Statement on ​Definition of ʺImmediately Availableʺ When Medically Directing

Developed By: Committee on Economics
Last Amended: October 23, 2024 (Original Approval: October 17, 2012)

Definition: 
An anesthesiologist who personally performs an anesthetic is exclusively and completely dedicated to that case. A medically directing anesthesiologist is defined as “immediately available” if the anesthesiologist is in a physical proximity that allows them to re-establish direct contact with the patient to address 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.

Guidelines Regarding Immediate Availability: 
The physical layouts of operating rooms and other anesthetizing locations are important factors to determine how medically directing anesthesiologists can fulfill the immediately available requirement. However, differences in facility design and size make it impossible to define a universally applicable time or distance requirement for “physical proximity.” 

To determine physical proximity for immediate availability, the facility director of Anesthesia services should consider objective elements that recognize the specific local environment such as distance, mapping, and travel time so that a medically directing anesthesiologist is available to immediately conduct hands-on intervention for each patient. The demands of particular surgical and other diagnostic or therapeutic procedures as well as the clinical needs of patients may further restrict what constitutes immediate availability under specific circumstances. 

The medically directing anesthesiologist may perform other services as allowed by Medicare or Medicare Administrative Contractors. The other services should be interruptible and allow the anesthesiologist to re-establish direct contact with the patient to address urgent or emergent clinical situations. An anesthesiologist maintains medical direction and remains immediately available providing a personal break of short duration to a staff member when direct contact with the patient can be re-established in a timely manner. These responsibilities may also be met through coordination among anesthesiologists of the same group or department. 

There are some activities that are not appropriate for the medically directing anesthesiologist. Examples of such activities include, but are not limited to (1) personally performing another anesthetic, (2) performing other elective procedures on patients not undergoing a surgical procedure (such as chronic pain blocks) or (3) engaging in any other activity that would prevent re-establishing direct contact with the patient in a timely manner to address medical needs and any urgent or emergent clinical problems.