New Jersey Administrative Code › Title 13 - LAW AND PUBLIC SAFETY › Chapter 35 - BOARD OF MEDICAL EXAMINERS › Subchapter 4A - SURGERY, SPECIAL PROCEDURES AND ANESTHESIA SERVICES PERFORMED IN AN OFFICE SETTING › Section 13:35-4A.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Advanced cardiac life support trained" means that a licensee has successfully completed an advanced cardiac life support course offered by a recognized accrediting organization appropriate to the licensee's field of practice. For example, for those licensees treating adult patients, training in advanced cardiac life support (ACLS) is appropriate; for those treating children, training in pediatric advanced life support (PALS) or advanced pediatric life support (APLS) is appropriate.
"Advanced practice clinician" or "APC" means an advanced practice nurse licensed pursuant to N.J.S.A. 45:11-45, a physician assistant licensed pursuant to N.J.S.A 45:9-27.10, or certified nurse midwives (CNMs) and certified midwives (CMs) licensed pursuant to N.J.S.A. 45:10-1.
"Ambulatory surgery center" means a facility licensed by the New Jersey Department of Health pursuant to N.J.S.A. 26:2H-12 and subject to N.J.A.C. 8:43A.
"Anesthesia services" means administration of any anesthetic agent with the purpose of creating moderate sedation, regional anesthesia, or general anesthesia. For the purposes of this subchapter, the administration of topical or local anesthesia, minor conduction blocks, pain management or pain medication shall not be deemed to be anesthesia services.
"Anesthesiologist" means a physician who has successfully completed a residency program in anesthesiology approved by the Accreditation Council of Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA), or who currently is a diplomate of either the American Board of Anesthesiology or the American Osteopathic Board of Anesthesiology, or who was made a Fellow of the American College of Anesthesiology before 1982.
"Anesthetic agent" means any drug or combination of drugs administered with the purpose of creating moderate sedation, regional anesthesia, or general anesthesia.
"Anesthetizing location" means any location in an office where anesthetic agents are administered to a patient.
"Board" means the New Jersey State Board of Medical Examiners.
"Certified registered nurse anesthetist" (CRNA) means a registered professional nurse who is licensed in this State as an advanced practice nurse specializing in anesthesia services and who holds current certification under a program governed or approved by the American Association of Nurse Anesthetists (AANA).
"Collaborating agreement" means a written document entered into by an APC and a physician, to include joint protocols for APNs, delegation agreements for PAs, or clinical guidelines for CNMs and CMs.
"Complications" means an untoward event occurring at any time within 48 hours of any surgery, special procedure or the administration of anesthesia services which was performed in an office including, but not limited to, any of the following events: paralysis, nerve injury, malignant hyperthermia, seizures, myocardial infarction, renal failure, significant cardiac events, respiratory arrest, aspiration of gastric contents, cerebral vascular accident, transfusion reaction, pneumothorax, allergic reaction to anesthesia, wound infections requiring intravenous antibiotic treatment or hospitalization, uterine perforation or injury to another organ, or unintended return to an operating room or hospitalization, death or temporary or permanent loss of function not considered to be a likely or usual outcome of the procedure.
"Early aspiration abortion" means a procedure that terminates a pregnancy in the first trimester of pregnancy (defined as up to 14 completed weeks as calculated by an estimate of gestational age that utilizes the last menstrual period, ultrasound, and/or physical examination, as appropriate, to the standard of care) utilizing manual or electric suction to empty the uterus.
"General anesthesia" means the administration of a drug or drugs which cause loss of consciousness as the result of which the patient is unable to make meaningful responses but may still display reflex withdrawal from a painful stimulus.
"Health care personnel" means any office staff member who is licensed by a professional or health care occupational licensing board such as an advanced practice nurse, professional registered nurse, licensed practical nurse, certified nurse midwife, certified midwife, or physician assistant.
"Hospital" means a hospital licensed by the state in which it is situated.
"Local anesthesia" means an agent which produces a transient and reversible loss of sensation in a circumscribed portion of the body.
"Minor conduction block" means the injection of local anesthesia to stop or prevent a painful sensation in a circumscribed area of the body (that is, local infiltration or local nerve block), or the block of a nerve by direct pressure or refrigeration. Minor conduction blocks include, but are not limited to, retrobulbar blocks, peribulbar blocks, pudendal blocks, digital blocks, metacarpal blocks, ankle blocks, and paracervical blocks.
"Minor conduction block" does not include regional anesthesia that affects larger areas of the body, such as brachial plexus anesthesia or spinal anesthesia. "Minor procedure" means an intervention that can safely and comfortably be performed on a patient who has received no more than the maximum manufacturer recommended dose of local or topical anesthesia, without more than minimal pre-operative medication or minimal intra-operative tranquilization and where the likelihood of complications requiring hospitalization is remote. Minor procedure specifically excludes all procedures performed utilizing anesthesia services as defined in this section. Minor procedure also specifically excludes procedures which may be performed under local anesthesia, but which involve extensive manipulation or removal of tissue such as liposuction or lipo-injection, breast augmentation or reduction, and removal of breast implants. Minor procedure includes the excision of moles, warts, cysts, lipomas, skin biopsies, the repair of simple lacerations, or other procedures limited to the skin and subcutaneous tissue. Additional examples of minor procedures include closed reduction of a fracture, the incision and drainage of abscesses, certain simple ophthalmologic procedures, such as treatment of chalazions and non-invasive ophthalmologic laser procedures performed with topical anesthesia, limited endoscopies such as flexible sigmoidoscopies, anoscopies, proctoscopies, arthrocenteses, thoracenteses, paracenteses, and early aspiration abortions. Minor procedures shall not include any procedure identified as "major surgery" within the meaning of N.J.A.C. 13:35-4.1.
