CMS Revises Interpretive Guidelines; Win for ASCs Regarding Physician Discharge

February 5, 2015

The Centers for Medicare & Medicaid Services (CMS) has released a surveyor memo announcing updates to the State Operations Manual, Appendix L: Guidance for Surveyors – Ambulatory Surgical Centers (commonly referred to as the “Interpretive Guidelines”).

One positive change clarifies the physician discharge order requirements for ASC patients. The previous guidance indicated that the patient was expected to leave the facility within 15-30 minutes of the time the discharge order was signed by the physician who performed the surgery or procedure. ASCA has long advocated that physicians should be allowed to specify that a patient be released when stable and not set a specific timeframe. The guidelines now state that “it is permissible for the operating physician to write a discharge order indicating ‘the patient may be discharged when stable,'" even if that is past the 15-30 minute window.

In addition, the surveyor memo indicates that the Interpretive Guidelines were updated to reflect the recent rule change, reported by ASCA last spring, that included positive changes to the radiologist on staff requirement. The Interpretive Guidelines, Laboratory and Radiologic Services, §416.49(b), was revised to:

o Make explicit that radiologic services may only be provided in an ASC when integral to surgical procedures offered by the ASC.


o Require the ASC’s governing body to appoint an individual who is responsible for overseeing radiologic services. This individual can be someone already working in the ASC who is qualified in accordance with State law and Federal regulations.

CMS also amended several other sections, including:

• Hospitalization; emergency transfers, §416.41(b);


• Physical Environment; operating room requirements, §416.44(a);


• Exercise of rights and respect for property and person, signatures required for informed consent, §416.50(e)

Please contact Kara Newbury at with any questions.