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 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 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
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
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 each question
Check Yes or No
For purposes of this survey “direct financial interest” means:
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
Yes
No
organization?
5. Serve as a consultant, researcher, expert witness (excluding professional
liability testimony), speaker or writer for an organization, where payment
Yes
No
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.
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
1
Demographic information will be kept confidential.
Physician's NAME Last:
First:
Physician’s Primary Office (STATE)
E-mail address
General Surgery
Orthopaedic Surgery
SPECIALTY
(check ALL that apply)
Plastic Surgery
Podiatry
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
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
2
Please consider these “typical patients” when completing this survey
976A1 Negative pressure wound therapy (eg, vacuum assisted drainage collection),
utilizing durable medical equipment (DME), including topical
Survey
application(s), wound assessment, and instruction(s) for ongoing care, per
Code
session; total wound(s) surface area less than or equal to 50 square
centimeters
Global XXX
The patient is a male with a diabetic foot ulcer of the heel that measures 3.5 x 3.8 x
Typical 1.2 cm. The base of the wound is clean and red, but with significant serous drainage.
Patient Negative pressure wound therapy using an electrically powered vacuum assisted
closure device (eg, VACTM) is applied.
Is your typical patient for 976A1 similar to the typical patient described above?
Yes?
No?
If "No," please describe your typical patient below:
976A3 Negative pressure wound therapy, (eg, vacuum assisted drainage collection),
utilizing disposable, non-durable medical equipment, including provision of
Survey
exudate management collection system, topical application(s), wound
Code
assessment, and instructions for ongoing care, per session; total wounds(s)
surface area less than or equal to 50 square centimeters
Global XXX
The patient is a male with a diabetic foot ulcer of the heel that measures 2.0 x 1.8 x
Typical 0.8 cm. The base of the wound is clean and red and has minimal necrotic tissue.
Patient Negative pressure wound therapy using a disposable mechanical wound care
system (eg, SNaPTM) is applied.
Is your typical patient for 976A3 similar to the typical patient described above?
Yes?
No?
If "No," please describe your typical patient below:
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
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 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
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
4
QUESTION 1: Which reference code below is most similar to the physician work for each survey
code / typical patient described above?
Reference Service List - Choose only ONE reference code for each survey code.
Only one "X"
per column
976A1
976A3
CPT
Code
DESCRIPTOR
work
global
RVU
period
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
0.76
XXX
0.84
000
0.97
XXX
99231
12001
99213
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.
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
trunk and/or extremities (including hands and feet); 2.5 cm or less
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.
Reference service list continues on next page -- >
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
5
Reference Service List - continued
CPT
976A1
976A3
work
global
Code
DESCRIPTOR
RVU
period
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
1.50
XXX
1.74
000
1.92
XXX
99214
16025
99221
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.
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)
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.
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.
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
6
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 is required per patient treated for each of the following
steps in patient care?
976A1
976A3
Pre-service time:
minutes
Intra-service time:
minutes
Post-service time
minutes
QUESTION 3:
For each Survey CPT code and for each 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 codes were 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
Rate
Ref
Code
Rate
976A3
Rate
Ref
Code
PRE-service complexity
INTRA-service complexity
POST-service complexity
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
7
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.
Please continue to next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
8
QUESTION 4:
For each Survey CPT code and for each 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 codes were chosen in Question 1 above.)
INSERT Intensity
Rating of 1, 2, 3, 4, or 5
in each green cell
Rate
(rating scale: 1=low; 5=high)
Rate
Rate
Rate
976A1
Ref Code
976A3
Ref Code
Mental Effort and Judgment
The range of possible diagnoses and/or management options
that must be considered
The amount and/or complexity of medical records, diagnostic
tests, and/or other information that must be 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
QUESTION 5:
Experience - How many times in the past 12 months have you performed each survey code
procedure and each reference code procedure you chose in Question 1?
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?
976A1
Ref Code
976A3
Ref Code
Experience
Experience
Experience
Experience
Please continue to LAST page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
9
******************************VERY IMPORTANT******************************
QUESTION 6:
Based on your review of all previous steps, please provide your estimated work RVU for the survey
CPT codes. Please indicate value to two decimal places (eg, 0.25, 0.64, 1.12)
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 or more work
than the reference service you would estimate a work RVU that is less or more than the work RVU of the reference
service. This methodology attempts to set the work RVU of the survey service “relative” to the work RVU of
comparable and established reference services. Please keep in mind the range of work RVUs for the reference codes
listed in Question 1 above when providing your estimate.
Estimated
work RVU:
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
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
Please save you work and 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.
10