CMS issued guidance to state surveyors on Dec. 17, 2010, clarifying the requirements contained in the Ambulatory Surgical Center (ASC) Interpretive Guidelines for medical histories and physical examinations (H&Ps).

This guidance was issued in response to confusion among state surveyors who did not know whether the requirement that H&Ps be performed not more than 30 days before a scheduled surgery allowed the H&Ps to be performed on the same day of the surgery.

The guidance clarifies three major issues in connection with Medicare surveys of ASCs:

  1. The comprehensive H&P can be performed on the same day as the surgical procedure. Pursuant to the Medicare conditions for coverage for ASCs at 42 CFR 416.52, each patient must have a comprehensive medical H&P assessment by a physician or other qualified practitioner within 30 days before the date of the patient’s scheduled surgery. The new CMS guidance clarifies there is no prohibition against performing the H&P on the same day as the surgery, including performing the H&P in the ASC, as long as the H&P is comprehensive and the results are placed in the patient’s medical record before the procedure. It is not acceptable, according to the CMS guidance, to conduct the H&P after the patient has been prepped for surgery and brought into the operating or procedure room.  
  2. If the H&P is performed on the date of the surgery in the ASC, the H&P assessment may be combined with some, but not all, of the elements of the required presurgical assessment. The Medicare conditions for coverage for ASCs also require patients to undergo a pre-surgical assessment that documents, at a minimum, any changes in the patient’s condition since the completion of the H&P. The CMS guidance makes it clear that if the H&P was conducted before the date of the surgery, then the pre-surgical assessment will require a separate examination in the ASC on the date of the surgery. However, if the H&P is conducted on the same day as the surgery, some of the elements of the pre-surgical assessment may be incorporated into the H&P. This does not apply to the anesthetic/procedure risk assessment required to be performed pursuant to 42 CFR 416.42, which must be performed separately immediately prior to the surgery and after the H&P. The H&P must still be placed into the patient’s medical record prior to the procedure.  
  3. A comprehensive H&P is required regardless of the type of surgical procedure. CMS makes clear there is no exemption for ASCs that perform less invasive procedures from the requirement to perform a comprehensive H&P. CMS cautions those ASCs that believe the comprehensive H&P requirement is too burdensome given the types of procedures they perform to consider voluntarily terminating their Medicare certification as an ASC and instead perform those procedures as physician office-based surgical services.  

The guidelines contained in the memorandum are effective immediately.