Download 2-Colonoscopy-Survey..

The AMA / RUC Physician Work Survey
Please email your completed survey to: [email protected]
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.
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
45386
Colonoscopy, flexible; with transendoscopic balloon dilation
453X2
Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)
453X4
Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube,
when performed
________________________
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.
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 1
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
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
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 2
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
General Surgery
SPECIALTY(s)
(check all that apply)
Colon and Rectal Surgery
Minimally Invasive Surgery
Other (specify) 
YEARS Practicing Specialty
Rural
Primary Geographic Practice Setting:
(check one)
Suburban
Urban
Solo Practice
Primary Type of Practice:
(check one)
Single Specialty Group
Multispecialty Group
Medical School Faculty Practice Plan
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 3
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 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:
*
*
*
visits and other physician services provided within 24 hours prior to the service;
provision of the service; and
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
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 4
Please consider the “typical patients” shown below when completing this survey.
Survey
Code
45378
45380
45386
453X2
453X4
Diagnostic
Descriptor
Colonoscopy, flexible; diagnostic, including collection
of specimen(s) by brushing or washing, when performed
(separate procedure)
Typical Patient
Global
A 64-year-old patient is referred for colorectal cancer screening.
000
000
Biopsy
Colonoscopy, flexible; with biopsy, single or multiple
A 66-year-old patient presents with diarrhea, anemia, and
intermittent rectal bleeding. Colonoscopy with biopsies of a lesion
is performed.
Dilation
Colonoscopy, flexible; with transendoscopic
balloon dilation
A 65-year-old patient with history of resection of a sigmoid colon
cancer presents with abdominal pain. Therapeutic colonoscopy
with dilation of the anastomotic stricture is performed.
000
Colonoscopy, flexible; with endoscopic stent
placement (includes pre- and post-dilation and
guide wire passage, when performed)
A 68-year-old patient with history of resection of a sigmoid
cancer presents with abdominal pain and imaging findings of an
obstructing lesion in the mid-transverse colon. Colonoscopy with
dilation of the colon and placement of a stent is performed.
000
A 76- year- old patient with history of altered mental status
presents with abdominal distension and a megacolon on imaging
studies. Colonoscopy with decompression of the colon and
placement of a tube is performed.
000
Stent
Colonoscopy, flexible; with decompression (for
pathologic distention) (eg, volvulus, megacolon),
Decompress
including placement of decompression tube, when
performed
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 5
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
45378
45380
45386
453X2
453X4
Diagnostic
Biopsy
Dilation
Stent
Decompress
work
global
Code
CPT
DESCRIPTOR
RVU
period
32554
Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging
guidance
1.82
000
36556
Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older
2.50
000
31622
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
diagnostic, with cell washing, when performed (separate procedure)
2.78
000
32551
Tube thoracostomy, includes connection to drainage system (eg, water seal), when
performed, open (separate procedure)
3.29
000
31628
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with
transbronchial lung biopsy(s), single lobe
3.80
000
31629
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with
transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)
4.09
000
32550
Insertion of indwelling tunneled pleural catheter with cuff
4.17
000
37191
Insertion of intravascular vena cava filter, endovascular approach including vascular
access, vessel selection, and radiological supervision and interpretation, intraprocedural
roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
4.71
000
36246
Selective catheter placement, arterial system; initial second order abdominal, pelvic, or
lower extremity artery branch, within a vascular family
5.27
000
35475
Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each
vessel
5.75
000
36247
Selective catheter placement, arterial system; initial third order or more selective abdominal,
pelvic, or lower extremity artery branch, within a vascular family
6.29
000
52352
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of
calculus (ureteral catheterization is included)
6.75
000
52344
Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon
dilation, laser, electrocautery, and incision)
7.05
000
31600
Tracheostomy, planned (separate procedure);
7.17
000
37220
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel;
with transluminal angioplasty
8.15
000
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 6
Background for Questions 2 and 3 (000 global period)
Pre-service period
The pre-service period includes physician services provided from the day before the operative procedure until the time of the operative procedure and may include
the following:
 Assessment of the patient’s status for indications, contraindications, and fitness to undergo the endoscopy procedure. May include procedural work-up,
review of records, communicating with other professionals, patient and family, coordinating scheduling and preparation and obtaining consent.
 Assessment of the patient’s fitness for administration of moderate sedation, if personally administered/supervised by endoscopist.
 Other pre-operative work may include dressing, scrubbing, and waiting before the operative procedure, preparing patient and needed equipment for the
operative procedure, positioning the patient and other “non-scope-in to non-scope-out” work in the OR.
 All time for the administration of moderate sedation from the first dose administered until the endoscopic procedure begins (if necessary) if personally
administered / supervised by the endoscopist, including management of sedation.
 When appropriate, includes work that is intrinsic to the procedure which follows withdrawal of the last endoscope, such as bougie dilation or endoscopy
completion.
The following services are not included:
 Consultation or evaluation at which the decision to provide the procedure was made (reported with modifier -57).
 Distinct evaluation and management services provided in addition to the procedure (reported with modifier -25).
 Mandated services (reported with modifier -32).
