New Application: Colon and Rectal Surgery
Review Committee for Colon and Rectal Surgery
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
SPONSORING INSTITUTION
1. What percentage of the program director’s administrative time, apart from teaching, is supported by
the sponsoring institution? [PR I.A.1.] .......................................................................................... # %
2. Is the program director required to generate clinical or other income to provide administrative
support? [PR I.A.3.] ........................................................................................................ ☐ YES ☐ NO
PROGRAM PERSONNEL AND RESOURCES
Program Director
1. Is the program director a member of the medical staff of the sponsoring institution or a participating
site? [PR II.A.3.c).(1)] .................................................................................................... ☐ YES ☐ NO
2. Does the program director have at least three years of clinical practice in colon and rectal surgery
[PR II.A.3.d)] .................................................................................................................. ☐ YES ☐ NO
3. Does the program director have at least three years of prior experience as a faculty member in
either a general surgery or colon and rectal surgery residency program? [PR II.A.3.e)]
..................................................................................................................................... ☐ YES ☐ NO
4. Briefly describe how the policy that clearly defines the lines of authority between the program
residents, other learners, the program faculty, other faculty, and the administration is implemented.
[PR II.A.4.p)]
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a) Is this policy distributed to all residents, learners, and faculty members? ................ ☐ YES ☐ NO
5. Does the program director ensure that a current, well-organized, written plan for rotation of
residents among the various services and participating institutions involved is: [PR II.A.4.q)]
a) maintained ............................................................................................................... ☐ YES ☐ NO
b) available to the residents and faculty members ........................................................ ☐ YES ☐ NO
c) reviewed and updated at least annually.................................................................... ☐ YES ☐ NO
6. Is there a policy in place for the program director to monitor resident stress, including mental or
emotional conditions inhibiting performance or learning, and drug- or alcohol-related dysfunction?
[PR II.A.4.r)] ................................................................................................................... ☐ YES ☐ NO
Faculty
1. Is at least one faculty member actively involved in regional or national specialty societies?
[PR II.B.5.d)] .................................................................................................................. ☐ YES ☐ NO
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
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2. Is at least one faculty member regularly active in scholarly inquiry? [PR II.B.5.e)].......... ☐ YES ☐ NO
Other Program Personnel
1. What percentage of the program coordinator’s time will be dedicated to the program? [PR II.C.1.]
.................................................................................................................................................... # %
2. If the program will have more than one resident, does the program factor this into the overall
allotted coordinator time? [PR II.C.1.a)].......................................................................... ☐ YES ☐ NO
Resources
1. How will the program ensure the necessary volume and variety of colon and rectal patients and
surgeries to ensure adequate education of residents? [PR II.D.1.]
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2. Will residents be provided with: [PR II.D.2.]
a) office workspace and computer hardware ................................................................ ☐ YES ☐ NO
b) software ................................................................................................................... ☐ YES ☐ NO
c) support ..................................................................................................................... ☐ YES ☐ NO
d) Internet access ......................................................................................................... ☐ YES ☐ NO
e) reference assistance ................................................................................................ ☐ YES ☐ NO
f)
statistical support ..................................................................................................... ☐ YES ☐ NO
3. Describe the system in place that ensures a reliable system for prompt communication between
residents and supervising faculty members. [PR II.D.3.]
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Medical Information Access
Will the major online, full-text journals relevant to the specialty for education and patient care be
conveniently available to residents at all participating sites? [PR II.E.1.] .............................. ☐ YES ☐ NO
RESIDENT APPOINTMENTS
Eligibility
How does the program ensure that prior to appointment in the program, residents should have
demonstrated a satisfactory level of clinical maturity, technical skills, and surgical judgment? [PR III.A.1]
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Appointment of Fellows and Other Learners
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Provide the information requested below regarding other learners (residents from other specialties,
nurse practitioners, etc.) assigned to the program. Add rows as necessary. [PR III.D.]
