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 through stoma is the examination of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, 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.

Report colonoscopy through stoma (44388-4439X8) for endoscopic examination of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection) and has a colostomy.

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:

44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

44389 Colonoscopy through stoma; with biopsy, single or multiple

443X4 Colonoscopy through stoma; with directed submucosal injection(s), any substance

443X3 Colonoscopy through stoma; with endoscopic mucosal resection

443X8 Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, 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 | | | | |

|44388 |Diagnostic |Colonoscopy through stoma; diagnostic, including collection of |A 65-year-old patient with a history of abdominal perineal resection of a rectal cancer |000 |

| | |specimen(s) by brushing or washing, when performed (separate |undergoes colonoscopy through stoma for surveillance. | |

| | |procedure) | | |

|44389 |Biopsy |Colonoscopy through stoma; with biopsy, single or multiple |A 65-year-old patient with a history of abdominal perineal resection of a rectal cancer |000 |

| | | |presents with occult blood in the stool. Colonoscopy through stoma with biopsies of a lesion | |

| | | |is performed. | |

|443X4 |Injection |Colonoscopy through stoma; with directed submucosal injection(s), any |A 68-year-old patient with a history of abdominal perineal resection of a rectal cancer is |000 |

| | |substance |found to have a colonic cancer that cannot be resected endoscopically. Colonoscopy through | |

| | | |stoma with injection of India ink to tattoo the lesion is performed prior to surgical | |

| | | |referral. | |

|443X3 |EMR |Colonoscopy through stoma; with endoscopic mucosal resection |A 65-year-old patient with a history of abdominal perineal resection of a rectal cancer |000 |

| | | |undergoes colonoscopy through stoma. A large sessile polyp is identified, and endoscopic | |

| | | |mucosal resection is performed. | |

|443X8 |Decompress |Colonoscopy through stoma; with decompression (for pathologic |A 76-year-old patient with altered mental status and a permanent colostomy presents with |000 |

| | |distention) (eg, volvulus, megacolon), including placement of |abdominal distension and a megacolon on imaging studies. Colonoscopy through stoma with | |

| | |decompression tube, when performed |decompression of the colon and placement of tube is 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 |

|44388 |44389 |443X4 |443X3 |443X8 | |

|Diag-nostic |Biopsy |Inject |EMR |Decom-press | |

|Day Before Procedure | | | | | |

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

| PRE-service evaluation time | |

| |RATE |

| |44388 |

| |Diagnostic |

| |RATE |RATE |RATE |

| |44388 |Ref code |44389 |

| |Diagnostic | |Biopsy |

| | | | |

|44389 |YES? |NO? |If No, please describe your typical patient below: |

|Biopsy | | | |

| | | | |

|443X4 |YES? |NO? |If No, please describe your typical patient below: |

|Injection | | | |

| | | | |

|443X3 |YES? |NO? |If No, please describe your typical patient below: |

|EMR | | | |

| | | | |

|443X8 |YES? |NO? |If No, please describe your typical patient below: |

|Decom-press | | | |

| | | | |

Please continue to next page (

44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

44389 Colonoscopy through stoma; with biopsy, single or multiple

443X4 Colonoscopy through stoma; with directed submucosal injection(s), any substance

443X3 Colonoscopy through stoma; with endoscopic mucosal resection

443X8 Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, 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. | | | |

|44388 |Diagnostic | | |

| |44388 |Diagnostic |Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) |

| |44389 |Biopsy |Colonoscopy through stoma; with biopsy, single or multiple |

| |443X4 |Injection |Colonoscopy through stoma; with directed submucosal injection(s), any substance |

| |443X3 |EMR |Colonoscopy through stoma; with endoscopic mucosal resection |

| |443X8 |Decompress |Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of |

| | | |decompression tube, when performed |

Please email your completed survey to:

RUCsurvey@

THANK YOU!

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