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 Orthopaedic Foot & Ankle Society, 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

976A2 total wound(s) surface area greater than 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

976A4 total wounds(s) surface area greater than 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 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.

Please Complete Survey Areas Shaded in Green

Physician's NAME / Last: First:
Office (STATE)
E-mail address
SPECIALTY
(check all that apply) / General Surgery
Orthopaedic Surgery
Plastic Surgery
Podiatry
Other (specify) à
Number of YEARS Practicing Specialty
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

(Demographic information is kept confidential.)

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Please consider the “typical patients” shown below when completing this survey

Survey
Codes / 2015 Descriptor / Typical Patients / Global /
976A1
DME
≤ 50 cm2 / 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 / A: The patient is a male with a Stage III pressure ulcer of the sacrum that measures 8.5 x 5.0 x 3.2 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. / XXX
B: 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.
976A2
DME
> 50 cm2 / 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 greater than 50 square centimeters / A: The patient is a female who underwent major abdominal surgery. The incision showed signs suspicious of infection on post-op day two and was opened creating a wound that measured 25.0 x 3.0 x 3.0 cm. On post-op day four, negative pressure wound therapy using an electrically powered vacuum assisted closure device (eg, VACTM) is applied. / XXX
B: The patient is a male who sustains a crush injury to his lower leg and develops an acute anterior and lateral compartment syndrome requiring compartment releases.The resulting wound is 14.0 x 6.0 x 2.0 cm. Negative pressure wound therapy using an electrically powered vacuum assisted closure device (eg, VACTM) is applied.
976A3
Disposable
≤ 50 cm2 / 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 / 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. / XXX
976A4
Disposable
> 50 cm2 / 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 greater than 50 square centimeters / The patient is a female with a venous ulcer of the right anterior leg that measures 10.2 x 6.8 x 1.2 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. / XXX

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 Service below is most similar to each procedure and patient described above? You may choose one code for all procedures being surveyed or a different code for each procedure. Please put only one "X" in each column.

Reference Service List
SURVEY CODES
Please put only one "X" in each column. / CPT
Code / DESCRIPTOR / work
RVU / global
period
976A1
DME ≤50cm2 / 976A2
DME >50cm2 / 976A3
Disp ≤50cm2 / 976A4
Disp >50cm2
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

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Reference Service List - CONTINUED
976A1
DME ≤50cm2 / 976A2
DME >50cm2 / 976A3
Disp ≤50cm2 / 976A4
Disp >50cm2 / CPT
Code / DESCRIPTOR / work
RVU / global
period
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
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.


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 in minutes is required per patient treated for each of the following steps in patient care related to the surveyed code and typical patient?

976A1
DME ≤50cm2 / 976A2
DME >50cm2 / 976A3
Disp ≤50cm2 / 976A4
Disp >50cm2
PRE-service time: / minutes
INTRA-service time: / minutes
POST-service time: / minutes

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QUESTION 3: For the Survey codes and for the Reference codes 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. (Your reference code was 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
DME
≤50cm2 / RATE
Your
Ref Code / RATE
976A2
DME
>50cm2 / RATE
Your
Ref Code / RATE
976A3
Disposable
≤50cm2 / RATE
Your
Ref Code / RATE
976A4
Disposable
>50cm2 / RATE
Your
Ref Code
PRE-service complexity
INTRA-service complexity
POST-service complexity

Discussion of Physician Work for Question 4