Type of Program
Name of Rotation
Length of Rotation
Number of
Residents/Fellows
Assigned
EDUCATIONAL PROGRAM
Competency-based Goals and Objectives
1. Prior to the beginning of each rotation, will each resident review, with the appropriate faculty
member(s), the goals and objectives of that rotation? [PR IV.A.2.a)].............................. ☐ YES ☐ NO
2. As part of the evaluation of the resident, the faculty, the rotation, and the program, will each
resident review the educational goals and objectives at the end of each rotation, with the
appropriate faculty member(s), to assess the degree to which they were attained? [PR IV.A.2.b)]
...................................................................................................................................... ☐ YES ☐ NO
Regularly Scheduled Didactic Sessions
1. Provide the titles of the planned conference lectures for the next academic year, as well as the
names of the staff members or residents (underline residents’ names) who will give the
presentations. [PR IV.A.3.a)]
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2. Will regular colon and rectal conferences be coordinated among program sites to allow attendance
by a majority of faculty members and residents? [PR IV.A.3.b)] ..................................... ☐ YES ☐ NO
a) How will resident and faculty member attendance be monitored? [PR IV.A.3.b).(1)]
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b) Will each resident attend at least 70% of all educational conferences (excluding excused time
away for meetings, vacation, and illness)? [PR IV.A.3.b).(2)] ................................... ☐ YES ☐ NO
3. List the planned regularly scheduled didactic sessions/conferences in the program (i.e., colon and
rectal surgery educational conferences, morbidity and mortality, journal club, skills lab/simulation,
mock orals, dedicated teaching rounds, other). Identify the frequency, whether the
session/conference is required or elective, presented by residents, and if there is participation by
faculty. Add rows as necessary. [PR IV.A.3.c)-d)]
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
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Name of Session/
Conference
Morbidity and Mortality
Journal Club
Formal clinical teaching
rounds
Related pathology and
radiology studies
Other (specify)
Frequency
(weekly,
monthly, etc.)
Required or
Elective
Colon and
Rectal Surgery
Presented by
Faculty
Residents?
Participation?
(Y/N)
(Y/N)
Patient Care
1. Indicate the settings and activities in which residents will demonstrate proficiency in the evaluation
and management of the areas of patient care listed below. Also indicate the method(s) that will be
used to assess competence.
Proficiency Area
Settings/Activities
Preoperative diagnosis,
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indications, alternatives, risks
and preparation for operation
[PR IV.A.5.a).(2).(a).(i).(a)]
Assessment of patient risk,
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nutritional status, co-morbidities,
and need for preoperative
treatment and perioperative
prophylaxis
[PR IV.A.5.a).(2).(a).(i).(b)]
Appropriate non-operative
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management
[PR IV.A.5.a).(2).(a).(i).(c)]
Operative management
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including all technical aspects,
intraoperative decision-making,
avoidance and management of
intraoperative complications,
and management of unexpected
findings
[PR IV.A.5.a).(2).(a).(i).(d)]
Postoperative management
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including recognition and
treatment of complications; and,
appropriate follow-up and
additional treatment
[PR IV.A.5.a).(2).(a).(i).(e)]
Abdominal and Pelvic Disorders [PR IV.A.5.a).(2).(a).(ii)]
Carcinoma of the colon, rectum Click here to enter text.
