General Surgery Operative Log Guidelines

This page provides General Surgery Residents with guidelines for preparing their surgery operative log data for submission to the ACGME and the American Board of Surgery (ABS) at the completion of training. Please be sure to review Dr. Hirose's General Guide to Case Logging, which provides important information and tips on successful case logging.

American Board of Surgery 

ACGME Surgery Case Log Info

Dr. Hirose's Guide to Case Logging     

Credit Roles for Surgery Residents

Only one resident may take credit as surgeon for each operation and only for one procedure in a multi-procedure operation. On the same patient/day/operation, a senior resident may take credit as Surgeon Junior/Surgeon Chief while another resident takes credit as a First Assistant, or a senior resident may take credit as a Teaching Assistant while a more junior resident takes credit as a Surgeon Junior.

• SC = Surgeon Chief Year (only cases credit as surgeon during 12 months of Chief Year)
• SJ = Surgeon Junior Years (all cases credited as surgeon prior to Chief Year)
• TA = Teaching Assistant (more senior resident working with junior resident who takes credit as surgeon)
• FA = First Assistant (any instance in which a resident assists at an operation with another surgeon—an attending or more senior resident—responsible for the operation.

Defined Category Minimum Requirements

ACGME Case Log Information

Total Major Cases by Year (Program Expectation)

Residents are expected by the program to log the following number of total major (see defined category report) cases by the end of each post-graduate (PG) year. Total major cases are comprised of all Surgeon Chief, Surgeon Junior, and the first 50 Teaching Assistant cases up to and including Operative Trauma.

• PGY1: 150
• PGY2: 300
• PGY3: 500
• PGY4: 800
• PGY5: 1050+

Defined Case Category Minimums (ACGME Requirement)

Trauma & Non-Operative Trauma Cases (MOTNOR)

Guidelines:

• To log non-operative trauma cases: select CPT code #99199
• The category, major organ trauma, no operation required, is defined as patients with major organ trauma who were admitted to a specialty care unit in the hospital (i.e., SICU, CCU, Burn Unit, etc.)
• The most senior resident on the trauma service should claim credit for the MOTNOR case. In the instance where there is no trauma service, a fourth or fifth year general surgery resident may claim credit. 
• If the patient subsequently requires a general surgery operative procedure that may be claimed in the defined category Operative Trauma, then this case should be recorded as Operative Trauma and not as MOTNOR

Critical Care Index Log Reports

Critical Care Cases

The ACGME requires that general surgery residents do at least 40 Critical Care index cases (CPT code 99292). Within this code category you will be prompted to select an RRC code to map to the 99292 CPT code. You should have at least two RRC codes selected per patient out of the seven available categories. Detailed information regarding critical care guidelines can be found under the "procedure tab" when logging into the ACGME case log system.

Critical Care Case Log Guidelines

The ACGME case log system allows general surgery residents to identify the required minimum 40 surgical critical care index cases by using CPT code 99292. This code will map to all seven of the surgical critical care conditions. 

It is important that new users entering CPT code 99292 understand that this index category is different from all other codes. CPT code 99292 is the only code that will allow credit to be taken for multiple procedures on the same patient on the same day.

Reports run from the ACGME case log system will provide both a summary of all instance in which the resident managed two of the seven index critical care conditions, as well as a detailed report for each patient encounter that will identify all the seven conditions that were managed by the resident for any one patient.

RRC Code Assignments

RRC procedure values that have been assigned to the surgical critical care patient management procedures:

8410 - Ventilatory management (>24 hours on ventilator)
8420 - Bleeding (non-trauma patient >3 units)
8430 - Hemodynamic instability (req. inotropic/pressor support)
8440 - Organ dysfunction (renal, hepatic, cardiac failure)
8450 - Dysrhythmias (requiring drug management)
8460 - Invasive line management/monitoring (Swan-Ganz, catheter, arterial lines, etc.)
8470 - Parenteral/enteral nutrition

Generating ACGME Case Log Reports

Residents may run and review the following case log reports directly from the ACGME case log system:

1. Resident Experience Report by Role
2. Defined Category Report
3. Year 2 Minimum Report
4. Resident Full Detail Report
5. Resident Activity Report
6. Critical Care Log Report

Questions

Please contact Alexi Callen