9/25/13 – Conditions Required for Medically Directed Anesthesia

Question: What conditions are required for payment of medically directed anesthesia?

Answer:  In order to bill medically directed anesthesia services, seven primary elements need to be clearly indicated in the medical record:


1) The physician must perform a pre-anesthetic examination and evaluation.

2) The physician must prescribe the anesthesia care.

3) The physician must personally participate in the most demanding aspects of the anesthesia plan, including, if applicable, induction and emergence.

4) The physician must assure that any procedures in the anesthesia plan, that he or she does not perform, are performed by a qualified individual as defined in the operating instructions.

5) The physician must monitor the course of the anesthesia administration at frequent intervals.

6) The physician must remain physically present and available for immediate diagnosis and treatment of emergencies.

7) The physician must provide indicated post-anesthesia care.


If one or more of these elements is not indicated in the medical record, the claim may be denied altogether, sometimes for both the physician and the CRNA services. The physician alone is responsible for documenting each of these activities in the chart. Like everything else, if it is in the chart, it was not done.


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