Governing Rule: 12.4
Insofar as multiple surgical procedures are concerned, the principles that apply to payment of surgical benefits should also apply to payment of anesthetic benefits. The exceptions to this are:
12.4.1
The surgical treatment of multiple benign skin lesions under anesthesia of less than 35 minutes duration may only be claimed according to the appropriate single anesthetic benefit.
12.4.2
The payment modifications for flaps and tissue resection procedures in reconstructive surgery do not apply to anesthetic benefits.
12.4.3
In multiple fractures treated by closed reduction, the listed anesthetic benefit for the major fracture plus 50% of the anesthetic benefit for each other fracture shall apply.
12.4.4
In cases of compound fractures requiring extensive debridement, the listed anesthetic benefit will be 50% greater.
12.4.5
If unrelated surgical procedures are performed by two physicians in a sequence in different anatomic areas utilizing the same anesthetic, the anesthetic benefit for the major procedure will be paid at 100% and the lesser at 75%.
12.4.6
Notwithstanding 12.4.5, when two physicians are operating simultaneously in different areas, only the greater anesthetic benefit may be claimed.
12.4.7
Anesthesia services for oral surgical procedures insured under the Schedule of Oral and Maxillofacial Surgery Benefits will be paid according to GR 6.9.
12.4.8
The benefits that may be claimed for a redo cardiac, thoracic or vascular anesthetic are as follows:
- 150% of the listed anesthetic benefit if the procedure is performed entirely through a previous incision;
- 125% if part of the procedure is performed through a previous incision.
Refer to GR 6.15.
12.4.9
Notwithstanding GR 6.9.7e), a benefit may be claimed at the full rate for each fracture, which requires open reduction, continuous traction, or extensive skeletal fixation in addition to the full benefit for the major fracture.