Level I Office Surgery includes, but is not limited to 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. Most of these are considered “minor surgery” and have a 10-day global period.
Level II Office Surgery includes peri-operative medication and sedation used intravenously, intramuscularly, or rectally, thus making intra and post-operative monitoring necessary. This includes any surgery where the patient is placed in a state that 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 (i.e., WALANT). 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 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 and general anesthesia.