Current through Register Vol. 63, No. 9, September 1, 2024
Office-based surgeries are classified by complexity.
(1) Level I are minor surgical procedures
performed without anesthesia or under topical, local, or minor conduction block
anesthesia not involving drug-induced alteration of consciousness, other than
minimal sedation utilizing preoperative oral anxiolytic medications.
(a) The licensee must pursue continuing
medical education in the field for which the services are being provided and in
the proper drug dosages, management of toxicity, and hypersensitivity to local
anesthetic and other drugs.
(b) The
licensee must maintain active American Heart Association Basic Life Support
(BLS) certification or equivalent CPR course that includes a practical skills
evaluation.
(2) Level II
are minor or major surgical procedures performed under moderate
sedation/analgesia, such as oral, parenteral, or intravenous sedation or under
analgesic or dissociative drugs.
(a) In
addition to the requirements in section (1) of this rule, the licensee must:
(A) Maintain board certification or board
eligibility in a specialty recognized by the American Board of Medical
Specialties (ABMS), the American Osteopathic Association's Bureau of
Osteopathic Specialists (AOA-BOS), the American Board of Podiatric Medicine
(ABPM), the American Board of Foot and Ankle Surgery (ABFAS) or the National
Commission on Certification of Physician Assistants (NCCPA), or
(B) Obtain fifty hours each year of
accredited continuing medical education (CME) relevant to the Level II surgical
procedures to be performed in the office-based facility. This requirement may
not be satisfied with cultural competency CME or other CME that is only
generally relevant to the licensee's practice.
(b) The licensee must maintain active
American Heart Association Advanced Cardiovascular Life Support (ACLS)
certification or equivalent ACLS course that includes a practical skills
evaluation. The licensee must be on site at all times when patients are under
the effects of anesthetic.
(c) The
licensee administering anesthesia must evaluate and document the ASA Physical
Status of the patient.
(d) The
patient must be appropriately monitored as defined in 847-017-0005.
(3) Level III are major surgical
procedures that require deep sedation/analgesia, general anesthesia, or
regional blocks, and require support of vital bodily functions.
(a) In addition to the requirements in
section (1) of this rule, the licensee must:
(A) Have staff privileges to perform the same
procedure in a hospital or ambulatory surgical center, or
(B) Maintain board certification or board
eligibility in an appropriate specialty recognized by the ABMS, the AOA-BOS,
the ABPM, the ABFAS or the NCCPA.
(b) The licensee must maintain active
American Heart Association Advanced Cardiovascular Life Support (ACLS)
certification or equivalent ACLS course that includes a practical skills
evaluation. The licensee must be on site at all times when patients are under
the effects of anesthetic.
(c) The
licensee administering anesthesia must evaluate and document the ASA Physical
Status of the patient.
(d) The
patient must be appropriately monitored as defined in 847-017-0005.
(e) The licensee performing the procedure may
not administer anesthesia other than additional local anesthesia and may not be
primarily responsible for monitoring anesthesia during the procedure.
(4) Procedures or treatments
involving the injection of a medication or substance for cosmetic purposes are
the practice of medicine and must be performed as an office-based surgical
procedure.
(5) Lipoplasty involving
the removal of 500 cc or less volume of supernatant fat may be performed as a
Level I surgical procedure. Office-based lipoplasty involving more than 500 cc
volume of supernatant fat must be performed as a Level II or Level III surgical
procedure.
(a) The performance of lipoplasty
in an office-based setting may not result in the removal of more than 5% of
total body weight or more than 4500 cc volume of supernatant fat removed,
whichever is less.
(b) The licensee
may not use more than 55 mg/kg of Lidocaine or 70 mcg/kg of epinephrine for
tumescent anesthesia. The concentration of epinephrine in tumescent solutions
may not exceed 1.5 mg/L.
(6) The following may not be performed in an
office-based surgical facility:
(a) Procedures
that may result in blood loss of more than 4% of the estimated blood volume in
a patient with a normal hemoglobin;
(b) Procedures requiring intracranial,
intrathoracic, or abdominal cavity entry;
(c) Joint replacement procedures;
and
(d) Level II or Level III
procedures on patients with an ASA Physical Status IV or higher.
Statutory/Other Authority: ORS
677.265
Statutes/Other Implemented: ORS
677.265
