ACGME Case Log System

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ACGME Surgery Documents and Resources

Defined Category Minimum Numbers for General Surgery Residents and Credit Role Review Committee for Surgery

Defined category minimums, and discreet cases within each category, are in effect for residents graduating in 2018. Beginning with the January 2020 ACGME annual program review, the Review Committee will use these defined minimums to assess graduate Case Logs. 

Minimum Case Requirements by PGY-3

Residents must have at least 250 operations by the beginning of their PG-3 year, effective with applicants who began residency in July 2014.

The 250 cases can include procedures performed as Operating Surgeon or First Assistant.

Of the 250, at least 200 must be in the defined categories, endoscopies, or e-codes (see below for information on e-codes). 

Up to 50 non-defined cases can be applied to this requirement. These requirements are in effect for residents graduating in 2020, and will be assessed beginning with the 2021 ACGME annual program review.

E-Codes: General surgery residents can use e-codes to receive ACGME Case Log credit for vascular surgical procedures. E-codes allow more than one resident to take credit for an arterial exposure and repair. The resident who accomplishes the exposure should add an "E" to the case ID for the system to allow credit for a second procedure on the same patient. The relevant CPT codes to use are: 35201 (Repair blood vessel, direct; neck); 35206 (upper extremity); 35216 (intra-thoracic without bypass); 35221 (intra-abdominal), and 35226 (lower extremity). Four categories are available under Trauma for residents to enter arterial exposures. 

ABS Training Requirements

Operative Experience

The following operative requirements are effective with applicants graduating residency in the 2017-2018 academic year. The previous operative case numbers are noted in parenthesis — applicants who graduated before the 2017-2018 year will be required to meet those numbers.

• At least 850 (previously 750) operative procedures as surgeon over 5 years, with at least 200 (previously 150) in the chief resident year. Teaching assistant cases may count toward the 850 total; however these cases may not count toward the 200 chief year cases.
• At least 40 (previously 25) cases in surgical critical care, with at least one in each of the seven categories: ventilatory management; bleeding (non-trauma); hemodynamic instability; organ dysfunction/failure; dysrhythmias; invasive line management and monitoring; and parenteral/enteral nutrition.
• At least 25 cases as teaching assistant by the completion of residency.

• At least 250 operations by the beginning of PGY-3 year, effective with applicants who began residency in July 2014. The 250 cases can include procedures performed as operating surgeon or first assistant. Of the 250, at least 200 must be either in the defined categories, endoscopies, or e-codes (see below for info on e-codes). Up to 50 non-defined cases may be applied to this requirement.

  E-Codes: General surgery residents can use e-codes to receive ACGME case log credit for vascular surgical procedures. E-codes allow more than one resident to take credit for an arterial exposure and repair. The resident who accomplishes the exposure should add an "E" to the case ID for the system to allow credit for a second procedure on the same patient. The relevant CPT codes to use are: 35201 (Repair blood vessel, direct; neck); 35206 (upper extremity); 35216 (intra-thoracic without bypass); 35221 (intra-abdominal), and 35226 (lower extremity). Four categories are available under Trauma for residents to enter arterial exposures.

For specific inquiries regarding ABS training requirements, please send an email to the ABS coordinator.

Credit Roles for General Surgery Residents

Residents must function in the role of Surgeon for a minimum of 850 operative procedures over the five years of residency. Of these 850, at least 200 must be accomplished as a Chief Resident.

A resident is considered the Surgeon only when he or she can document a significant role in the following aspects of management:

1. determination or confirmation of the diagnosis
2. provision of pre-operative care
3. selection and accomplishment of the appropriate operative procedure
4. direction of the post-operative care

For multi-procedure operations, residents must record all procedures performed and indicate which procedure will count as the primary procedure. When more than one resident is involved in the same patient/same day/same operation/procedure, a senior resident may take credit as Surgeon, while another resident may take credit as First Assistant; or, a senior resident may take credit as Teaching Assistant while a more junior resident takes credit as Surgeon Junior. If two residents perform different procedures on the same patient (different CPT codes), then each may take credit as Surgeon.

Abbreviations for use in the Case Log System

SC = Surgeon Chief: Used for cases credited as “Surgeon” during the 12 months of Chief experience

SJ = Surgeon Junior: Used for cases credited as “Surgeon prior” to Chief experience

TA = Teaching Assistant: Used when a Chief Resident is working with a junior resident who takes credit as “Surgeon Junior”

The minimum required number of TA cases may be reported during the PG-4 and 5 years.  All TA cases will count toward the total major cases, and will coun in the defined categories, but will not count toward the 200 minimum cases needed to fulfill the operative requirements for the Chief year. 

FA = First Assistant: Used when a resident assists another surgeon with an operative procedure and when he or she is not the primary

To be Board eligible, the American Board of Surgery require you to have:

• At least 40 (previously 25) cases in surgical critical care, with at least one in each of the seven categories: ventilatory management; bleeding (non-trauma); hemodynamic instability; organ dysfunction/failure; dysrhythmias; invasive line management and monitoring; and parenteral/enteral nutrition.
• At least 40 cases in of non-operative trauma management

These cases must be logged into the ACGME case log system, just like an operation. For the rising 4s, if you haven't done it yet, then I suggest you go back through your ICU time soon and log those cases before you can't find them.

Major traumas when you lead resuscitation

Select CPT Code 92950

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.

Trauma & NON-Operative Trauma Cases 

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

For your Residency training, the ACGME requires you to do at least 40 Trauma Non-operative management Cases

The category, major organ trauma, no operation required (MOTNOR), is defined as patients with major organ trauma who were admitted to a specialty care unit in the hospital, i.e., SICU, Burn Unit, T/NICU.  If the patient subsequently requires a general surgery operative procedure (thoractomy, laparotomy) that may be claimed in the defined category, “Trauma, operative,” this case should be recorded using an operative code and not as MOTNOR.

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 non-operative management

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 non-operative management.

The category, major organ trauma, no operation required (MOTNOR), is defined as patients with major organ trauma who were admitted to a specialty care unit in the hospital, i.e., SICU, Burn Unit, T/NICU. ▪ The most senior resident on the trauma service should claim credit for the MOTNOR cases. The CPT code is 99199. ▪ If the patient subsequently requires a general surgery operative procedure that may be claimed in the defined category, “Trauma, operative,” this case should be recorded using an operative code and not as MOTNOR.

Visit the ABS Requirements Page on Scalpel---> How to Get Assessments Completed section

Scalpel's ABS Training Requirements Page