1. Understanding the RUC Survey 1

2. PURPOSE OF THE SURVEY Measure physician work involved in the new, surveyed procedure code by comparing the new procedure code to another existing CPT code 2

3. PURPOSE OF THE SURVEY The RUC defines physician work as: Physician time it takes to perform the service Physician mental effort and judgment Physician technical skill and physical effort Physician psychological stress that occurs when an adverse outcome has serious consequences 3

4. THE SURVEY STEP 1 – Review code descriptor and vignette (a short description of the patient) STEP 2 – Review introduction & complete contact information STEP 3 – Identify a reference procedure STEP 4 – Estimate your time STEP 5 – Compare the survey procedure to a reference procedure STEP 6 – Moderate Sedation STEP 7 – Estimate work RVU (relative value unit)

5. Review Code Descriptor and Vignette The vignette describes the estimated TYPICAL clinical scenario for the procedure Base your answers on this TYPICAL patient and scenario. You will be asked if this vignette represents your typical patient. 5

6. Review Introduction and Complete Contact Information Although contact and basic practice information may be collected, your name is never forwarded to the AMA or RUC nor used for tracking purposes. It is extremely rare, but you may be contacted by ISIS staff if we need additional information or clarification 6

7. Identify a Reference Service List of Reference Services: The survey site includes a list of reference services. Your Task: Select a code from this list that is most similar to this procedure. Purpose: The reference service will be used as a comparison to the studied code throughout the survey. 7

8. Estimate Your Time This section of the survey asks you to estimate how much time it takes you to perform the procedure. These estimates must be based on personal experience. Do not consider the time involved for any other procedures that would be separately reported. 8

9. Estimate Your Time Physician Time Includes: Pre-Service Intra-Service Post-Service * Physician Time DOES NOT include: Services provided by clinical staff Other services provided on the same day that can be coded separately 9

10. 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

11. Pre-Service Period INCLUDED: Hospital admission work-up. The pre-operative evaluation may include the procedural work-up, review of records, communicating with other professionals, patient and family, and obtaining consent. 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-skin-to-skin” work in the OR.

12. Pre-Service Period 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).

13. Intra-Service Period Defined The intra-service period includes all “skin to skin” work that is a necessary part of the procedure

14. Post-Service Period Depending on global period Day of procedure: “non-skin-to-skin” work in the OR after procedure patient stabilization in the recovery room or special unit, communicating with the patient and other professionals (including written and telephone reports and orders) patient visits on the day of the operative procedure and global period

15. Post-Service Period NOT INCLUDED: Unrelated evaluation and management service provided during the post-operative period (reported with modifier -24) Return to the operating room for a related procedure during the post-operative period (reported with modifier -78) Unrelated procedure or service performed by the same physician during the post-operative period (reported with modifier -79)

16. Compare Surveyed Code to Reference Code In this step you will be asked to compare the complexity and intensity of the new code with the reference code you selected 16

17. Conscious Sedation and Typical Patient You will be asked if you or someone under your direct supervision typically administers conscious sedation for this procedure 17

18. Estimate Work RVU In this final step you will be asked to estimate the physician work RVU You are asked to consider the reference service in developing your estimate The survey methodology attempts to set the work RVU of the new service “relative” to the work RVU of the comparable and established reference service 18

19. WHAT HAPPENS NEXT? The specialty societies involved in the development of physician work and practice expense recommendations, will prepare recommendations based on the survey data, relativity comparisons and set precedent. AMA’s RUC approves a value which is confidential until CMS’ publication RUC submits physician work and practice expense recommendations to CMS CMS makes final decisions 19