ࡱ> 35012_ ,Nbjbj ErbbEp p 8,BdcDCCCCCCC$AGIDDDx!x!x!Cx!Cx!x!n<S@pk( .J> C3D0cDj>yJ FyJ@@@yJ@80"x!DD cDyJp : The AMA / RUC Physician Work Survey Please email your completed survey to: RUCsurvey@aol.com  For 2015, the CPT Editorial Panel has approved new and revised codes to report negative pressure wound therapy. These new / revised CPT codes require review of physician work. The American College of Surgeons, American Academy of Orthopaedic Surgeons, American Society of Plastic Surgeons, and American Podiatric Medical Association need your help to complete this survey to assure relative values will be accurately and fairly presented to CMS during this review process.  Survey Codes 976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment,including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters  START HERE Please Complete Survey Areas Shaded in Green Financial Disclosure: Do you or a family member have a direct financial interest in the procedure(s) shown above, other than providing these procedure(s) in the course of patient care? For purposes of this survey direct financial interest means:For each question Check Yes or NoA financial ownership interest in an organization of 5% or more?YesNoA financial ownership interest in an organization which contributes materially to your income?YesNoOwnership of stock options in an organization?YesNoA position as proprietor, director, managing partner, or key employee in an organization?YesNoServe as a consultant, researcher, expert witness (excluding professional liability testimony), speaker or writer for an organization, where payment contributes materially to your income?YesNoFamily member means spouse, domestic partner, parent, child, brother, or sister. Disclosure of family members interest applies to the extent known by you. Organization means any entity that makes or distributes the product that is utilized in performing the procedure/service and NOT the physician group or facility in which you work or perform the procedure/service. Materially means income of $10,000 or more (excluding any reimbursement for expenses) for the past 24 months. Please continue to next page (  Demographic information will be kept confidential. Physician's NAMELast: First: Physicians Primary Office (STATE)E-mail address SPECIALTY (check ALL that apply)General SurgeryOrthopaedic SurgeryPlastic SurgeryPodiatryOther (specify) (YEARS Practicing Specialty(Primary Geographic Practice Setting: (check ONE)RuralSuburbanUrbanPrimary Type of Practice: (check ONE)Solo PracticeSingle Specialty GroupMultispecialty Group Medical School Faculty Practice Plan Please continue to next page ( Please consider these typical patients when completing this survey Survey Code976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimetersGlobalXXXTypical PatientThe patient is a male with a diabetic foot ulcer of the heel that measures 3.5 x 3.8 x 1.2 cm. The base of the wound is clean and red, but with significant serous drainage. Negative pressure wound therapy using an electrically powered vacuum assisted closure device (eg, VACTM) is applied.Is your typical patient for 976A1 similar to the typical patient described above? Yes?No?If "No," please describe your typical patient below:  Survey Code976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment,including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimetersGlobalXXXTypical PatientThe patient is a male with a diabetic foot ulcer of the heel that measures 2.0 x 1.8 x 0.8 cm. The base of the wound is clean and red and has minimal necrotic tissue. Negative pressure wound therapy using a disposable mechanical wound care system (eg, SNaPTM) is applied.Is your typical patient for 976A3 similar to the typical patient described above? Yes?No?If "No," please describe your typical patient below: Introduction "Physician work" includes the following elements: Physician time it takes to perform the service Physician mental effort and judgment Physician technical skill and physical effort, and Physician psychological stress that occurs when an adverse outcome has serious consequences All of these elements will be explained in greater detail as you complete this survey. "Physician work" does not include the services provided by support staff who are employed by your practice and cannot bill separately, including registered nurses, licensed practical nurses, medical secretaries, receptionists, and technicians; these services are included in the practice expense relative values, a different component of the RBRVS. Background for Question 1 The Table in Question 1 presents reference services that have been selected for use as comparison services for this survey because their relative values are sufficiently accurate and stable to compare with other services. The work RVU column presents current Medicare fee schedule work RVUs (relative value units). In Question 1 you will be asked to select one code from this list which is most similar to the survey code descriptor and typical patient/service. It is very important to consider the global period when you are comparing the survey code to the reference services. XXX A global period does not apply to the code and evaluation and management and other diagnostic tests or minor services performed, may be reported separately on the same day 000 0 days of post-service care are included in the work RVU: visits and other physician services provided within 24 hours prior to the service; provision of the service; and visits and other physician services on the day of the service Please continue to next page (  QUESTION 1: Which reference code below is most similar to the physician work for each survey code / typical patient described above? Reference Service List - Choose only ONE reference code for each survey code.Only one "X" per column CPT CodeDESCRIPTORwork RVUglobal period976A1976A373620Radiologic examination, foot; 2 views0.16XXX11720Debridement of nail(s) by any method(s); 1 to 50.3200011055Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion0.3500099212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.0.48XXX17250Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)0.5000097597Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less0.5100029580Strapping; Unna boot0.5500020552Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)0.6600016020Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)0.7100099231Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.0.76XXX12001Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less0.8400099213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.0.97XXXReference service list continues on next page -- > Reference Service List - continued976A1976A3CPT CodeDESCRIPTORwork RVUglobal