"Moderate sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone, or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is "usually maintained." Moderate sedation does not include an oral dose of pain medication or minimal pre-procedure tranquilization, such as the administration of a pre-procedure oral dose of a benzodiazepine designed to calm the patient. Moderate sedation shall be synonymous with the term "sedation/analgesia" as used by the American Society of Anesthesiologists.
"Monitoring" means continuous visual observation of a patient and continuous observation of the patient using instruments to measure, display and record the values of certain physiologic variables, such as pulse, oxygen saturation, blood pressure, end-tidal carbon dioxide and respiration.
"Office" means a location at which medical, surgical, or podiatric services are rendered and which contains only one operating room and which is not subject to the jurisdiction and licensure requirements of the New Jersey State Department of Health.
"Operating room" means that location in the office dedicated to the performance of surgery or special procedures.
"Pain management" means the administration to a patient, by any route, of pharmacologic agents or drugs which are not intended to result in a loss of consciousness, awareness or defensive reflexes, but which are intended to alleviate pain. It includes the use or application of other modalities and medical devices such as, but not limited to, heat or cold, massage, transepidermal nerve stimulation (TENS), and neurolytic techniques such as radiofrequency coagulation and cryotherapy.
"Pain medication" means, for the purpose of this subchapter, the administration to a patient, by any route, of pharmacologic agents or drugs which are not intended to result in a loss of consciousness, awareness or defensive reflexes, but which are intended to alleviate pain occurring in the absence of an invasive, operative or manipulative procedure.
"Physical status classification" means a description of a patient used in determining if an office surgery or special procedure is appropriate. The American Society of Anesthesiologists enumerates classifications: I--Normal healthy patient; II--A patient with mild systemic disease; III--A patient with severe systemic disease limiting activity but not incapacitating; IV-- A patient with incapacitating systemic disease that is a constant threat to life; and V--Moribund patients not expected to live 24 hours with or without operation.
"Physician" means an individual holding an M.D. or D.O. degree licensed pursuant to N.J.S.A. 45:9-1et seq.
"Podiatrist" means an individual holding a D.P.M. degree licensed pursuant to N.J.S.A. 45:5-1et seq.
"Practitioner" means a physician or a podiatrist.
"Privileges" means the authorization granted to a practitioner by a hospital licensed in the jurisdiction in which it is located to provide specified services, or an ambulatory surgery center licensed by the Department of Health or alternatively by the Board pursuant to N.J.A.C. 13:35-4A.12, such as surgery or special procedures or the administration or the supervision of administration of one or more types of anesthetic agents.
"Recovery area" means a room or limited access area of an office dedicated to providing medical services to patients recovering from surgery or anesthesia.
" Regional anesthesia" means the administration of anesthetic agents to a patient to interrupt nerve impulses without loss of consciousness and includes epidural, caudal, spinal and brachial plexus anesthesia. Regional anesthesia does not include minor conduction blocks as defined in this section.
"Special procedure" means patient care that requires anesthesia services because it involves entering the body with instruments in a potentially painful manner, or requires the patient to be immobile; for a diagnostic or therapeutic procedure. Examples of special procedures include diagnostic or therapeutic endoscopy or bronchoscopy performed utilizing moderate sedation or general anesthesia; invasive radiologic procedures performed utilizing moderate sedation, pediatric magnetic resonance imaging performed utilizing moderate sedation, manipulation under anesthesia (MUA), or abortions, other than early aspiration abortions. The term special procedure does not include a procedure which only requires medication to reduce anxiety such as oral benzodiazepine, unless the dose given is intended to provide moderate sedation.
"Supervision" means responsibility by a credentialed physician who is immediately available to oversee the administration and monitoring of anesthesia by health care personnel authorized by this rule to render anesthesia services in an office.
"Surgery" means a manual or operative procedure, including the use of lasers, performed upon the body for the purpose of preserving health, diagnosing or treating disease, repairing injury, correcting deformity or defects, prolonging life, or relieving suffering. Surgery includes, but is not limited to: incision in tissue or an organ; suture or other repair of tissue or an organ; a closed or open reduction of a fracture.
"Surgical practice" means a structure or suite of rooms that has the following characteristics:
1. Has no more than one room dedicated for use as an operating room that is specifically equipped to perform surgery, and is designed and constructed to accommodate invasive diagnostic and surgical procedures;
2. Has one or more post-anesthesia care units or a dedicated recovery area where the patient may be closely monitored and observed until discharged; and is established by a physician professional association surgical practice, or other professional practice form specified by the State Board of Medical Examiners pursuant to N.J.A.C. 13:35-6.1(f) solely for the physician's, association's or other professional entity's private medical practice.
"Topical anesthesia" means an anesthetic agent applied directly or by spray to the skin or mucous membranes, intended to produce a transient and reversible loss of sensation to a circumscribed area.