top of page

Doctor's Office or Surgery Center? What the differences are?

The differences in codes and regulations between a doctor's office and a surgery center are mainly influenced by the scope of services they provide, the complexity of the procedures performed, and the level of care required. Here's a general overview of the key differences:


puppets asking if they can help you when working in a doctors office


1. Licensing and Accreditation

  • Doctor's Office: Typically requires a state medical license for the practicing physicians and may not need specific facility accreditation if only non-invasive or minor procedures are performed.

  • Surgery Center: Requires a state license as an ambulatory surgery center (ASC) and often needs accreditation from a recognized body such as the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission. This is because surgery centers perform more invasive procedures and must meet higher standards for patient safety and care.

2. Facility Requirements

  • Doctor's Office: Facility requirements are generally less stringent, focusing on basic health, safety, and privacy standards. They must be ADA compliant and have appropriate facilities for examination and minor treatments.

  • Surgery Center: Must adhere to more rigorous facility standards, including sophisticated surgical environments (operating rooms), recovery areas, and advanced medical equipment. They are also required to have systems in place for emergency situations, including life support equipment.

3. Staffing and Personnel

  • Doctor's Office: Staff typically includes physicians, nurses, and administrative personnel. There may not be a requirement for staff to have advanced surgical training or certifications beyond their professional credentials.

  • Surgery Center: Must have a surgical staff that includes board-certified surgeons, anesthesiologists or certified registered nurse anesthetists (CRNAs), and nursing staff with surgical and emergency care experience. Credentialing for all surgical staff is more stringent.

4. Patient Care and Safety Protocols

  • Doctor's Office: Focuses on outpatient care, with procedures generally involving lower risks. Patient care protocols might include basic emergency response plans and follow-up care instructions.

  • Surgery Center: Must have comprehensive patient care and safety protocols, including pre-operative assessments, intra-operative care, post-operative care, and emergency response procedures. There are strict guidelines for sterility, medication administration, and patient monitoring.

5. Regulatory Oversight

  • Doctor's Office: Subject to state medical board regulations and Health Insurance Portability and Accountability Act (HIPAA) compliance for patient information.

  • Surgery Center: In addition to state and HIPAA regulations, surgery centers are often subject to Medicare and Medicaid services regulations, which include specific conditions for coverage, reporting of quality data, and compliance with federal healthcare standards. In some states, a surgery center must be nationally accredited to be operational while some states require state licensure, accreditation, and even CMS certification. It varies from state to state.

6. Insurance and Billing

  • Doctor's Office: Billing is typically for office visits, minor procedures, and consultations. The complexity of billing may be less than that of a surgery center.

  • Surgery Center: Involves more complex billing that includes facility fees, surgeon's fees, anesthesia fees, and charges for any additional medical supplies or services provided during surgery. Surgery centers must navigate a more complex insurance pre-authorization and billing landscape.


These distinctions highlight the regulatory and operational complexities associated with providing higher levels of care, such as those offered by surgery centers. Regulations and codes are designed to ensure patient safety, quality of care, and appropriate facility and staff capabilities to handle the medical services provided.

12 views0 comments

Comments

Rated 0 out of 5 stars.
No ratings yet

Add a rating
bottom of page