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Operative Log Guidelines for General Surgery Residents

General Guide to Case Logging |  American Board of Surgery  |  ACGME Surgery Case Log Info | Questions

This page provides General Surgery Residents with guidelines for preparing their Surgery OPERATIVE LOG Data for submission to the ACGME at the completion of training.

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 same patient/same day/same operation a senior resident may take credit as surgeon 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. 

  • SC = Surgeon Chief Year (only cases credited 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

DC Minimums (General Surgery Defined Category Mappings)

Total Cases (TTL MAJ) by Year

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

PGY-1 -  150
PGY-2 -  300
PGY-3 -  500
PGY-4 -  800
PGY-5 - 1050+

 

Defined Categories/Sub-categories Minimum Operative Experience for Chiefs (effective 2017-18) NOTES
     
Skin, Soft Tissue (SS) 25  
Breast (B) 40  
    Mastectomy 5  
    Axilla 5  
Head and Neck (H&N) 25  
Alimentary Tract (ALTR) 180  
    Esophagus 5  
    Stomach 15  
    Small Intestine 25  
    Large Intestine 40  
    Appendix 40  
    Anorectal 20  
Abdominal (AB) 250  
    Biliary 85  
    Hernia 85  
    Liver 5  
    Pancreas 5  
Vascular (VASC) 50  
    Access 10  
    Anastamosis, Repair, or 
    Endarterectomy		 10  
Endocrine (ENDO) 15  
    Thyroid or Parathyroid 10  
Operative Trauma (TRAUMOP) 10  
Non-operative trauma (TRNONOP) 40 Use code 92950 to log
    Resuscitations as Team 
    Leader		 10 Use code 92950 to log
Thoracic Surgery (THOR) 20  
    Thoracotomy 5  
Pediatric Surgery (PED) 20  
Plastic Surgery (PLAS) 10  
Surgical Critical Care 40  
Laparoscopic Basic (LAP-B) 100 Includes:
Cholecystectomy
Appendectomy
Endoscopy (ENDO) 85  
    Upper Endoscopy 35 Includes percutaneous endoscopic gastrostomy
    Colonoscopy 50  
Laparoscopic Complex (LAP-C) 75 Includes:
Lap, gastrostomy and feeding jejunoscopy;
Lap, inguinal and incisional herniorrhaphy;
Bariatric laparoscopy;
Lap, anti-reflux procedure;
Lap, enterolysis;
Lap, small and large bowel;
Lap, renal and adrenal surgery;
Lap, donor nephrectomy;
Lap, splenectomy
Total Cases    
Major Credit 850 Program goal: 1050+
Chief Credit 200 Program goal: 250
Other Case Types/Surgeon Roles  
Critical Care 25 Use code 99292 to log
Teaching Assistant 25  
Minimum Operative Experience for PGY2s (starting 2014)  
Total Cases 250 Program goal: 300
Defined Category Cases 200  

Trauma & NON-Operative Trauma Cases (MOTNOR)

Log Non-Operative Trauma Cases: Select CPT Code # 99199

Guidelines include:

  • 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, ie, 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, "Trauma, operative," then this case should be recorded as "Trauma," and not as MOTNOR.

Critical Care Index LOG Reports

Select CPT Code #99292

Critical Care Cases

For your Residency training, the ACGME requires you to 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 2 RRC codes selected per patient out of the seven available categories. Detailed information regarding critical care guidelines can be found under the 'procedure tab' after you log into the ACGME database.

Critical Care Case Log Guidelines

The system will allow residents to identify the required minimum 40 surgical critical care index cases by using CPT Code 99292. Code 99292 will map to all seven of the surgical critical care conditions.

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

Reports will provide both a summary of all instances in which the resident managed 2 of the seven index critical care conditions and a detailed report for each patient encounter that will identify all the 7 conditions that were managed by the resident for any one patient.

Rrc Code Assignment to New Surgical Critical Care Procedures

Following is a list of RRC procedure values that have been assigned to the newly developed Surgical Critical Care Patient Management Procedures:

8410 - Ventilatory Management (>24 hrs 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 Operative Reports

Residents may review and request their case log reports directly from the ACGME website.

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

Questions

For questions or copies of your ACGME reports or electronic case list, please contact: [email protected] 

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