Anesthesia Medical direction guidelines.

Criteria for Medical Direction

Anesthesiologists can be reimbursed for the personal medical direction (as distinguished from supervision) that they furnish to CRNAs.
Medical direction services personally performed by an anesthesiologist will be reimbursed only if the anesthesiologist:
• Performs a pre-anesthetic examination and evaluation;
• Prescribes the anesthesia plan;
• Personally participates in the most demanding procedures in 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 individual;
• Monitors the course of anesthesia administration at frequent intervals;
• Remains physically present in the surgical suite and available for immediate diagnosis and treatment of emergencies; and
• Provides indicated post-anesthesia care.
 If anesthesiologists are in a group practice, one physician member may provide the preanesthesia examination and evaluation, and another may fulfill the other criteria. Similarly, one physician member of the group may provide post anesthesia care, while another member of the group provides the other component parts of anesthesia services. However, the medical record
must indicate that physicians provided the services and identify the physicians who rendered them.
MHCP will reimburse anesthesiologists for supervision of residents per Medicare’s formula and restrictions. The teaching physician must be present during induction, emergence, and during all critical portions of the procedure, and immediately available to provide services during the entire procedure. The documentation in the medical records must indicate the teaching anesthesiologist’s presence or participation in the administration of the anesthesia. The teaching physician’s presence is not required during the pre-operative or post-operative visits with the recipient. MHCP follows Medicare guidelines for reimbursement to anesthesiologists for the supervision of residents. MHCP does not reimburse for anesthesia assistants or interns.

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