Or. Admin. R. 847-017-0003 - Classification of Office-Based Surgery
(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.
Notes
Statutory/Other Authority: ORS 677.265
Statutes/Other Implemented: ORS 677.265
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