Level I Office Surgery

Level I Office Surgery. A. Scope 1. Level I office surgery includes, but not limited to, the following: i. Minor procedures such as excision of skin lesions, moles, warts, cysts, lipomas, Loop Electrosurgical Excision Procedures (LEEP), laser cone of cervix, laser/cautery ablation of warts or other lesions, 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. ii. Incision and drainage of superficial abscesses, limited endoscopies such as proctoscopies, flexible sigmoidoscopies, hysteroscopies, skin biopsies, arthrocentesis, paracentesis, dilation of urethra, cystoscopy procedures, and closed reduction of simple fractures or small joint dislocations (i.e., finger and toe joints). iii. Procedures requiring only topical, local or no anesthesia. Only minimal or no preoperative sedation should be required or used. No drug-induced alteration of respiratory effort or consciousness other than minimal pre-operative tranquilization of the patient is permitted in Level I Office Surgery. iv. Chances of complication requiring hospitalization are remote. 2. Standards for Level I Office Surgery i. Training Required The surgeon's continuing medical education should include management of toxicity or hypersensitivity to local anesthetic drugs. The surgeon’s continuing medical education shall include Basic Life Support Certification. ii. Equipment and Supplies Required Oral airway, positive pressure ventilation device, epinephrine (or other vasopressor), corticosteroids, antihistamines and atropine, if any anesthesia is used. The equipment and skills to establish intravenous access must be available if any other medications are administered. The equipment and supplies should reflect the patient population, i.e., pediatrics, etc. iii. Assistance of Other Personnel Required No other assistance is required, unless the specific surgical procedure being performed requires an assistant.