The American Society of Anesthesiologist (ASA) recently amended and expanded their statement concerning the definition of “immediately available” when medically directing initially published on Oct. 17th, 2012.

Per the statement, “an anesthesiologist who is personally performing an anesthetic is exclusively and completely dedicated to that case. A medically directing anesthesiologist is immediately available if s/he is in physical proximity that allows the anesthesiologist to re-establish direct with the patient to meet medical needs and any urgent or emergent clinical problems. These responsibilities may also be met through coordination among anesthesiologists of the same group or department.”1

The amended statement now specifies that groups should “establish objective and specific written policies regarding immediate availability that consider objective elements such as distance, a map or time that recognizes the specific local environment, and factors that should be taken into account so that a medically directing anesthesiologist is available to immediately conduct hands-on intervention for each patient.”2

The ASA statement provides examples of activities that are not appropriate for a medically directing anesthesiologist. These examples include, but are not limited to the following,3  

  • Personally performing another anesthetic
  • Performing other elective procedures on patients not undergoing a surgery (such as chronic pain blocks)
  • Engaging in any activity that would prevent a timely return to establishing direct with the patient.

The ASA also states that “the medically directing anesthesiologists may perform other services allowed by Medicare (or local contractor). The activity should be interruptible and allow the anesthesiologist to re-establish direct with the patient to address urgent or emergent clinical situations. A medically directing anesthesiologist maintains medical direction and is immediately available when providing a personal break of short duration to a staff member under circumstance in the written policies established by the department or practice.”4

Excerpted from 2015 Relative Value Guide® Book name of document/copyright year) of the American Society of Anesthesiologists. A copy of the full text can be obtained from ASA, 1061 American Lane, Schaumburg, Illinois 60173.

1Relative Value Guide® Book, pg 68-69 Definition of “Immediately Available” when Medically Directing committee of Origin: Economics (Approved by the ASA House of Delegates October 17, 2013, and last amended October 15, 2014).

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About the author

Mary Jo Gross, CPC, CANPC of Compliance – Anesthesia and Pain Management, Studiomaca Business Performance Services