and anus
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Assessment Method(s)
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Proficiency Area
Settings/Activities
[PR IV.A.5.a).(2).(a).(ii).(a).(i)]
Colorectal infectious diseases
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including sexually transmitted
diseases (STDs) and other
colidities including clostridium
difficile and HIV related infection
[PR IV.A.5.a).(2).(a).(ii).(a).(ii)]
Diverticular disease
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[PR IV.A.5.a).(2).(a).(ii).(a).(iii)]
Gastrointestinal obstruction
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including those due to
adhesions, malignancy,
volvulus, hernias and pseudo
obstruction
[PR IV.A.5.a).(2).(a).(ii).(a).(iv)]
Inflammatory bowel disease
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including Crohn's disease and
ulcerative colitis
[PR IV.A.5.a).(2).(a).(ii).(a).(v)]
Inherited colorectal disorders
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including familial polyposis,
hereditary cancer syndromes;
other inherited polyposis
syndromes and related genetic
disorders
[PR IV.A.5.a).(2).(a).(ii).(a).(vi)]
Lower gastrointestinal
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hemorrhage
[PR IV.A.5.a).(2).(a).(ii).(a).(vii)]
Other neoplastic processes
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including GIST tumors,
lymphoma, carcinoid, desmoids,
small bowel and mesenteric
tumors
[PR IV.A.5.a).(2).(a).(ii).(a).(viii)]
Radiation enteritis and the
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effects of ionizing radiation
[PR IV.A.5.a).(2).(a).(ii).(a).(ix)]
Anorectal and Perineal Disorders [PR IV.A.5.a).(2).(a).(ii).(b)]
Anal fissure
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[PR IV.A.5.a).(2).(a).(ii).(b).(i)]
Anorectal stenosis
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[PR IV.A.5.a).(2).(a).(ii).(b).(ii)]
Fistulas, anorectal and
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rectovaginal
[PR IV.A.5.a).(2).(a).(ii).(b).(iii)]
Hemorrhoids
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[PR IV.A.5.a).(2).(a).(ii).(b).(iv)]
Hidradenitis
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[PR IV.A.5.a).(2).(a).(ii).(b).(v)]
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Assessment Method(s)
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Proficiency Area
Settings/Activities
Meningocele, chordoma, and
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teratoma
[PR IV.A.5.a).(2).(a).(ii).(b).(vi)]
Necrotizing fasciitis.
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[PR IV.A.5.a).(2).(a).(ii).(b).(vii)]
Pilonidal disease
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[PR IV.A.5.a).(2).(a).(ii).(b).(viii)]
Presacral/retrorectal lesions
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including cysts
[PR IV.A.5.a).(2).(a).(ii).(b).(ix)]
Pruritus ani
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[PR IV.A.5.a).(2).(a).(ii).(b).(x)]
Pelvic Floor Disorders [PR IV.A.5.a).(2).(a).(ii).(c)]
Constipation including clinical
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and physiological evaluation,
dysmotility, animus and other
forms of pelvic outlet obstruction
[PR IV.A.5.a).(2).(a).(ii).(c).(i)]
Fecal incontinence.
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[PR IV.A.5.a).(2).(a).(ii).(c).(ii)]
Rectal and pelvic prolapse,
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solitary rectal ulcer syndrome,
rectocele
[PR IV.A.5.a).(2).(a).(ii).(c).(iii)]
Assessment Method(s)
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2. Indicate the settings and activities in which residents will develop a high level of skill and dexterity in
the performance of the following essential colon and rectal surgical procedures. Also indicate the
method(s) that will be used to assess competence.
Competency Area
Settings/Activities
Abdominal Procedures [PR IV.A.5.a).(2).(b).(i)]
Abdominoperineal resection Click here to enter text.
and total proctocolectomy
[PR IV.A.5.a).(2).(b).(i).(a)]
Creation of stomas and
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surgical management of
stoma complications
[PR IV.A.5.a).(2).(b).(i).(b)]
Ileal pouch-anal anastomosis Click here to enter text.
[PR IV.A.5.a).(2).(b).(i).(c)]
Laparoscopic abdominal and Click here to enter text.
gastrointestinal surgery,
including colon and rectal
resections, ostomy
construction and prolapse
repair
[PR IV.A.5.a).(2).(b).(i).(d)]
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Assessment Method(s)
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Competency Area
Settings/Activities
Low anterior resection with
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colorectal and coloanal
anastomosis
[PR IV.A.5.a).(2).(b).(i).(e)]
Procedures for rectal
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prolapse
[PR IV.A.5.a).(2).(b).(i).(f)]
Segmental colectomy
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including ileocolic resection
and colon resection
[PR IV.A.5.a).(2).(b).(i).(g)]
Small bowel resection
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[PR IV.A.5.a).(2).(b).(i).(h)]
Stricturoplasty
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[PR IV.A.5.a).(2).(b).(i).(i)]
Anorectal and Perineal Procedures [PR IV.A.5.a).(2).(b).(ii)]
Anoplasty
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[PR IV.A.5.a).(2).(b).(ii).(a)]
Fistulotomies including
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primary and staged
advancement flap repairs of
complex anorectal and
rectovaginal fistulas
[PR IV.A.5.a).(2).(b).(ii).(b)]
Hemorrhoidectomy including Click here to enter text.
