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Frequently Asked Questions for Alternative Privileges

The FAQ will be updated regularly. Additional questions and answers will be added to this page. Answers will also be available to questions received at the e-mail address alternativeprivileges@lps.state.nj.us.

  1. What are alternative privileges?
  2. If I have privileges in a hospital, do I need "alternative privileges?"
  3. If I have hospital privileges, does anything in this regulation apply to me or my office?
  4. What are anesthesia services?
  5. I only use local or topical anesthesia in my office. Do I need alternative privileges?
  6. Who has to apply for "alternative privileges?"
  7. What is a practitioner?
  8. When must physicians and podiatrists without hospital privileges submit an application for alternative privileges?
  9. Can a practitioner continue their office practice before starting or completing the alternative privileging procedure?
  10. When I am performing a procedure in my office that requires conscious sedation of the patient, I use a Certified Registered Nurse Anesthetist to administer anesthesia. I don't need any alternative privileges, right?
  11. Can the same physician perform a surgical procedure in an office setting and also administer the anesthesia ?
  12. What do I need to do to be able to start to or to continue to administer or supervise the administration of conscious sedation in an office setting if I do not have hospital privileges for conscious sedation?
  13. The applications for alternative privileges each include an attachment (Attachment 1) consisting of the applicant's attestation to the number of procedures for which the applicant provided anesthesia services or performed the surgery or special procedure(s) with "acceptable results" in the past two years. In this context, what is the meaning of "acceptable results?"
  14. What do you mean by "complications?"
  15. Is there any reporting requirement for in-office anesthesia and special procedures?
  16. What does "attestation" to the number of procedures mean? (Application Attachment 1)
  17. What information goes on a patient log (Application Attachment 4)
  18. How are patient names to be handled in the log?
  19. What does "personal identifiers redacted" mean?
  1. What are alternative privileges?
    The term "Privileges" is defined in the regulation and means permission to perform certain procedures in a licensed hospital or in an office setting. Privileges to perform procedures in a licensed hospital are granted to a practitioner by the hospital. Alternative Privileges are privileges to perform procedures in an office setting and must be granted by the Medical Board. Alternative privileges are needed when a practitioner <i>does not possess hospital privileges</i> to perform the particular procedure(s).
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  2. If I have privileges in a hospital, do I need "alternative privileges?"
    You do not need alternative privileges to perform surgery, special procedures or anesthesia services in the office setting if your hospital privileges are for the same procedures or anesthesia services. Some procedures can be performed in a licensed hospital or in the office setting. If you have hospital privileges to perform a particular procedure that can also be performed in an office setting, you do not need to obtain alternative privileges to perform the procedure in an office setting. If you do not have hospital privileges that include the specific anesthesia services or procedure(s) you want to perform in the office, you do need alternative privileges. Click here to go to the page with links to the application forms that will let you see what is required in your specialty to obtain alternative privileges and what procedures are covered.
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  3. If I have hospital privileges, does anything in this regulation apply to me or my office?
    Yes, most of the regulation applies to you. To review the regulation click here. The part of the regulation that does not apply to you is the part requiring alternative privileges to perform surgery and special procedures or administer anesthesia services in an office setting, because you already have hospital privileges. All of the other aspects of the regulation still apply to you and your office in performing surgery and special procedures and administering anesthesia services in an office setting.
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  4. What are anesthesia services?
    The term "anesthesia services" means general or regional anesthesia and conscious sedation. The term does not include local anesthesia. This term is important because the scope of the surgery, special procedures and anesthesia services rule encompasses "practitioners and physicians who perform surgery (other than minor surgery),special procedures and administer anesthesia services in an office setting.

    This means that alternative privileges are not necessary for minor surgery procedures performed using local or topical anesthesia. There are, however, certain procedures that are not included in the definition of "minor surgery" and they do require alternative privileges, even though anesthesia services are not used. The procedures that are not considered "minor surgery" are those procedures "which involve extensive manipulation or removal of tissue such as liposuction or lipo-injection, breast augmentation or reduction, and removal of breast implants."
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  5. I only use local or topical anesthesia in my office. Do I need alternative privileges?
    Alternative privileges are not needed for minor surgery performed using local or topical anesthesia. It is important to look carefully at what is included in "minor surgery" and what is not included in minor surgery. While most procedures performed using local or topical anesthesia are considered "minor surgery" (and do not require alternative privileges) there are specific procedures using local anesthesia that are not considered minor surgery and do require alternative privileges. Specifically, those procedures "which involve extensive manipulation or removal of tissue such as liposuction or lipo-injection, breast augmentation or reduction, and removal of breast implants" are not minor surgery, even though they may be performed under local anesthesia. Whether alternative privileges are required depends upon the procedure(s) to be performed in an office setting. There is a list of procedures in each specialty which may be performed in an office setting and which require hospital or alternative privileges. The procedures in each specialty that require alternative privileges can be reviewed by clicking on the Table of Specialties.
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  6. Who has to apply for "alternative privileges?"
    Practitioners who perform surgery (except "minor surgery") or special procedures or who administer anesthesia or supervise the administration of anesthesia in an office setting and who do not have hospital privileges for those procedures or anesthesia services must apply for alternative privileges.

