7/25/13 – Medical Direction

Question: Does an anesthesiologist have to be physically present to provide medical direction?

Answer: The words “supervision” and “medical direction” often are used interchangeably, but for Medicare reimbursement purposes, the two terms mean different things:


–  Supervision refers to the anesthesiologist who is involved in more than four concurrent procedures in which one or more CRNAs, AAs or medical residents or interns are involved.

–  Medical direction refers to an anesthesiologist’s involvement with a CRNA or AA in one, two, three or four concurrent procedures where the anesthesiologist is physically present.


Medicare doesn’t recognize medical direction by the anesthesiologist if he is                   involved in more than four concurrent procedures.  In the case where the                           anesthesiologist takes on five or more concurrent procedures or performs                         other services while directing the concurrent procedures, he is supervising, not                medically directing, the anesthetists.


Exception – The following three situations, however, aren’t counted by                                Medicare as concurrent procedures:


1) Addressing an emergency of short duration in the immediate area
2) Administering an epidural or caudal anesthetic to ease labor pain
3) Periodic, rather than continuous, monitoring of an obstetrical patient


These three situations don’t “substantially diminish the scope of control                               exercised by the physician in directing the administration of anesthesia to the                     surgical patients.” Medicare wouldn’t count these instances as separate procedures when determining whether a procedure is medically directed or supervised.


Similarly, except for the situation listed above, CRNA’s are considered supervised, not medically directed, if the anesthesiologist isn’t physically  present for a procedure.


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