The AMA / RUC Physician Work Survey

The AMA / RUC Physician Work Survey

Please email your completed survey to:

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

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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 No
1.  A financial ownership interest in an organization of 5% or more? / Yes / No
2.  A financial ownership interest in an organization which contributes materially to your income? / Yes / No
3.  Ownership of stock options in an organization? / Yes / No
4.  A position as proprietor, director, managing partner, or key employee in an organization? / Yes / No
5.  Serve as a consultant, researcher, expert witness (excluding professional liability testimony), speaker or writer for an organization, where payment contributes materially to your income? / Yes / No

·  Family member means spouse, domestic partner, parent, child, brother, or sister. Disclosure of family member’s 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.

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Demographic information will be kept confidential.

Physician's NAME / Last: First:
Physician’s Primary Office (STATE)
E-mail address
SPECIALTY
(check ALL that apply) / General Surgery
Orthopaedic Surgery
Plastic Surgery
Podiatry
Other (specify) à
YEARS Practicing Specialtyà
Primary Geographic Practice Setting:
(check ONE) / Rural
Suburban
Urban
Primary Type of Practice:
(check ONE) / Solo Practice
Single Specialty Group
Multispecialty Group
Medical School Faculty Practice Plan

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Please consider these “typical patients” when completing this survey

Survey Code / 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
Global / XXX
Typical Patient / The 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 Code / 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
Global / XXX
Typical Patient / The 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

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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
Code / DESCRIPTOR / work
RVU / global
period /
976A1 / 976A3 /
73620 / Radiologic examination, foot; 2 views / 0.16 / XXX
11720 / Debridement of nail(s) by any method(s); 1 to 5 / 0.32 / 000
11055 / Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion / 0.35 / 000
99212 / Office 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. / 0.48 / XXX
17250 / Chemical cauterization of granulation tissue (proud flesh, sinus or fistula) / 0.50 / 000
97597 / Debridement (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 less / 0.51 / 000
29580 / Strapping; Unna boot / 0.55 / 000
20552 / Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) / 0.66 / 000
16020 / Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) / 0.71 / 000
99231 / Subsequent 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. / 0.76 / XXX
12001 / Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less / 0.84 / 000
99213 / Office 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. / 0.97 / XXX

Reference service list continues on next page -- >

Reference Service List - continued /
976A1 / 976A3 / CPT
Code / DESCRIPTOR / work
RVU / global
period /
11042 / Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less / 1.01 / 000
95908 / Nerve conduction studies; 3-4 studies / 1.25 / XXX
99214 / Office 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. / 1.50 / XXX
16025 / Dressings 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) / 1.74 / 000
99221 / Initial 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. / 1.92 / XXX

CPT 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.

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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?

976A1 / 976A3
Pre-service time: / minutes
Intra-service time: / minutes
Post-service time / minutes

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
976A1 / Rate
Ref Code / Rate
976A3 / Rate
Ref Code
PRE-service complexity
INTRA-service complexity
POST-service complexity

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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 physician’s 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.

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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.)