operative and non-operative
treatment
[PR IV.A.5.a).(2).(b).(ii).(c)]
Internal sphincterotomy
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[PR IV.A.5.a).(2).(b).(ii).(d)]
Perineal repairs of rectal
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prolapse
[PR IV.A.5.a).(2).(b).(ii).(e)]
Transanal excision of rectal Click here to enter text.
neoplasms
[PR IV.A.5.a).(2).(b).(ii).(f)]
Treatment of hidradenitis
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[PR IV.A.5.a).(2).(b).(ii).(g)]
Treatment of pilonidal
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disease
[PR IV.A.5.a).(2).(b).(ii).(h)]
Endoscopic Procedures [PR IV.A.5.a).(2).(b).(iii)]
Anoscopy
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[PR IV.A.5.a).(2).(b).(iii).(a)]
Colonoscopy, including
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diagnostic and therapeutic
[PR IV.A.5.a).(2).(b).(iii).(b)]
Sigmoidoscopy including
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rigid and flexible
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Assessment Method(s)
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Competency Area
Settings/Activities
[PR IV.A.5.a).(2).(b).(iii).(c)]
Administration of conscious
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sedation and local analgesia
[PR IV.A.5.a).(2).(b).(iv)]
Pelvic floor procedures including Click here to enter text.
interpretation of clinical and
laboratory study results,
including anorectal
ultrasound/pelvic magnetic
resonance imaging (MRI),
anorectal manometry,
defecography, and transit time
studies
[PR IV.A.5.a).(2).(b).(v)]
Assessment Method(s)
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Medical Knowledge
1. Indicate the activity(ies) (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which
residents will demonstrate expertise in their knowledge in each of the following areas. Also indicate
the method(s) that will be used to assess resident expertise in each area.
Competency Area
Settings/Activities
Anatomy, embryology and
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physiology of the colon, rectum,
anus and related structures;
[PR IV.A.5.b).(1)]
Essential colorectal disorders
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[PR IV.A.5.b).(2)]
Assessment Method(s)
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2. Indicate the activity(ies) (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which
residents will develop substantial familiarity with the following additional colon and rectal surgeryrelated issues. Also indicate the method(s) that will be used to assess resident familiarity with each
area.
Competency Area
Congenital disorders, including
imperforate anus,
Hirschsprung's disease,
urogenital and sacral
dysgenesis, including spina
bifida, and congenital pelvic and
sacral neoplasms
[PR IV.A.5.b).(3).(a)]
Genetics and molecular biology
as they apply to colorectal
disorders
[PR IV.A.5.b).(3).(b)]
Gynecological disorders,
including endometriosis,
considerations in managing the
Settings/Activities
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Assessment Method(s)
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Competency Area
pregnant patient with colorectal
disorders, and related intraoperative findings such as
ovarian lesions, fibroids and
endometrial implants,
gynecological prolapse
[PR IV.A.5.b).(3).(c)]
Other pediatric and congenital
disorders, including prolapse,
encopresis, childhood fissure,
Meckel's diverticulum, juvenile
polyposis and malrotation
[PR IV.A.5.b).(3).(d)]
Other pelvic disorders, including
urinary incontinence, cystocele,
vaginal and uterine prolapse
and enterocele
[PR IV.A.5.b).(3).(e)]
The pathology of colon and
rectal disorders
[PR IV.A.5.b).(3).(f)]
Radiological and other imaging
modalities, including plain xrays, contrast studies,
computed tomography (CT),
positron emission tomography
(PET), CT colonography
magnetic resonance imaging
(MRI), nuclear medicine scans,
angiography, defecography,
abdominal ultrasound,
evaluation for deep vein
thrombosis and pulmonary
embolism, fistulograms and
sinograms
[PR IV.A.5.b).(3).(g)]
Related medical conditions [PR
IV.A.5.b).(3).(h)]
Urological disorders, including
urinary incontinence, fistulas to
the urinary tract, involvement of
the ureters, bladder and urethra
in colorectal disease, and
identifying and avoiding intraoperative injury to the ureters
[PR IV.A.5.b).(3).(i)]
Vascular and mesenteric
disorders affecting the colon
and rectum
[PR IV.A.5.b).(3).(j)]
Settings/Activities
Assessment Method(s)
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
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3. Indicate the activity(ies) (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which
residents will develop substantial familiarity with the following additional colon and rectal surgeryrelated procedures. Also indicate the method(s) that will be used to assess resident familiarity with
each area.
