CMS SOM App. L, Tag Q-0266

The ASC must -

(2) Ensure each patient has a discharge order, signed by the physician who

performed the surgery or procedure in accordance with applicable State health and

safety laws, standards of practice, and ASC policy.

Interpretive Guidelines: §416.52(c)(2)

No patient may be discharged from the ASC unless the physician who performed the

surgery or procedure signs a discharge order. The ASC must ensure that physicians

follow applicable State laws as well as generally accepted standards of practice and ASC

policy when determining that a patient has recovered sufficiently from surgery and may

be discharged from the ASC, or, as applicable, that the patient must be transferred to

another healthcare facility that can provide the ongoing treatment that the patient requires

and that the ASC is unable to provide. It is permissible for the operating physician to

write a discharge order indicating “the patient may be discharged when stable.” (73 FR

68721). In such cases there must be documentation of when patient was stable. It is

expected that a patient will actually leave the ASC within 15 – 30 minutes of the time

when the physician signs the discharge order or when he or she was found to be stable,

whichever happens later.

Survey Procedures: §416.52(c)(2)

• Determine whether there is a discharge order, signed by the physician who

performed the surgery/procedure, in the sample of medical records being

reviewed.

• Determine whether there is a discharge order signed by the physician for

patients being discharged while the survey takes place.