Medically Directed
Concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether these other procedures overlap each other. Medical direction occurs if the physician medically directs qualified individuals in two, three, or four concurrent cases, and the physician performs the following activities:
** Pre-anesthetic examination and evaluation
** Prescribes the anesthesia plan
** Personally participates in the most demanding procedures in the anesthesia plan, including, if applicable, induction and emergence
** Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist
** Monitors the course of anesthesia administration at frequent intervals
** Remains physically present and available for immediate diagnosis and treatment of emergencies
** Provides indicated post-anesthesia care
The medical record must reflect that the physician performed services as indicated above. It should be noted that if anesthesiologists are in a group practice, one physician may provide the pre- and/ post-anesthesia exam and evaluation while another fulfills the other criteria. The medical record must reflect that services were performed by physicians and identify the physicians who furnished them.
Monitored Anesthesia Care
Intra-operative monitoring by an anesthesiologist or other qualified provider under the direction of the anesthesiologist, of the patient’s vital physiological signs in anticipation of the need for admission of general anesthesia or the development of adverse physiological patient reaction to the surgical procedure.
MAC is eligible for coverage when performed by an eligible provider (see above), and all of the following criteria is met:
** MAC is requested by the attending physician or operating surgeon
** There is performance of a pre-anesthetic examination and evaluation
** There is a prescriptive anesthesia plan outlining the anesthesia care required
** Administration of necessary oral and parenteral medication takes place
** There is continuous physical presence of the anesthesiologist or in the case of medical direction, a qualified anesthetist