Competency Area
Abdominal procedures,
including continent ileostomy
and pelvic exenteration
[PR IV.A.5.b).(4).(a)]
Alternate pelvic pouch
techniques, including colonic Jpouch and coloplasty
[PR IV.A.5.b).(4).(b)]
Anastomotic techniques,
including both sewn and stapled
methods of colonic and anal
anastomoses
[PR IV.A.5.b).(4).(c)]
Anorectal procedures, including
alternative methods of fistula
repair, including fibrin glue
and/or plug placement
[PR IV.A.5.b).(4).(d)]
Flaps and grafts for perineal
reconstruction
[PR IV.A.5.b).(4).(e)]
Management of colorectal
trauma and foreign bodies
[PR IV.A.5.b).(4).(f)]
Other procedures for fecal
incontinence, including
alternative methods of sphincter
repair, augmentation and
implantable devices
[PR IV.A.5.b).(4).(g)]
Pelvic floor and gastrointestinal
physiological assessment and
procedures, their uses, and
indications, including
performance and interpretation
of anorectal manometry,
electromyography and pudendal
nerve testing,
defecography/dynamic MRI,
transit time assessment, pelvic
floor exercise, rehabilitation,
and directed biofeedback
[PR IV.A.5.b).(4).(h)]
Procedures for pelvic prolapse
in addition to rectal prolapse,
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Assessment Method(s)
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Competency Area
including rectocele and
enterocele repairs
[PR IV.A.5.b).(4).(i)]
Transanal endoscopic
microsurgery
[PR IV.a.5.b).(4).(j)]
Settings/Activities
Assessment Method(s)
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Practice-based Learning and Improvement
1. Briefly describe one planned learning activity in which residents engage to identify strengths,
deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set
learning and improvement goals; identify and perform appropriate learning activities to achieve selfidentified goals (lifelong learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)
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2. Briefly describe one planned quality improvement activity or project that will allow the resident to
demonstrate an ability to analyze, improve and change practice or patient care. Describe planning,
implementation, evaluation and provisions of faculty support and supervision that will guide this
process. [PR IV.A.5.c).(4)] (Limit response to 400 words)
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3. Briefly describe how residents will receive and incorporate formative evaluation feedback into daily
practice. (If a specific tool is used to evaluate these skills have it available for review by the site
visitor.) [PR IV.A.5.c).(5)] (Limit response to 400 words)
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4. Briefly describe one example of a learning activity in which residents engage to develop the skills
needed to use information technology to locate, appraise, and assimilate evidence from scientific
studies and apply it to their patients' health problems. [PR IV.A.5.c).(6)-(7)] (Limit response to 400
words)
The description should include:
 Locating information
 Using information technology
 Appraising information
 Assimilating evidence information (from scientific studies)
 Applying information to patient care
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5. Briefly describe how residents will develop teaching skills necessary to educate patients, families,
students, and other residents. [PR IV.A.5.c).(8)] (Limit response to 400 words)
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6. Describe how residents will develop skills and habits to be able to evaluate and analyze patient
care outcomes. [PR IV.A.5.c).(9)]
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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7. Describe how residents will develop skills and habits to be able to utilize an evidence-based
approach to patient care. [PR IV.A.5.c).(10)]
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Interpersonal and Communication Skills
1. Briefly describe one learning activity in which residents develop competence in communicating
effectively with patients and families across a broad range of socioeconomic and cultural
backgrounds, and with physicians, other health professionals, and health-related agencies. [PR
IV.A.5.d).(1)-(2)] (Limit response to 400 words)
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2. Briefly describe one learning activity in which residents develop their skills and habits to work
effectively as a member or leader of a health care team or other professional group. In the example,
identify the members of the team, responsibilities of the team members, and how team members
communicate to accomplish responsibilities. [PR IV.A.5.d).(3)] (Limit response to 400 words)
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3. Briefly describe how residents will be provided with opportunities to act in a consultative role to
other physicians and health professionals. [PR IV.A.5.d).(4)] (Limit response to 400 words)
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4. Briefly describe how residents will be provided with opportunities to maintain comprehensive,
timely, and legible medical records, if applicable. [PR IV.A.5.d).(5)] (Limit response to 400 words)
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Professionalism
1. Briefly describe the learning activity(ies), other than lecture, by which residents develop a
commitment to carrying out professional responsibilities and an adherence to ethical principles,
including: compassion, integrity, and respect for others; responsiveness to patient needs that
supersedes self-interest; respect for patient privacy and autonomy; accountability to patients,
society, and the profession; and sensitivity and responsiveness to a diverse patient population,
including diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. [PR
IV.A.5.e).(1)-(5)] (Limit response to 400 words)
Click here to enter text.
