Becker's Healthcare Review states this:
Accreditation for Office Based Surgery vs. Ambulatory Surgery Centers: Frequently Asked Questions
Office-based surgery accreditation:
Twenty-six state health departments plus D.C. have jurisdiction on office based surgery meeting various thresholds. The most common specialties performing office based surgery are pain management, plastic surgery and GI. The requirement is typically based on the levels of anesthesia used and/or complexity of procedure performed. For instance, New York and Pennsylvania refer to pain management as "invasive and complex" regardless of whether anesthesia or moderate sedation is used with the procedure. The twenty-six health departments include Alabama, Arizona, California, Colorado, Connecticut, DC, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Mississippi, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia and Washington. Delaware will implement by the end of 2012. Accreditation by a third party is the most typical way of satisfying the office based surgery state regulation. A few states however, require their own survey. In either case, both the state regulations and the accreditation standards will have governance.
Frequently asked questions:
Q: Once accredited, can I bill facility fees?
A: Office-based accreditation is NOT an avenue to receive facility fees. Local and state law, and third party payer policies (commercial and workers' comp) typically require the facility to be licensed and certified in order for facility fees to be paid. There have been cases of what the prosecution labeled as wire and mail fraud for billing facility fees outside of the ASC program. Insurance companies have also visited office-based surgery practices in an attempt to show a scheme to defraud the insurance company.
Q: I see the Medicare standards listed in the accreditation manual. Does that apply since our office based surgery practice treats Medicare beneficiaries?
A: No. CMS is the authority having jurisdiction for ambulatory surgery centers only. CMS does not govern office-based surgery. The standards shown in accreditation manuals are for those ASCs seeking deemed status Medicare surveys from the accreditation body. The Medicare conditions of participation, also known as the state operation manual, are regulations that all ASCs must meet in order to be recommended for participation in the Medicare program as a provider of surgical services (certification).
More here.
*******************************************************************************************************************
A lot of info from the Florida Public Health Department, to show what types of procedures can be done:
Q: What are the different levels of office surgery?
A: Level I office surgery includes, but is not limited to, the following:
- 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.
- Liposuction involving the removal of less than 4000cc supernatant fat is permitted.
- 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).
- Pre-operative medications not required or used other than minimal pre-operative tranquilization of the patient; anesthesia is local, topical, or none. No drug-induced alteration of consciousness other than minimal pre-operative tranquilization of the patient is permitted in level I Office Surgery.
- Chances of complication requiring hospitalization are remote.
Level II Office Surgery is that in which peri-operative medication and sedation are used intravenously, intramuscularly, or rectally, 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. Also, includes any surgery in which the patient is placed in a state which allows the patient to tolerate unpleasant procedures while maintaining adequate cardiorespiratory 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.
Level III Office Surgery is that surgery 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:
- Intravenous sedation beyond that defined for Level II office surgery;
- General Anesthesia: loss of consciousness and loss of vital reflexes with probable requirement of external support of pulmonary or cardiac functions; or
- Major conduction anesthesia.
Only patients classified under the American Society of Anesthesiologist’s (ASA) risk classification criteria as Class I or, II, are appropriate candidates for Level III office surgery.
Q: What should be recorded on the surgical log?
A: The items required on the surgical log form are:
- Confidential patient identifier
- Time of arrival in the operating suite
- Name of the physician who provided medical clearances
- Surgeon's name
- Diagnosis
- CPT Codes <-------
- Patient ASA classification
- Type of procedure
- Level of surgery
- Anesthesia provider
- Type of anesthesia used
- Duration of the procedure
- Type of post-operative care
- Duration of recovery
- Disposition of the patient upon discharge
- List of medications used during surgery and recovery
- Any adverse incidents, as identified in Section 458.351, F.S.
More info here.