Medical direction may apply to a single anesthesia service furnished by a CRNA or up to four
concurrent anesthesia services. A physician who is directing the administration of anesthesia to four
surgical members is not expected to be involved routinely in furnishing any additional services to other
members. Addressing an emergency of short duration in the immediate area, administering an
epidural or caudal anesthetic to ease labor pain, or periodic rather than continual monitoring of an
obstetrical member would not substantially diminish the physician’s capacity to direct the CRNA

The medical directing anesthesiologist must document in the member’s medical record that all
medical direction requirements have been met, including:

• Perform the pre-anesthetic examination and evaluation

• Prescribe the anesthesia plan

• Participate personally in the most demanding aspects of the anesthesia plan, including, if
applicable, induction and emergence

• Ensure a qualified individual performs any procedure in the anesthesia plan he/she does not
perform personally

• Monitor the course of anesthesia administration at frequent intervals

• Remain physically present and available for immediate diagnosis and treatment of emergency
that may develop

• Provide indicated post-anesthesia care.

A physician may appropriately receive members entering the operating suite for the next surgery while
directing concurrent anesthesia procedures. However, checking or discharging members in the
recovery room and handling scheduling matters are not compatible with reimbursement to the
physician for directing concurrent anesthesia procedures.

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