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**ANESTHESIA MEDICATIONS

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Medications Used in General Anesthesia:
Propofol, Vecuronium bromide, pancuronium, Halothane, Enflurane, Isoflurane, Midazolam, Ketamine, Nitrous Oxide, Thiopental, Etomidate, Atracurium

Regional Anesthesia:
Mepivacaine, Chloroprocaine, Lidocaine

Local Anesthesia:
Procaine, Lidocaine, Tetracaine, Bupivacaine

Topical Anesthesia:
Benzocaine, Lidocaine, Dibucaine, Pramoxine, Butamben, Tetracaine (Sprays, Ointments, Creams, Gels)

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ANESTHESIA CARE TEAM

Anesthesia Medications ::: A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside of anesthesia, although others are used commonly by all disciplines. Anesthetics are categorized in to two classes: general anesthetics , which cause a reversible loss of consciousness, and local anesthetics , which cause a reversible loss of sensation for a limited region of the body while maintaining consciousness. Combinations of anesthetics are sometimes used for their synergistic and additive therapeutic effects, however, adverse effects may also be increased. **See Below For A Quick Look At Anesthesia Medications
ANESTHESIA CARE TEAM
- ASA
ADDENDUM B:
Commonly Used Billing Rules and Definitions:
ASA recognizes the existence of commercial and governmental payer rules applying to billing for anesthesia services and encourages its members to comply with them whenever possible. Some commonly prescribed duties include:

Performing a preanesthetic history and physical examination of the patient; Prescribing the anesthetic plan; Personal participation in the most demanding portions of the anesthetic, including induction and emergence, where applicable; Delegation of anesthesia care only to qualified anesthesia providers; Monitoring the course of anesthesia at frequent intervals; Remaining physically available for immediate diagnosis and treatment while medically responsible;
Providing indicated postanesthesia care, and; Performing and documenting a post-anesthesia evaluation.
ASA also recognizes the lack of total predictability in anesthesia care and the variability in patient needs that can, in particular and infrequent circumstances, make it less appropriate from the viewpoint of overall patient safety and quality to comply with all payment rules in each patient at every moment in time. Reporting of services for payment must accurately reflect the services provided. The ability to prioritize duties and patient care needs, moment to moment, is a crucial skill of the anesthesiologist functioning safely within the anesthesia care team. Anesthesiologists must strive to provide the highest quality of care and greatest degree of patient safety to ALL patients in the perioperative environment at ALL times.
MEDICAL "DIRECTION" by anesthesiologists - A billing term describing the specific anesthesiologist work required in and restrictions involved in billing payers for the management and oversight of nonphysician anesthesia providers. This pertains to situations where anesthesiologists are involved in not more than four concurrent anesthetics. See individual payer manuals for specifics.

MEDICAL "SUPERVISION" by anesthesiologists - Medicare payment policy contains a special payment formula for "medical supervision" which applies "when the anesthesiologist is involved in furnishing more than four procedures concurrently or is performing other services while directing the concurrent procedures." [Note: The word "supervision" may also be used outside of the Anesthesia Care Team to describe the perioperative medical oversight of nonphysician anesthesia providers by the operating practitioner/surgeon. Surgeon provided supervision pertains to general medical perioperative patient management and the components of anesthesia care that are medical and not nursing functions (e.g., determining medical readiness of patients for anesthesia and surgery, and providing critical medical management of unexpected emergencies).]

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