    The specific procedures and anesthesia services that may be performed in the office setting and that require either hospital or alternative privileges are identified in the Table of Specialties. In addition, physicians who perform certain procedures using local anesthesia must obtain alternative privileges if they do not have hospital privileges for these procedures. Procedures requiring privileges which may involve local anesthesia are liposuction or lipo-injection, breast augmentation or reduction, and removal of breast implants.
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  7. What is a practitioner?
    A New Jersey licensed physician or podiatrist.
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  8. When must physicians and podiatrists without hospital privileges submit an application for alternative privileges?
    Immediately. Practitioners who do not have hospital privileges and who are wondering whether their office practice requires alternative privileges or whether their background satisfies necessary training for surgery, special procedures or anesthesia services in an office practice they can review the procedures which require alternative privilegesand procedures requiring any additional training.
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  9. Can a practitioner continue their office practice before starting or completing the alternative privileging procedure?
    Practitioners without hospital privileges may continue to perform services and provide supervision as they have been doing until such time as the Board acts on their applications. Practitioners without hospital privileges who do not submit an application would be in violation of this regulation if they were to perform surgery, special procedures or anesthesia services without obtaining alternative privileges.
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  10. When I am performing a procedure in my office that requires conscious sedation of the patient, I use a Certified Registered Nurse Anesthetist to administer anesthesia. I don't need any alternative privileges, right?
    You may not be right. If you have hospital privileges for conscious sedation and for the procedure you want to perform, then you do not need alternative privileges. If you do not have hospital privileges for conscious sedation you do need to apply for alternative privileges for conscious sedation. Also, if you do not have hospital privileges for the procedure you will perform, you also need to apply for alternative privileges for the surgery or special procedure, unless it is a non-invasive procedure (such as a radiological procedure). You can check the procedures that may be performed in an office setting with alternative privileges by clicking here and then click on the specialty.
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  11. Can the same physician perform a surgical procedure in an office setting and also administer the anesthesia ?
    If the surgery or special procedure requires general anesthesia or regional anesthesia, the physician administering the anesthesia is not to be the practitioner performing the surgery or the special procedure. If the surgery or special procedure requires conscious sedation, the practitioner can supervise a Certified Registered Nurse Anesthetist, a registered professional nurse or a physician assistant in the administration of conscious sedation and the practitioner may also be responsible for patient care. The person who is monitoring the patient under conscious sedation is not to be the practitioner who is performing the surgery or special procedure.
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  12. What do I need to do to be able to start to or to continue to administer or supervise the administration of conscious sedation in an office setting if I do not have hospital privileges for conscious sedation?
    To obtain alternative privileges for conscious sedation (but for no other form of anesthesia services),you must show that you have clinical experience, and current certification in anesthesiology or in Critical Care Medicine or Emergency Medicine or must be able to show satisfactory evidence that you are advanced cardiac life support trained with updated training from a recognized accrediting organization and that you either have successfully completed an educational home study program, with a test of basic knowledge obtained from the Board, or you have successfully completed a course in conscious sedation offered by a licensed hospital or for continuing medical education credits. Finally, in your application for alternative privileges in conscious sedation, you must submit a list of all patients (if any) who have experienced complications relating to your provision of conscious sedation in an office setting or licensed ambulatory care facility setting and the resulting outcomes of the complications. An application for alternative privileges in conscious sedation can be reviewed by clicking conscious sedation application.
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  13. The applications for alternative privileges each include an attachment (Attachment 1) consisting of the applicant's attestation to the number of procedures for which the applicant provided anesthesia services or performed the surgery or special procedure(s) with "acceptable results" in the past two years. In this context, what is the meaning of "acceptable results?"
    "Acceptable results" means an outcome that would not have triggered reporting under the regulation. The regulation reporting requirement applies to "complications" (as defined in the regulation) and to any other untoward events identified in the Confidential Report of an Incident Related to Anesthesia Services. In addition to the number of procedures or anesthesia services in the prior two years with acceptable results appearing on Attachment 1, the conscious sedation procedure log, the anesthesia procedure log and the surgery and special procedures log that are part of the application also requires identification of each anesthesia service and procedure which had complications and the outcomes of those complications.
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  14. What do you mean by "complications?"
    The regulation provides a definition of "complications." The term "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 setting 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, 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.

