Anesthesia Guidelines Clarified: CMS Issues Transmittal on May 21, 2010

On May 21, 2010, CMS issued a new transmittal clarifying the interpretive guidelines for the hospital conditions of participation for anesthesia services. The transmittal serves to revise Appendix A “Survey Protocol, Regulations and Interpretive Guidelines for Hospitals”.

Consistent with the CMS December 11, 2009 memorandum, the transmittal confirms that “The administration of medication via an epidural or spinal route for the purposes of analgesia, during labor and delivery, is not considered anesthesia and therefore is not subject to the anesthesia supervision requirements at 42 CFR 482.52(a)”. CRNAs providing “anesthesia” as opposed to “analgesia” require physician supervision unless such services are provided in an “Opt-Out State.” (Note: Since the issuance of the 2001 CMS regulation permitting opt-outs, 15 states have formally opted-out). In particular, a CRNA administering general, regional and monitored anesthesia care must be supervised either by the operating practitioner who is performing the procedure, or by an anesthesiologist who is immediately available. According to the transmittal, “immediately available” requires that the anesthesiologist is physically located within the same area as the CRNA “e.g., in the same operative/procedural suite, or in the same labor and delivery unit, and not otherwise occupied in a way that prevents him/her from immediately conducting hands-on intervention, if needed.”

Notably, this transmittal changes earlier revisions with respect to the post-anesthesia evaluation. With respect to outpatient surgery, although the transmittal reflects that the post-anesthesia evaluation must be completed within 48 hours after surgery, the language requiring that the evaluation be completed prior to discharge has now been deleted.

For more information, please contact Abby Pendleton, Esq. or Carey F. Kalmowitz, Esq. at (248) 996-8510.