Part 755 - Free-Standing and Off-Site Hospital Based Ambulatory Surgery Services

Effective Date: 
Wednesday, February 22, 2012
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Statutory Authority: 
Public Health Law, Section 2803

Section 755.1 - Ambulatory surgery definition

Section 755.1 Ambulatory surgery definition. An ambulatory surgery service is a service organized to provide those surgical procedures which need to be performed for safety reasons in an operating room on anesthetized patients requiring a stay of less than 24 hours' duration. These procedures do not include those outpatient surgical procedures which can be performed safelyin a private physician's office or an outpatient treatment room. Ambulatory surgery services may be provided in a free-standing ambulatory surgery center or a hospital-based ambulatory surgery center. Hospital-based ambulatory surgery centers may be on-site or off-site, as described in section 405.20 of this Title. The provisions of this Part shall be applicable to free-standing ambulatory surgery centers and off-site hospital-based ambulatory surgery centers.

Effective Date: 
Wednesday, March 11, 1998
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Section 755.2 - Administrative requirements

755.2 Administrative requirements. When ambulatory surgery services are provided, the operator shall ensure that:

(a) there is a documented plan and procedure for the transfer of patients to a nearby hospital when hospitalization is indicated. Such plans shall include arrangements for an ambulance service and, when appropriate, escort of the patient to the hospital by clinical staff member of the ambulatory surgery service;

(b) the specific ambulatory surgical procedures which each physician and dentist is qualified and competent to perform are delineated in writing, reviewed on an ongoing basis by the medical staff and revised as necessary;

(c) the medical staff develops, maintains and reviews at least biannually a list of surgical procedures which may be performed in this service;

(d) each member of the medical staff practicing at the center with three or fewer physicians in any one specialty has an appointment with equivalent delineated privileges at one or more hospitals in the area. When there are four or more physicians in any one specialty practicing at the center, such appointments are not required;

(e) the medical staff adopts, with the operator's approval, bylaws which provide formal procedures for the evaluation of the application and credentials of registered physician's assistants and registered specialist's assistants applying for employment or privileges in the facility for the purpose of providing medical services under the supervision of a physician; and

(f) evidence of compliance with operational standards, as set forth in Section 751.11 of this Title, shall apply. New facilities shall obtain accreditation from an accreditation agency to which the Centers for Medicare and Medicaid Services has granted deeming status and which the Commissioner has determined has accrediting standards sufficient to assure the Commissioner that ambulatory surgery services so accredited are in compliance with ambulatory surgery services operational standards under this Chapter within two full years of operation.

Effective Date: 
Wednesday, February 22, 2012
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Section 755.3 - Surgery services

755.3 Surgery services. The operator shall ensure that:

(a) a surgeon or anesthesiologist who meets the definition of a qualified specialist, and is licensed by and currently registered with the New York State Education Department, is responsible for the surgery service and may fulfill the requirement for medical director;

(b) all surgical procedures are performed in accordance with current standards of professional practice;

(c) all tissues removed during surgery are examined by a qualified pathologist, except for those exempted by the operator on recommendation of the medical staff consistent with current standards of professional practice; and

(d) blood and blood products are maintained and used in accordance with Subpart 58-2 of this Title and are administered by only physicians or registered professional nurses.

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Section 755.4 - Anesthesia services

755.4 Anesthesia services. The operator shall ensure that:

(a) an anesthesiologist, licensed by and currently registered with the New York State Education Department, and who meets the definition of a qualified specialist, is responsible for the anesthesia services and may fulfill the requirement for medical director;

(b) administration of anesthesia is in accordance with current standards of professional practice;

(c) anesthesia is administered by only a qualified anesthesiologist, or a physician or dentist qualified to administer anesthesia, or a certified registered nurse anesthetist;

(d) when nonphysicians administer anesthesia, the anesthetist must be under the direct personal supervision of a qualified physician, who may be the operating surgeon;

(e) the person administering the anesthesia, other than local anesthesia, is not the operating surgeon; and

(f) a physician examines each patient immediately prior to surgery to evaluate the risk to anesthesia and the procedure to be performed.

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Section 755.5 - Nursing services

755.5 Nursing. The operator shall ensure that:

(a) nursing services are staffed to assure that the nursing needs of all patients are met;

(b) patient care responsibilities are delineated in writing for all nursing service personnel;

(c) nursing services are provided in accordance with current standards of professional practice;

(d) a registered professional nurse is in charge of the nursing services in the operating room; and

(e) only registered professional nurses function as circulating nurses in the operating room.