    This definition is only one of the circumstances that require a report to the Board of Medical Examiners.
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  15. Is there any reporting requirement for in-office anesthesia and special procedures?
    The New Jersey State Board of Medical Examiners requires the reporting of the following: (1) All deaths in anesthetizing locations, and (2) all events relating to surgery, special procedures or anesthesia services and occurring within 48 hours of surgery, special procedure or anesthesia services which result in transport of the patient to the hospital for observation or treatment for a period in excess of 24 hours or which result in other complications or untoward events including but not limited to 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, or allergic reaction to anesthesia. Reporting does not presume that anesthesia was the cause of the incident. This report should be made by the practitioner or the anesthesiologist (if an anesthesiologist is present) by telephone within 24 hours (609-826-7100 during normal business hours), and must be made in writing within 7 days to the State Board of Medical Examiners, P.O. Box 183, Trenton, New Jersey 08625-0183. This information will be used for official board purposes only and will not be made available to the public.
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  16. What does "attestation" to the number of procedures mean? (Application Attachment 1)
    Attesting to the number of procedures performed means the applicant is standing by the number provided as true and correct or, to put it another way, the applicant is certifying that the number is true and correct.
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  17. What information goes on a patient log (Application Attachment 4)
    The log is a record of patients who received anesthesia services, surgery or special procedures administered or performed by the practitioner during the two years before the date of the application for alternative privileges. The log is to include complications related to the anesthesia services or surgery/special procedures performed in an office setting or licensed ambulatory care facility setting.

    There are three versions of the log form, depending upon the alternative privileges requested.

    The first log form is for the list of patients who received general or regional anesthesia. The second log form is for the list of patients who received surgery or special procedures. The log format works best if practitioners who are applying for alternative privileges to perform more than one surgical or special procedure complete a separate Attachment 4A log sheet for each different procedure. The third log form is slightly different because it does not require a list of all patients who received conscious sedation. The conscious sedation log is for a list of only those patients who received conscious sedation and experienced complications.

    In an application for alternative privileges for general or regional anesthesia, the log is Attachment 4 and the information to be provided for each patient during the two years before the date of the application is the following:

    1. a patient number or code which corresponds to a list of names maintained, in confidence, by the practitioner (because the patient's name must be kept confidential);
    2. the type of anesthesia service provided;
    3. the surgery or special procedure; 3. the date of the service; and
    4. any complications and resulting outcomes.

    In an application for alternative privileges for surgery or special procedures, the log is form 4A and the information to be provided for each patient is the following:

    1. a patient number or code which corresponds to a list of names maintained, in confidence, by the practitioner (because the patient's name must be kept confidential);
    2. the type of anesthesia service provided;
    3. the surgery or special procedure performed;
    4. indications for that procedure
    5. the date of the service and;
    6. any complications and resulting outcomes.

    In an application for alternative privileges for conscious sedation, the log is form 4B and list of patients includes only the patients who experienced complications relating to the applicant's provision of conscious sedation in an office setting or licensed ambulatory care facility setting and their resulting outcomes. The information to be provided for each patient is the following:

    1. a patient number or code which corresponds to a list of names maintained, in confidence, by the practitioner (because the patient's name must be kept confidential);
    2. the surgery or special procedure performed;
    3. the date of the service and;
    4. complications and resulting outcomes.
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  18. How are patient names to be handled in the log?
    Patient names must be kept confidential and so they are not to be used in the log. Instead of names, a number (or other code the applicant chooses) should be substituted for the name. So that the patient can be identified, the applicant shall maintain a corresponding list of the name and number (or coding) as a means to identify the actual patient, from the number included in the log. In connection with provision of other patient records, patient names and other patient personal identifying data throughout the application process must be redacted ( blocked out, crossed out or deleted) from the copies submitted in the application process.
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  19. What does "personal identifiers redacted" mean?
    "Personal identifiers" means personal information like name, specific address (house number, apartment number), personal telephone number; security number; insurance card numbers; and similar information that is linked to a specific individual. "Redacted" means removed or blocked out, or crossed out so that the information cannot be seen and the patient's confidentiality is protected.
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