The Anesthesia Medical Consultation

The PPAC provides an important service—the anesthesia medical consultation. This is not simply a routine preoperative examination but a conference requested by a primary care physician or surgeon who seeks advice on the suitability of the patient for anesthesia in light of the patient's medical condition. Obtaining these consultations 6 or more days before the planned day of surgery has many advantages. It facilitates the planning of intraoperative anesthesia and monitoring requirements, the obtaining of outside consultations and additional testing, and preparation for perioperative pain therapy and discharge. Although this system seems formidable, it was assembled in small steps by a team. The members of the team have agreed in advance not only to develop the plan but also who has responsibility for each aspect of the plan.

An anesthesia medical consultation increases the awareness of surgeons and patients regarding the expertise of the anesthesiologist in perioperative medicine. This process has led to a greater role for the anesthesiologist in perioperative medicine (see The Evolution of Anesthesiology section). This consultation may initiate diagnostic and/or therapeutic actions for a specific medical problem, including referral of the patient to a specialist such as a cardiologist, for help in evaluating and managing a specific concern.

The expertise of the anesthesiologist is evident when he or she is involved in the decision-making process regarding consultations. Fischer^[25] reported a 73% reduction in unnecessary consultations with medical specialists when the anesthesiologist was involved in the consultation decision process, an obvious system cost saving.

Regarding billings, PPAC consultations are first coded using the CPT of the AMA. A professional fee is then submitted, and reimbursement is requested. Although routine visits (those usual in the past) are not billed for, the educational/evaluation process that differs from the past is billed for, and any savings that accrue from reduced length of stay are shared in order to fund the clinic.