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Section 755.6 - Patient admission and discharge

755.6 Patient admission and discharge. The operator shall ensure that:

(a) patients shall be admitted only under the care of a licensed and currently registered physician or dentist, who shall be a member of the staff. The patient's condition and provisional diagnosis shall be established on admission by the patient's physician or dentist;

(b) the patient receives a history and physical examination and preoperative studies. The data and information are incorporated into the medical record prior to surgery;

(c) informed consent of the patient or, if applicable, the patient's representative, is obtained before surgery;

(d) each patient is evaluated by a physician or by an individual qualified to administer anesthesia as set forth in subdivision (c) in Section 755.4 of this Part for proper anesthesia recovery, and discharged upon the written order of a physician;

(e) verbal instructions understandable to the patient, confirmed by written instructions, are provided to each patient at discharge, and include at least the following:

(1) information about complications that may arise;

(2) telephone number(s) to be used by the patient should complications or questions arise;

(3) directions for medications prescribed, if any;

(4) date, time and location of the follow-up visit or return visit; and

(5) designated place to go for treatment in the event of emergency; and

(f) all patients who have received anesthesia are discharged in the company of a responsible adult, unless exempted by a physician.

Effective Date: 
Wednesday, December 29, 2010
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Section 755.7 - Medical record system

755.7 Medical record system. In addition to the requirements of section 751.7 of this Title, the medical record shall contain the following information:

(a) a history, physical examination, pertinent preoperative diagnostic studies and a preoperative diagnosis incorporated into the medical record prior to surgery;

(b) a record of any allergies and abnormal drug reactions;

(c) evidence of the appropriate written informed consent for surgery;

(d) preoperative and post-operative instructions;

(e) anesthesia record;

(f) an operative report describing surgical procedures performed and findings, completed by the individual performing the operation;

(g) post-operative follow-up report, including any post-operative abnormalities or complications;

(h) pathology reports on anatomical parts and tissues removed during surgery;

(i) a discharge diagnosis; and

(j) follow-up plans.

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Section 755.8 - Emergency care

755.8 Emergency care. The operator shall ensure that:

(a) emergency supplies and equipment are provided in accordance with the scope of surgical services provided at the facility, and include at least the following:

(1) an emergency call system;

(2) oxygen;

(3) airways, manual breathing bag and ventilator;

(4) cardiac defibrillator;

(5) cardiac monitoring equipment;

(6) thoracotomy set;

(7) tracheostomy set;

(8) laryngoscope and endotracheal tubes;

(9) suction equipment; and

(10) emergency drugs and supplies as specified by the medical staff; and

(b) an anesthesiologist or other physician and a registered professional nurse who are qualified in resuscitative techniques and emergency care are present and available until all patients have been discharged from the service.

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Section 755.9 - Quality assurance

755.9 Quality assurance. In addition to the requirements set forth in section 751.8 of this Title, the operator shall ensure that there are reviews of the appropriateness and necessity of procedures performed, operative complications and circumstances leading to hospitalization.

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Section 755.10 - Data requirements

755.10 Data requirements. (a) All facilities having freestanding ambulatory surgery services shall submit to the department, for each patient visit to the service, the following information: permanent facility identifier number assigned by the department; an identity-shielded patient record number; the patient's birthdate, sex and ZIP code; the date of the visit; the hour of the admission and discharge for the visit; operating room time used; principal diagnosis code; principal procedure code; other procedure code; primary reimbursement code; county of the patient's residence; the disposition of the patient on discharge; and physician's or dentist's license number; and method of anesthesia and such additional elements as are approved by the commissioner upon finding that they are recommended by the National Uniform Billing Committee and the National Committee on Vital and Health Statistics or are necessary for permitted uses of SPARCS data under section 400.18(e) of this Title.

(b) Facilities which are using their own computer facilities to process and maintain such data, and those with contracted services for the processing of such data, shall submit such data in computer-readable format according to specifications provided by the commissioner. Resulting reports and any hospital owner magnetic media will be returned to the facility after use by the department.

(c) Facilities certified to provide freestanding ambulatory surgery services shall submit such data within 30 days of the end of each calendar quarter. Data will be submitted in the form and manner prescribed by the commissioner.

(d) Facilities which do not submit corrected data within 30 days of receipt of the department's error report concerning such data will not be reimbursed under section 86-1.41 of this Title until compliance with this section is certified by the commissioner or his designee.

(e) Requests for deniable individual or aggregate data or data reports based on data submitted pursuant to this section shall be processed pursuant to section 400.18(e) of this Title.

Effective Date: 
Wednesday, January 5, 1994
Doc Status: