent procedures, the anesthesia services are considered medically supervised
Anesthesia Services & Teaching Anesthesiologist
If a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he or she was present during all critical (or key) portions of the procedure.

The teaching physician’s physical presence during only the preoperative or postoperative visits with the beneficiary is not sufficient to receive Medicare payment. If an anesthesiologist is involved in concurrent procedures with more than one resident or with a resident and a non-physician anesthetist, the anesthesiologist’s services will be paid at the medically directed rate.

Use HCPCS modifier GC (Teaching Physician Service) to indicate the service has been performed in part by a resident under the direction of a teaching physician. This modifier is added after the anesthesia modifier.

References:

 

last updated on 08/17/2009
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