Anthem: It's not medically necessary for anesthesiologists to assist most cataract surgeries

Anthem will no longer cover monitored anesthesia care or general anesthesia for cataract surgery in most cases, according to a clinical guideline published Feb. 1.

Here are four things to know about the coverage change.

1. The guideline lists five exceptions when administration of anesthesia during a cataract surgery would be medically necessary. The exceptions are children under 18 years old; individuals who are unable to cooperate or communicate; patients who can't lie flat; people who have failed or have contraindications to anesthesia; or patients who are expected to have a long or complex surgery.

2. Under the policy, an eye surgeon may have to double as an anesthetist, Kaiser Health News reports. While cataract procedures are often performed as an outpatient service, anesthesiologists are present to give intravenous drugs and monitor vital signs, among other duties.  

3. Some anesthesiologists and ophthalmologists have spoken against the coverage change and called for Anthem to rescind it. David Glasser, MD, an ophthalmologist in Columbia, Md., and the secretary for federal affairs at the American Academy of Ophthalmology, told Kaiser Health News, "The presence of anesthesia personnel is one of the key ingredients in the patient safety and effectiveness of cataract surgery today. An ophthalmologist cannot administer conscious sedation and monitor the patient and do cataract surgery at the same time."

4. In a statement to Kaiser Health News, Anthem said its "Medical Policy and Technology Assessment Committee, a majority of whom are external physicians, reviewed the available evidence addressing the use of general anesthesia and monitored anesthesia care for cataract surgery. According to the literature reviewed, there is no one definitive approach regarding the use of anesthesia for cataract surgery and patient-specific needs should be taken into consideration as well as potential risk of harm to individuals who are sedated during surgical procedures."

For Anthem's full guidance, click here.

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