period11042Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less1.0100095908Nerve conduction studies; 3-4 studies1.25XXX99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.1.50XXX16025Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area)1.7400099221Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Usually, the problem(s) requiring admission are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.1.92XXXCPT five-digit codes, two-digit number modifiers, and descriptions only are copyright by the American Medical Association. No payment schedules, fee schedules, relative value units, scales, conversion factors, or components thereof are included in CPT. The AMA is not recommending that any specific relative values, fees, payment schedules, or related listings be attached to CPT. Any relative value scales or relative listings assigned to CPT codes are not those of the AMA, and the AMA is not recommending use of these relative values. Please continue to next page ( XXX Global Period Pre-service period Preparing to see the patient, reviewing records, and communicating with other professionals. Intra-service period Intra-service period includes treatment / therapy. Post-service period Post-service period includes arranging for further services communicating (written or verbal) with the patient, family and other professionals.  QUESTION 2. How much of your own time is required per patient treated for each of the following steps in patient care? 976A1976A3  Pre-service time:minutes Intra-service time:minutes Post-service timeminutes  QUESTION 3: For each Survey CPT code and for each reference service you chose in Question 1, rate the AVERAGE pre-, intra-, and post service complexity/intensity on a scale of 1 to 5 (1 = low; 3 =medium; 5 = high). Please base your rankings on the universe of codes your specialty performs. (Reference codes were chosen in Question 1 above.) INSERT Complexity Rating of 1, 2, 3, 4, or 5 in each green cell (rating scale: 1=low; 5=high)Rate 976A1Rate Ref CodeRate 976A3Rate Ref Code PRE-service complexity INTRA-service complexity POST-service complexity Please continue to next page (  Discussion of Physician Work Complexity and Intensity In evaluating the work of a service, it is helpful to identify and think about each of the components of a particular service. Focus only on the work that you perform during each of the identified components. The descriptions below are general in nature. Within the broad outlines presented, please think about the specific services that you provide. Physician work includes the following: Time it takes to perform the service. Mental Effort and Judgment necessary with respect to the amount of clinical data that needs to be considered, the fund of knowledge required, the range of possible decisions, the number of factors considered in making a decision, and the degree of complexity of the interaction of these factors. Technical Skill required with respect to knowledge, training and actual experience necessary to perform the service. Physical Effort can be compared by dividing services into tasks and making the direct comparison of tasks. In making the comparison, it is necessary to show that the differences in physical effort are not reflected accurately by differences in the time involved; if they are, considerations of physical effort amount to double counting of physician work in the service. Psychological Stress Two kinds of psychological stress are usually associated with physician work. The first is the pressure involved when the outcome is heavily dependent upon skill and judgment and an adverse outcome has serious consequences. The second is related to unpleasant conditions connected with the work that are not affected by skill or judgment. These circumstances would include situations with high rates of mortality or morbidity regardless of the physicians skill or judgment, difficult patients or families, or physician physical discomfort. Of the two forms of stress, only the former is fully accepted as an aspect of work; many consider the latter to be a highly variable function of physician personality.  Please continue to next page ( QUESTION 4: For each Survey CPT code and for each reference service you chose in Question 1, rate the intensity for each component listed on a scale of 1 to 5. (1= low; 3=medium; 5 = high). Please base your rankings on the universe of codes your specialty performs. (Reference codes were chosen in Question 1 above.) INSERT Intensity Rating of 1, 2, 3, 4, or 5 in each green cell (rating scale: 1=low; 5=high)Rate 976A1Rate Ref CodeRate 976A3Rate Ref CodeMental Effort and JudgmentThe range of possible diagnoses and/or management options that must be consideredThe amount and/or complexity of medical records, diagnostic tests, and/or other information that must be analyzedUrgency of medical decision makingTechnical Skill/Physical EffortTechnical skill requiredPhysical effort requiredPsychological StressThe risk of significant complications, morbidity and/or mortalityOutcome depends on skill and judgment of physicianEstimated risk of malpractice suit with poor outcome  QUESTION 5: Experience - How many times in the past 12 months have you performed each survey code procedure and each reference code procedure you chose in Question 1? In the past 12 months, how many times have you performed each survey code and how many times have you performed each reference code that you chose in Question 1?976A1 ExperienceRef Code Experience976A3 ExperienceRef Code Experience Please continue to LAST page (  ******************************VERY IMPORTANT****************************** QUESTION 6: Based on your review of all previous steps, please provide your estimated work RVU for the survey CPT codes. Please indicate value to two decimal places (eg, 0.25, 0.64, 1.12) For example, if the new/revised code involves the same amount of physician work as the reference service you choose in Question 1, you would assign the same work RVU. If the new or revised code involves less or more work than the reference service you would estimate a work RVU that is less or more than the work RVU of the reference service. This methodology attempts to set the work RVU of the survey service relative to the work RVU of comparable and established reference services. Please keep in mind the range of work RVUs for the reference codes listed in Question 1 above when providing your estimate. Estimated work RVU:976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment,including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters  Please save you work and email your completed survey to: RUCsurvey@aol.com THANK YOU!     CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.  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