Level I office surgery is surgery that in which: Surgical procedures where pre-operative medications are not required or used other than minimal pre-operative tranquilization of the patient; anesthesia is local, topical, or none; where no drug-induced alteration of consciousness other than minimal pre-operative tranquilization of the patient is permitted, and the chances of complications requiring hospitalization are remote. Such procedures shall include, but not be limited to:
1. Minor procedures such as excision of skin lesions, moles, warts, cysts, lipomas and repair of lacerations or surgery limited to the skin and subcutaneous tissue performed under topical or local anesthesia not involving drug-induced alteration of consciousness other than minimal pre-operative tranquilization of the patient.
2. Liposuction involving the removal of less than 4000cc supernatant fat is permitted.
3. Incision and drainage of superficial abscesses, limited endoscopies such as proctoscopies, skin biopsies, arthrocentesis, thoracentesis, paracentesis, dilation of urethra, cysto-scopic procedures, and closed reduction of simple fractures or small joint dislocations (i.e. finger and toe joints).
Level II Office Surgery is surgery that in which: peri-operative medication and sedation are used by any means altering the level of consciousness, thus making intra and post-operative monitoring necessary.
Such procedures shall include, but not be limited to: hemorrhoidectomy, hernia repair, reduction of simple fractures, large joint dislocations, breast biopsies, colonoscopy, and liposuction involving the removal of up to 4000cc supernatant fat. Peri-operative medication and sedation are used intravenously, intramuscularly, or rectally, thus making intra and post-operative monitoring necessary. Surgery in which the patient is placed in a state which allows the patient to tolerate unpleasant procedures while maintaining adequate cardio respiratory function and the ability to respond purposefully to verbal command and/or tactile stimulation. (Patients whose only response is reflex withdrawal from a painful stimulus are sedated to a greater degree than encompassed by this definition.) Such procedures shall include, but not be limited to: hemorrhoidectomy, hernia repair, reduction of simple fractures, large joint dislocations, breast biopsies, colonoscopy, and liposuction involving the removal of up to 4000cc supernatant fat
Level III Office Surgery is surgery that in which: Involves, or reasonably should require, the use of a general anesthesia or major conduction anesthesia and pre-operative sedation. This includes, but is not limited to, the use of:
a. Intravenous sedation beyond that defined for Level II office surgery;
b. General Anesthesia: loss of consciousness and loss of vital reflexes with probable requirement of external support of pulmonary or cardiac functions; or
c. Major conduction anesthesia.
Only patients classified under the American Society of Anesthesiologistâs (ASA) risk classification criteria as Class I or, II, are appropriate candidates for Level III office surgery.
