The Centers for Medicare and Medicaid Services is establishing a rule that specifies the periods when a teaching anesthesiologist must be present during a procedure to receive payment for the case at 100 percent of the anesthesia fee schedule amount, according to the release
Effective for services furnished on or after Jan. 1, payment may be made to a qualified teaching anesthesiologist under the Medicare Physician Fee Schedule, at the regular fee schedule amount, for training residents in a single anesthesia case, two concurrent cases or in a single case that is concurrent to another case paid under the medical direction rules.
For this special payment rule to apply:
- The teaching anesthesiologist (or different anesthesiologists in the same physician group) must be present during all critical or key portions of the anesthesia service;
- If different teaching anesthesiologists in the anesthesia group are present during the key or critical periods, the performing physician (for purposes of claims reporting) is the teaching anesthesiologist who started the case; and
- The teaching anesthesiologist (or another anesthesiologist with whom the teaching anesthesiologist has entered into an arrangement) must be immediately available to furnish anesthesia services during the entire procedure.
Patient medical record documentation must also indicate the presence of the teaching physician during all critical or key portion of the anesthesia procedure, according to the release.
For teaching CRNAs, the regular fee schedule amount under Medicare Part B can be paid when the teaching CRNA is continuously present and supervising a single case involving a student nurse anesthetist. For services furnished on or after Jan. 1, the teaching CRNA, not under the medical direction of a physician, can be paid for his/her involvement in each of two concurrent cases with student nurse anesthetists at 50 percent the regular fee schedule rate, according to the release.
A teaching CRNA can also be paid when involved with two student nurse anesthetists and the service is furnished on or after Aug. 1, 2002. Contractors will recognize the full base units (assigned to the anesthesia code) when the teaching CRNA is present with the student nurse anesthetist throughout pre- and post-anesthesia care; and the actual time the teaching CRNA is personally present with the student nurse anesthetist, according to the release. Anesthesia time may be discontinuous.
Read the AAPC’s release about the changes in teaching anesthesiologist payments.
