California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.3 - Official Medical Fee Schedule › Section 9789.18.2 - Anesthesia - Personally Performed Rate

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The anesthesia fee calculation will recognize the base
						unit for the anesthesia code and time units as calculated in accordance with
						section 9789.18.8 in any of the following
						circumstances:
(a) The physician
					 personally performed the entire anesthesia service alone;
(b) The physician is involved with one
					 anesthesia case with a resident and the physician is a teaching physician. A
					 teaching physician is a physician (other than another resident) who involves
					 residents in the care of his or her patients. The teaching physician must
					 document in the medical records that he/she was present during all critical (or
					 key) portions of the procedure. The teaching physician's physical presence
					 during only the preoperative or postoperative visits with the patient is not
					 sufficient;
(c) The physician is
					 involved in the training of physician residents in a single anesthesia case,
					 two concurrent anesthesia cases involving residents or a single anesthesia case
					 involving a resident that is concurrent to another case paid under the medical
					 direction rules. The teaching anesthesiologist, or different anesthesiologists
					 in the same anesthesia group, must be present during all critical or key
					 portions of the anesthesia service or procedure involved. The teaching
					 anesthesiologist (or another anesthesiologist with whom the teaching physician
					 has entered into an arrangement) must be immediately available to furnish
					 anesthesia services during the entire procedure. The documentation in the
					 patient's medical records must indicate the teaching physician's presence
					 during all critical or key portions of the anesthesia procedure and the
					 immediate availability of another teaching anesthesiologist as
					 necessary;
(d) The physician is
					 continuously involved in a single case involving a student nurse
					 anesthetist;
(e) The physician is
					 continuously involved in one anesthesia case involving a CRNA (or AA). If the
					 physician is involved with a single case with a CRNA (or AA) the physician
					 service and the CRNA (or AA) service may be paid in accordance with the medical
					 direction payment policy; or
(f)
					 The physician and the CRNA (or AA) are involved in one anesthesia case and the
					 services of each are found to be medically necessary. Documentation must be
					 submitted by both the CRNA and the physician to support payment of the full fee
					 for each of the two providers. The physician reports the "AA" modifier and the
					 CRNA reports the "QZ" modifier for a nonmedically directed case.
1. New
						section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and
						print only pursuant to Government Code section
						11340.9(g)
						(Register 2013, No. 39).
2. Amendment of first paragraph filed
						11-6-2018; operative 1-1-2019. Submitted to OAL for filing and printing only
						pursuant to Government Code section
						11340.9(g)
						(Register 2018, No. 45).
Note: Authority: Sections
						  133,
						  4603.5,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  5307.1 and
						  5307.11, Labor
						  Code.