2. Describe how the program will ensure that residents will develop a high standard of ethical
behavior. [PR IV.A.5.e).(6)] (Limit response to 400 words)
Click here to enter text.
3. Describe how the program will ensure that residents will develop a commitment to continuity of care
[PR IV.A.5.e).(7)] (Limit response to 400 words)
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 12 of 27
Click here to enter text.
Systems-based Practice
1. Describe the learning activity(ies) through which residents achieve competence in the elements of
systems-based practice: work effectively in various health care delivery settings and systems,
coordinate patient care within the health care system; incorporate considerations of costcontainment and risk-benefit analysis in patient care; advocate for quality patient care and optimal
patient care systems; and work in interprofessional teams to enhance patient safety and care
quality. [PR IV.A.5.f).(1)-(5)] (Limit response to 400 words)
Click here to enter text.
2. Describe an activity that fulfills the requirement for experiential learning in identifying system errors
and implementing potential systems solutions. [PR IV.A.5.f).(6)] (Limit response to 400 words)
Click here to enter text.
Curriculum Organization and Resident Operative Experiences
1. Is the program organized so that residents will participate in patient evaluation and care in each of
the following settings: [PR IV.A.6.a).(1)-(5)]
a) ambulatory clinic/office ............................................................................................. ☐ YES ☐ NO
b) emergency department ............................................................................................ ☐ YES ☐ NO
c) endoscopy suite/center ............................................................................................ ☐ YES ☐ NO
d)
inpatient care/hospital ............................................................................................. ☐ YES ☐ NO
e) operating room, including in-patient and ambulatory ............................................... ☐ YES ☐ NO
2. Will residents be exposed to basic and complex patients with the following conditions:
[PR IV.A.6.b)]
a) the broad spectrum of anorectal disease [PR IV.A.6.b).(1)] ...................................... ☐ YES ☐ NO
b) colon, rectal, and anal cancer [PR IV.A.6.b).(2)] ....................................................... ☐ YES ☐ NO
c) colorectal physiological disorders, including fecal incontinence, constipation, rectal and pelvic
prolapse, and intestinal dysmotility [PR IV.A.6.b).(3)] ............................................... ☐ YES ☐ NO
d) diverticular disease [PR IV.A.6.b).(4)] ...................................................................... ☐ YES ☐ NO
e) inflammatory bowel disease, including ulcerative colitis ........................................... ☐ YES ☐ NO
f)
relevant genetic disorders, including familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC) ...................................................................... ☐ YES ☐ NO
3. Will residents have a broad operative experience, including: [PR IV.A.6.c)]
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Page 13 of 27
a) Abdominal/pelvic, both open and laparoscopic [PR IV.A.6.c).(1)] ............................ ☐ YES ☐ NO
b) Anorectal [PR IV.A.6.c).(2)] ..................................................................................... ☐ YES ☐ NO
c) Endoscopic, including rigid proctoscopy, flexible sigmoidoscopy, and colonoscopy
[PR IV.A.6.c).(3)] ..................................................................................................... ☐ YES ☐ NO
4. Will residents have exposure to testing methods, including: [PR IV.A.6.d)]
a) anorectal manometry [PR IV.A.6.d).(1)] .................................................................... ☐ YES ☐ NO
b) defecography/dynamic MRI [PR IV.A.6.d).(2)] .......................................................... ☐ YES ☐ NO
c) electromyography and pudendal nerve testing [PR IV.A.6.d).(3)] ............................. ☐ YES ☐ NO
d) pelvic floor exercise, rehabilitation, and directed biofeedback [PR IV.A.6.d).(4)] ....... ☐ YES ☐ NO
e) transit time assessment [PR IV.A.6.d).(5)] ................................................................ ☐ YES ☐ NO
5. Will residents participate in the evaluation and treatment of patients with the following diagnoses:
