The AMA / RUC Physician Work Survey



The AMA / RUC Physician Work Survey

Please email your completed survey to: RUCsurvey@

For 2015, the CPT Editorial Panel has approved new and revised codes to report colonoscopy. These new / revised CPT codes require review of physician work. The ACS, SAGES, and ASCRS need your help with this survey to assure relative values will be accurately and fairly presented to CMS during this review process.

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Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum. or small bowel proximal to an anastomosis.

When performing an endoscopic procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 45378 (colonoscopy) or 44388 (colonoscopy through stoma) with modifier 53 and appropriate documentation.

If a therapeutic colonoscopy (45379, 45380, 45381, 45382, 453X1, 45384, 453X5, 44389-443X7) is performed beyond the splenic flexure and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy code with modifier 52.

Surgical endoscopy always includes diagnostic endoscopy.

Survey Codes:

45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

45380 Colonoscopy, flexible; with biopsy, single or multiple

45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

453X1 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

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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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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?

• 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.

|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 for an organization, where payment contributes |Yes | |No | |

|materially to your income? | | | | |

Please Complete Survey Areas Shaded in Green

(Demographic information is kept confidential.)

|Physician's NAME |Last: First: |

|Physician’s Primary Office (STATE) | |

|E-mail address | |

|SPECIALTY(s) | |General Surgery |

|(check all that apply) | | |

| | |Colon and Rectal Surgery |

| | |Minimally Invasive Surgery |

| | |Other (specify) ( | |

|YEARS Practicing 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 |

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 surveyed CPT 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. A service paid on a global basis includes:

1. visits and other physician services provided within 24 hours prior to the service;

2. provision of the service; and

3. visits and other physician services for a specified number of days after the service is provided.

The global periods listed refer to the number of post-service days of care that are included in the payment for the service as determined by CMS for Medicare payment purposes.

000 global = 0 days of post-service care are included in the work RVU

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

|Survey | |Descriptor |Typical Patient |Global |

|Code | | | | |

|45378 |Diagnostic |Colonoscopy, flexible; diagnostic, including collection of specimen(s) by |A 64-year-old patient is referred for colorectal cancer screening. |000 |

| | |brushing or washing, when performed (separate procedure) | | |

|45380 |Biopsy |Colonoscopy, flexible; with biopsy, single or multiple |A 66-year-old patient presents with diarrhea, anemia, and intermittent rectal bleeding. |000 |

| | | |Colonoscopy with biopsies of a lesion is performed. | |

|45384 |Hot biopsy |Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s)|A 66-year-old patient undergoes colonoscopy for colorectal cancer screening. Diminutive |000 |

| | |by hot biopsy forceps or bipolar cautery |polyps are identified in the proximal colon and removed | |

|45385 |Snare |Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s)|A 64-year old patient undergoes colonoscopy for colorectal cancer screening. Polyps are |000 |

| | |by snare technique |identified and removed by snare technique. | |

|453X1 |Ablation |Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other |A 65-year-old patient undergoes colonoscopy for evaluation of anemia and GI blood loss. A|000 |

| | |lesion(s) (includes pre- and post-dilation and guide wire passage, when |flat lesion is identified in the transverse colon and ablated. | |

| | |performed) | | |

QUESTION 1: Which Reference Service below is most similar to each procedure and patient described above? You may choose the same reference for all procedures being surveyed or a different reference for each procedure, but only put one "X" in each column.

|Reference Service List |

|Please – only ONE "X" per column |CPT |DESCRIPTOR |work |global |

| |Code | |RVU |period |

|45378 |45380 |45384 |45385 |453X1 | |

|Diag-nostic |Biopsy |Hot |Snare |Ablation | |

| | |biopsy | | | |

|Day Before Procedure | | | | | |

| PRE-service evaluation time: | | | | | |minutes |

| PRE-service evaluation time | |

| |RATE |

| |45378 |

| |Diagnostic |

| |RATE |RATE |RATE |

| |45378 |Ref code |45380 |

| |Diagnostic | |Biopsy |

| | | | |

|45380 |YES? |NO? |If No, please describe your typical patient below: |

|Biopsy | | | |

| | | | |

|45384 |YES? |NO? |If No, please describe your typical patient below: |

|Hot | | | |

|Biopsy | | | |

| | | | |

|45385 |YES? |NO? |If No, please describe your typical patient below: |

|Snare | | | |

| | | | |

|453X1 |YES? |NO? |If No, please describe your typical patient below: |

|Ablation | | | |

| | | | |

Please continue to next page (

45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

45380 Colonoscopy, flexible; with biopsy, single or multiple

45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

453X1 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

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Moderate sedation is a service provided by the operating physician or under the direct supervision of the physician performing the procedure to allow for sedation of the patient with or without analgesia through administration of medications via intravenous, intramuscular, inhalational, oral, rectal, or intranasal routes. For purposes of the following question, sedation and analgesia delivered separately by an anesthesiologist or other anesthesia provider not performing the primary procedure is not considered moderate sedation.

QUESTION 7: Do you or does someone under your direct supervision typically administer moderate sedation for this procedure when performed in the Hospital/ASC setting or in the Office Setting?

| | |Are YOU responsible for moderate sedation admin or supervision? |

| | |In the Hospital/ASC? |In the Office? |

| | |YES |NO |N/A |YES |NO |N/A |

| | | | |I do not perform this | | |I do not perform this |

| | | | |procedure in the Hospital| | |procedure in the Office. |

| | | | |/ ASC. | | | |

|45378 |Diagnostic | | |

| |45378 |Diagnostic |Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) |

| |45380 |Biopsy |Colonoscopy, flexible; with biopsy, single or multiple |

| |45384 |Hot biopsy |Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery |

| |45385 |Snare |Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |

| |453X1 |Ablation |Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, |

| | | |when performed) |

Please email your completed survey to:

RUCsurvey@

THANK YOU!

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