Intra-service period

“First scope-in to last scope-out”
Post-service period
The post-service period includes services provided on the day of the procedure and may include the following:
 Day of procedure: Post-operative care on day of the procedure includes “non-scope-in to non-scope-out” work in the OR, patient stabilization in the
recovery room or special unit, communicating with the patient and other professionals (including written and telephone reports and orders), and patient
visits on the day of the operative procedure.
 Assessment for fitness to discharge from the procedure area when performed by the physician.
 Discharge instructions and counseling to patient and caregivers when performed by the physician.
The following services are not included:
 Unrelated evaluation and management service provided during the postoperative period (reported with modifier -24)
 Return to the operating room for a related procedure during the postoperative period (reported with modifier -78)
 Unrelated procedure or service performed by the same physician during the postoperative period (reported with modifier -79)
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 7
45378
45380
45386
453X2
453X4
Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Colonoscopy, flexible; with biopsy, single or multiple
Colonoscopy, flexible; with transendoscopic balloon dilation
Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)
Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
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? Please keep in mind the descriptions of pre-, intra-, and post-work described on the previous page.
45378
45380
45386
453X2
453X4
Diagnostic
Biopsy
Dilation
Stent
Decompress
Day Before Procedure
PRE-service evaluation time:
minutes
Day of Procedure
PRE-service evaluation time
minutes
PRE-service positioning time
minutes
PRE-service scrub, dress, wait time
minutes
INTRA-service time
First scope-in to last scope-out
minutes
POST-service time*
minutes
*Post-service care on day of the procedure, includes “non-scope-in-to-scope-out” work in the OR, patient stabilization in the recovery
room or special unit and communicating with the patient and other professionals (including written and telephone reports and orders), and
patient visits on the day of the procedure.
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 8
QUESTION 3: For the Surveyed CPT code and for the reference service you chose in Question 1, RATE on a scale of 1 to 5 the AVERAGE
pre-, intra-, and post service complexity/intensity (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.)
RATE
45378
Diagnostic
INSERT YOUR RATING: 1, 2, 3, 4, or 5 IN EACH CELL BELOW
(rating scale: 1=low; 3=medium; 5=high)
RATE
RATE
RATE
RATE
RATE
RATE
RATE
RATE
Ref
Ref
Ref
Ref
45380
45386
453X2
453X4
code
code
code
code
Biopsy
Dilation
Stent
Decom-
RATE
Ref
code
press
PRE-service complexity
INTRA-service complexity
POST-service complexity
Discussion of Physician Work for Question 4
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.
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 9
QUESTION 4: For the Surveyed CPT code and for the reference service you chose in Question 1, RATE on a scale of 1 to 5 the intensity for
each component listed (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.)
RATE
45378
Diagnostic
INSERT YOUR RATING: 1, 2, 3, 4, or 5 IN EACH CELL BELOW
(rating scale: 1=low; 3=medium; 5=high)
RATE
RATE
RATE
RATE
RATE
RATE
RATE
RATE
Ref code 45380 Ref code 45386 Ref code 453X2 Ref code 453X4
Biopsy
Dilation
Stent
RATE
Ref code
Decompress
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
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 10
QUESTION 5: EXPERIENCE - How many times in the past 12 months have you performed each survey code and reference code(s) procedure?
In the past 12 months, how many times have
you performed each survey code and how
many times have you performed each
reference code that you chose in Question 1?
45378
Diagnostic
Ref
code
45380
Biopsy
Ref
code
45386
Dilation
Ref
code
453X2
Stent
Ref
code
453X4
Decompress
Ref
code
*Your reference codes were chosen in Question 1 above.
QUESTION 6: Is your typical patient similar to the typical patient described at the beginning of the survey?
45378
YES?
NO?
If No, please describe your typical patient below:
YES?
NO?
If No, please describe your typical patient below:
YES?
NO?
If No, please describe your typical patient below:
YES?
NO?
If No, please describe your typical patient below:
YES?
NO?
If No, please describe your typical patient below:
Diagnostic
45380
Biopsy
45386
Dilation
453X2
Stent
453X4
Decompress
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 11
45378
45380
45386
453X2
453X4
Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Colonoscopy, flexible; with biopsy, single or multiple
Colonoscopy, flexible; with transendoscopic balloon dilation
Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)
Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
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?
YES
45378
Diagnostic
45380
Biopsy
45386
Dilation
453X2
Stent
453X4
Decompress
NO
In the Office?
N/A
N/A
I do not perform this
procedure in the
Hospital / ASC.
I do not perform this
procedure in the
Office.
YES
NO
Please continue to last page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 12
******************************VERY IMPORTANT******************************
QUESTION 8:
Based on your review of all previous steps, please provide your estimated work RVU for each survey code.
Please indicate value to two decimal places (eg, 0.25, 0.64, 1.12)
Please keep in mind the range of work RVUs for the reference codes listed in Question 1 above when providing your estimate. For example, if the
new/revised 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 new or revised 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 new/revised service “relative” to the work RVU of comparable and
established reference services.
Estimated
work RVU:
Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or
washing, when performed (separate procedure)
45378
Diagnostic
45380
Biopsy
Colonoscopy, flexible; with biopsy, single or multiple
45386
Dilation
Colonoscopy, flexible; with transendoscopic balloon dilation
453X2
Stent
453X4
Decompress
Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and
guide wire passage, when performed)
Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus,
megacolon), including placement of decompression tube, when performed
Please email your completed survey to:
[email protected]
THANK YOU!
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Page 13