Florida Board of Medicine Clarifies That Common Cardiac Procedures Can Be Performed In Office Surgical Setting.

By Julie Gallagher on July 31, 2014

The Florida Board of Medicine recently amended its office surgery rules to clarify that many common cardiac procedures already being performed in office surgical settings around the state may, in fact, be performed legally in those settings. Rule 64B8-9.009, Fla. Admin. Code, sets forth the standard of care for office surgery. The rule previously defined office surgery, in part, as the type of surgical procedures that “do not result in blood loss of more than ten percent of estimated blood volume in a patient with normal hemoglobin; require major or prolonged intracranial, intrathoracic, abdominal, or major joint replacement procedures except for laparoscopic procures; directly involve major blood vessels; or are generally emergent or life threatening in nature.”

The exclusion of surgical procedures that “directly involve major blood vessels” from the type of procedure that could be done in an office setting was confusing for many physicians. It was unclear whether procedures that require insertion of catheters, wires or other devices to advance through blood vessels, using imaging guidance – already being performed in many registered office surgery centers, – would be considered office surgery such that these physicians would be required to perform them in a hospital or ambulatory surgery center. The matter was brought to the attention of the Board of Medicine, input was solicited and gathered from the profession and other States, and the Board came up with a solution rather quickly. Rather than require these physicians to move these procedures to a different facility, the board opted to include them in the type of procedure that may be performed in the office surgery setting. Hence, the amended rule now clarifies that percutaneous endovascular intervention does constitute office surgery.

The amended rule defines percutaneous intervention as:

“a procedure performed without open direct visualization of the target vessel, requires only needle puncture of an artery or vein followed by insertion of catheters, wires, or similar devices which are then advanced through the blood vessels using imaging guidance. Once the catheter reaches the intended location, various maneuvers to address the diseased area may be performed which include, but are not limited to, injection of contrast for imaging, treatment of vessels with angioplasty, artherectomy, covered or uncovered stenting, intentionally occluding vessels or organs (embolization), and delivering medications, radiation, or other energy such as laser, radiofrequency, or cryo.”

This extensive definition covers a long list of procedures performed by a variety of specialties. To require these procedures to be performed outside the office surgery setting, would have been burdensome for both physicians and patients. Given the other criteria for procedures eligible for office surgery—non emergent and not life threatening, no major blood loss, not overly invasive—percutaneous intervention fit nicely within the intended scope of the original rule.

However, despite the amendment, all physicians should remain mindful of the preamble to the office surgery rule:

NOTHING IN THIS RULE RELIEVES THE SURGEON OF THE RESPONSIBILITY FOR MAKING THE MEDICAL DETERMINATION THAT THE OFFICE IS AN APPROPRIATE FORUM FOR THE PARTICULAR PROCEDURE(S) TO BE PERFORMED ON THE PARTICULAR PATIENT.

This remains good advice.