0021 Anaesthetic fees are determined by obtaining the sum of the BASIC ANAESTHETIC UNITS AND THE TIME UNITS. IN CASES OF OPERATIVE PROCEDURES ON THE MUSCULO-SKELETAL SYSTEM, OPEN FRACTURES AND OPEN REDUCTION OF FRACTURES OR DISLOCATIONS ADD FEES AS LAID DOWN BY MODIFIERS 5441 TO 5448.
0023 The basic anaesthetic units are laid down in the tariff. These basic anaesthetic units reflect the additional anaesthetic risk, the technical skill required of the anaesthesiologist and the scope of the surgical procedure, but exclude the value of the actual time spent administering the anaesthetic. The time units (indicated by "T") will be added to the listed basic anaesthetic units in all cases on the following basis:
Anaesthetic time: The remuneration for anaesthetic time shall be per 15 minute period or part thereof, calculated from the commencement of the anaesthetic e.g. 2,00 anaesthetic units (R71.00) per 15 minute period or part thereof, provided that should the duration of the anaesthetic be longer than one hour the fee shall, after one hour be 3,00 anaesthetic units (R106.60) per 15 minute period or part thereof.
0024 If a pre-operative assessment of a patient by the anaesthesiologist, is not followed by an operation it will be regarded as consultation at the hospital or nursing home.
0025 Anaesthetic time is calculated from the time the anaesthesiologist begins to prepare the patient for the induction of anaesthesia in the operating theatre or in a similar equivalent area and ends when the anaesthesiologist is no longer required to give his personal professional attention to the patient, i.e. when the patient may, with reasonable safety, be placed under the customary post-operative supervision. Where prolonged personal professional attention is necessary for the well-being and safety of such patient, the necessary time will be valued on the same basis as indicated above for anaesthetic time. The anaesthesiologist must show in his account the exact anaesthetic time and the supervision time spent with the patient.
0027 Where more than one operation is performed under the same anaesthetic, the basic value will be that of the major operation with the highest unit value.
0029 When rendered necessary by the scope of the anaesthetic an assistant anaesthesiologist may be employed. The remuneration of the assistant anaesthesiologist shall be calculated on the same basis as in the case where a general practitioner administers the anaesthetic.
0031 Treatment with intravenous drips and transfusions is considered part of the normal treatment in administering an anaesthetic. No additional fees may be charged for such services when rendered either prior to, or during actual theatre or operating time.
0032 Anaesthesia administered to patients in the prone position shall have a minimum of 4,00 basic anaesthetic units (R142.10).
0033 When an anaesthesiologist is required to participate in the general care of a patient during a surgical procedure, but does not administer the anaesthetic, such services may be remunerated at full anaesthetic rate, subject to the provisions of modifier 0035.
0034 All anaesthetic administered for diagnostic, surgical or X-ray procedures on the head and neck shall have a minimum of 4,00 basic anaesthetic units (R142.10). When the basic anaesthetic units for the procedure is 3,00, one extra anaesthetic unit should be added. If the basic anaesthetic units for the procedure is 4,00 or more, no extra units should be added.
0035 No anaesthetic administered by a specialist anaesthesiologist shall have a total value of less than 7,00 anaesthetic units (R248.70).
0036 Fees for an anaesthetic administered by a general practitioner shall be two-thirds of the total number of units applicable to the specialist anaesthesiologist provided that no anaesthetic shall have a total value of less than 6,00 anaesthetic units (R213.10). The monetary value of the unit is the same for both a specialist anaesthesiologist and a general practitioner anaesthesiologist.
Note: Modifying units may be added to the basic unit value according to the following table.
0037 Utilisation of total body hypothermia: Add 3,00 anaesthetic units (R106.60).
0038 Peri-operative blood salvage: Add 4,00 anaesthetic units (R142.10) for intraoperative blood salvage and 4,00 anaesthetic units for post-operative blood salvage.
0039 Deliberate control of the blood pressure: All cases up to one hour add 3,00 anaesthetic units (R106.60) thereafter add 1 (one) additional anaesthetic unit (R35.50) per quarter hour or part thereof.
0041 Utilisation of hyperbaric pressurisation: Add 3,00 basic anaesthetic units (R106.60).
0042 Utilisation of extracorporal circulation: Add 3,00 anaesthetic units (R106.60).
Modifiers 5441 to 5448 - General practitioners refer to M 0036 (two-thirds).
Modification of the anaesthetic fee in cases of operative procedures on the musculo-skeletal system, open fractures and open reduction of fractures and dislocations is governed by adding units indicated by modifiers 5441 to 5448. (The letter "M" is annotated next to the number of units of the appropriate items, for facilitating identification of the relevant items).
5441 In all cases of open fractures, open reduction of fractures and dislocations: Add ONE anaesthetic unit (R35.50) except where the procedure refers to the bones named in Modifiers 5442 to 5448.
5442 Shoulder, scapula, clavicle, humerus, elbow joint, upper 1/3 tibia, knee joint, patella, mandible and temporo-mandibular joint: Add TWO anaesthetic units (R71.00).
5443 Maxillary and orbital bones: Add THREE anaesthetic units (R106.60).
5444 Shaft of femur: Add FOUR anaesthetic units (R142.10).
5445 Spine (except coccyx), pelvis, hip, neck of femur: Add FIVE anaesthetic units (R177.60).
5448 Sternum and/or ribs and musculo-skeletal procedures which involve an intra-thoracic approach: Add EIGHT anaesthetic units (R284.20).