The AMA / RUC Physician Work Survey



The AMA / RUC Physician Work Survey

Please email your completed survey to: RUCsurvey@

A new code to report wound therapy using ultrasonic mist has been approved for CPT 2014. The American Podiatric Medical Association needs your help to assure relative values will be accurately and fairly presented to CMS during this review process. This is important to you and other physicians because these values determine the rate at which Medicare and other payers reimburse for procedures.

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Survey Code

976X1 Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day

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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 |

|A financial ownership interest in an organization of 5% or more? |Yes | |No | |

|A financial ownership interest in an organization which contributes materially to your income? |Yes | |No | |

|Ownership of stock options in an organization? |Yes | |No | |

|A position as proprietor, director, managing partner, or key employee in an organization? |Yes | |No | |

|Serve as a consultant, researcher, expert witness (excluding professional liability testimony), speaker or writer |Yes | |No | |

|for an organization, where payment contributes materially to your income? | | | | |

• 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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Please Complete Survey Areas Shaded in Green

Demographic information will be kept confidential.

|Physician's NAME |Last: |First: |

|Physician’s Primary Office (STATE) | |

|E-mail address | |

|SPECIALTY | |Podiatry |

|(check all that apply) | | |

| | |Other (specify) ( | |

| Number of YEARS in Specialty: | | |

|Primary Geographic Practice Setting: | |Rural |

|(check one) | | |

| | |Suburban |

| | |Urban |

|Primary Type of Practice: | |Solo Practice |

|(check one) | | |

| | |Single Specialty Group |

| | |Multispecialty Group |

| | |Medical School Faculty Practice Plan |

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Introduction

"Physician work" includes the following elements:

1. Physician time it takes to perform the service

2. Physician mental effort and judgment

3. Physician technical skill and physical effort, and

4. 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.

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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

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Please consider this “typical patient” when completing this survey

|Survey Code |976X1 Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound |

| |assessment, and instruction(s) for ongoing care, per day |

|Global Period |XXX |

|Typical Patient |A 68-year-old female presents with a persistent lower extremity ulcer. The area is painful, has an indurated margin and the |

| |wound bed is a pale pink color with minimal yellow/white slough. |

Is your typical patient for the survey code similar to the typical patient described above?

|976X1 |YES? |NO? |If "No," please describe your typical patient below: |

| | | | |

Question 1: Which one of the Reference Services below is most similar to the survey code and typical patient described above?

|Reference Service List |

|Place ONLY ONE "X" in the first column to indicate your reference choice. |

|Choose |CPT |DESCRIPTOR |work |global |

|One |Code | |RVU |period |

| |73620 |Radiologic examination, foot; 2 views |0.16 |XXX |

| |93922 |Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower |0.25 |XXX |

| | |extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus | | |

| | |bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal | | |

| | |posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or | | |

| | |ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, | | |

| | |transcutaneous oxygen tension measurement at 1-2 levels) | | |

| |11720 |Debridement of nail(s) by any method(s); 1 to 5 |0.32 |000 |

| |29540 |Strapping; ankle and/or foot |0.39 |000 |

| |99212 |Office or other outpatient visit for the evaluation and management of an established patient, which requires at|0.48 |XXX |

| | |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. | | |

| |97597 |Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, |0.51 |000 |

| | |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 | | |

| |11721 |Debridement of nail(s) by any method(s); 6 or more |0.54 |000 |

| |29580 |Strapping; Unna boot |0.55 |000 |

| |76881 |Ultrasound, extremity, nonvascular, real-time with image documentation; complete |0.63 |XXX |

| |16020 |Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body |0.71 |000 |

| | |surface area) | | |

| |93925 |Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study |0.80 |XXX |

| |99213 |Office or other outpatient visit for the evaluation and management of an established patient, which requires at|0.97 |XXX |

| | |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. | | |

| |99308 |Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at |1.16 |XXX |

| | |least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused | | |

| | |examination; Medical decision making of low complexity. Usually, the patient is responding inadequately to | | |

| | |therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the | | |

| | |patient's facility floor or unit. | | |

| |95908 |Nerve conduction studies; 3-4 studies |1.25 |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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Treatment / Therapy - 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.

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QUESTION 2. How much of your own time is required per patient treated for each of the following steps in patient care related each procedure?

| |976X1 |

| Pre-service time: | |minutes |

| Intra-service time: | |minutes |

| Post-service time | |minutes |

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QUESTION 3: For the Survey code and for the 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 code was chosen on Page 4 above.)

| |INSERT RATING: 1, 2, 3, 4, or 5 |

| |IN EACH CELL BELOW |

| |(rating scale: 1=low; 5=high) |

| |Rate (1,2,3,4, or 5) |Rate (1,2,3,4, or 5) |

| |976X1 |Your 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 the Survey code and for the 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 code was chosen on Page 4 above.)

| |INSERT RATING: 1, 2, 3, 4, or 5 |

| |IN EACH CELL BELOW |

| |(rating scale: 1=low; 5=high) |

| |Rate (1,2,3,4, or 5) |Rate (1,2,3,4, or 5) |

| |976X1 |Your Ref Code |

|Mental Effort and Judgment | | |

|The number of possible diagnoses and/or the number of management options that must be | | |

|considered | | |

|The amount and/or complexity of medical records, diagnostic tests, and/or other | | |

|information that must be obtained reviewed and analyzed | | |

|Urgency of medical decision making | | |

|Technical Skill/Physical Effort | | |

|Technical skill required | | |

|Physical effort required | | |

|Psychological Stress | | |

|The risk of significant complications, morbidity and/or mortality | | |

|Outcome depends on skill and judgment of physician | | |

|Estimated risk of malpractice suit with poor outcome | | |

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|QUESTION 5: In the past 12 months, how many times |976X1 |Ref Code |

|have you performed 976X1 and how many times have you performed the Reference procedure you chose |experience |experience |

|on Page 4 above? | | |

| | | |

|If you have NOT performed 976X1 in the past 12 months, |Yes |No |

|have you ever performed this service? | | |

| | | |

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***************************VERY IMPORTANT QUESTION*************************

QUESTION 6: Based on your review of all previous steps, please provide your estimated work RVU for the survey code.

Please keep in mind the range of work RVUs for the reference codes listed in Question 1 on page 4 above when providing your estimate. For example, if the survey 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 survey code involves less work than the reference service you would estimate a work RVU that is less than the work RVU of the reference service and vice-versa. This methodology attempts to set the work RVU of the survey service “relative” to the work RVU of comparable and established reference services.

|Enter Your | |

|Estimated | |

|work RVU: | |

| |976X1 Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound |

| |assessment, and instruction(s) for ongoing care, per day |

Please email your completed survey to: RUCsurvey@

THANK YOU!

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