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6.3.4.7 Medical Direction by an Anesthesiologist
Medical direction by an anesthesiologist of an anesthesia practitioner is a benefit of Texas Medicaid if the following criteria are met:
• No more than four anesthesia procedures are being performed concurrently.
•The anesthesiologist is physically present in the operating suite.
Exception: Anesthesiologists may be considered for reimbursement when they medically direct more than four anesthesia services or simultaneously supervise a combination of more than four CRNAs or other qualified professionals under emergency circumstances only.
Medical direction provided by an anesthesiologist is a benefit of Texas Medicaid if the following criteria are met:
•The anesthesiologist performs a preanesthetic examination and evaluation.
•The anesthesiologist prescribes the anesthesia plan.
•The anesthesiologist personally participates in the critical portions of the anesthesia plan, including induction and emergence.
•The anesthesiologist ensures that a qualified professional can perform the procedures in the anesthesia plan that the anesthesiologist does not perform personally.
•The anesthesiologist monitors the course of anesthesia administration at intervals.
•The anesthesiologist provides direct supervision when medically directing an anesthesia procedure. Direct supervision means the anesthesiologist must be immediately available to furnish assistance and direction.
•The anesthesiologist provides postanesthesia care.
The anesthesiologist does not perform any other services (except as noted below) during the same time period. The anesthesiologist who directs the administration of no more than four anesthesia procedures may provide the following without affecting the eligibility of the medical direction services:
•Address an emergency of short duration in the immediate area
•Administer an epidural or caudal anesthetic to ease labor pain
•Provide periodic, rather than continuous, monitoring of an obstetrical patient
•Receive clients entering the operating suite for the next surgery
•Check or discharge clients in the recovery room
•Handle scheduling matters
As noted above, an anesthesiologist may concurrently medically direct up to four anesthesia procedures. Concurrency is defined as the maximum number of procedures that the anesthesiologist is medically directing within the context of a single procedure and whether those other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicaid client. For example, if three procedures are medically directed but only two involve Medicaid clients, the Medicaid claims should be billed as concurrent medical direction of three procedures.
For medical direction, the anesthesiologist must document in the client's medical record that he or she did the following:
•Performed the pre-anesthetic exam and evaluation.
•Provided indicated post-anesthesia care.
•Was present during the critical and key portions of the anesthesia procedure, including, if applicable, induction and emergence.
•Was present during the anesthesia procedure to monitor the client's status.
The following information must be available to state agencies upon request and is subject to retrospective review:
•The name of each CRNA or other qualified professional that was concurrently medically directed or supervised and a description of the procedure that was performed must be documented and maintained.
•Signatures of the anesthesiologist, CRNAs, or other qualified professionals involved in administering anesthesia services must be documented in the client's medical record.
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