When Anesthesia services are recommended

Patient-controlled analgesia (PCA) as a single postoperative limited consultation.

Postoperative epidural narcotic analgesia under the following circumstances:

* When general anesthesia is administered on the same date of service as a single epidural injection of narcotics or an epidural catheter insertion for continuous administration of narcotics.
* When epidural anesthesia is administered for the surgical procedure and post-operative epidural narcotics are administered on the same date of service, the post-operative epidural narcotic administration is covered under CPT code 01996 - daily hospital management, only if the record demonstrates that the anesthesiologists’ administration of the agent required patient care substantially beyond the intra-operative and normal recovery period

Monitored anesthesia care (MAC) when the following criteria are met:
• The service must be requested by the attending physician in accordance with accepted procedures of the institution where the service is performed.
• Request for MAC services must be documented to show that the anesthesiologist is physically present or immediately available during the period for which benefits are requested in accordance with the provisions of Rule 2 of our Rules and Regulations regarding participating providers.
• All regulations pertaining to anesthesia services must be honored, and all usual services performed by the anesthesiologist are furnished with exception of the administration of an “anesthetic agent." These services may include:
− Cardiocirculatory and respiratory monitoring
− Intravenous administration of vasoactive drugs, sedatives, tranquilizers, narcotics, and other analgesic and therapeutic agents.
− Oxygen administration
• Benefits are provided for MAC for ASA (American Society of Anesthesiologist) physical status 1-5, for the following categories:
extremes of age requiring sedation and/or monitoring
bleeding requiring fluid and/or blood therapy
extreme fear or apprehension requiring sedation
head, face, neck surgery involving concern for airway management
unusually long procedures requiring sedation

unstable medical conditions or emergency operations
anticipated pain not entirely manageable with local anesthesia
systemic severe illness complicating peri-operative care.
Insertion of epidural or intrathecal catheter for narcotic infusion for intractable pain due to malignant disease.

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