[PR IV.A.6.f)]
a) anorectal and physiologic disorders, including hemorrhoids, fistulas, abscesses, fissures,
constipation, incontinence, and pelvic floor problems (at least 110 patients) [PR IV.A.6.f).(1)]
................................................................................................................................. ☐ YES ☐ NO
b) abdominal disorders, including neoplasia of the colon, rectum and anus, inflammatory bowel
disease, diverticular disease, and rectal prolapse (at least 215 patients) [PR IV.A.6.f).(2)]
................................................................................................................................. ☐ YES ☐ NO
Residents’ Scholarly Activities
How will the program ensure that each resident will participate in at least two forms of scholarly activity
during the one-year program? [PRIV.B.2.a).(1-5)]
Click here to enter text.
RESIDENT FORMATIVE EVALUATION
1. Describe how and with what frequency the program director will formally discuss each resident’s
performance, including the six competencies, clinical experience, and duty hours. [PR V.A.2.a).(1);
V.A.2.a).(1).(a)]
Click here to enter text.
a) Will this evaluation be documented, signed by the program director and the resident?
[PR V.A.2.a).(1).(b)].................................................................................................. ☐ YES ☐ NO
b) Will this evaluation be maintained for review by the faculty, resident, institution, and site visitor?
[PR V.A.2.a).(1).(b)].................................................................................................. ☐ YES ☐ NO
2. Will the program director use the ACGME Case Log System to assess resident experience with
both diagnoses and procedures? [PR V.A.2.a).(2)] ........................................................ ☐ YES ☐ NO
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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a) Will the residents enter cases regularly and accurately? [PR V.A.2.a).(2).(a)] .......... ☐ YES ☐ NO
b) Will residents complete their case logs in its entirety prior to completing the program?
[PR V.A.2.a).(2).(a)].................................................................................................. ☐ YES ☐ NO
c) With what frequency will the program director review the Case Log results to assess each
resident’s progress and to ensure completion of the goals and objectives of each rotation?
[PR V.A.2.a).(2).(b)]
Click here to enter text.
d) Does the program director review case distribution regularly? [PR V.A.2.a).(2).(c)]
................................................................................................................................. ☐ YES ☐ NO
e) If a deficit is identified, describe the strategy used to remedy the problem. [PR V.A.2.a).(2).(c)]
Click here to enter text.
(1) Will these plans be documented and shared with the resident and faculty?
[PR V.A.2.a).(2).(c).(i)] ........................................................................................ ☐ YES ☐ NO
(2) Will the program director perform a review of these plans at the next quarterly evaluation to
assess results? [PR V.A.2.a).(2).(c).(ii)] .............................................................. ☐ YES ☐ NO
f)
Describe how the program director will ensure minimum case numbers for each resident and
assess resident technical competence. [PR V.A.2.a).(2).(d)]
Click here to enter text.
3. Will the program director use the Colon and Rectal Surgery In-Training Examination (CARSITE) or
a similar, specialty-specific examination as one method of resident evaluation? [PR V.A.2.d)]
...................................................................................................................................... ☐ YES ☐ NO
4. Describe how the results of the CARSITE will be reviewed with each resident and how faculty
members will provide feedback. [PR V.A.2.d).(1)]
Click here to enter text.
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Page 15 of 27
INSTITUTIONAL DATA
INSTRUCTIONS: This form must include data from each site in the program. The list should include all
procedures performed by the colon and rectal service that would have been available for the education
of colon and rectal surgery residents during the most recently completed academic year. Add columns
as needed for other participating sites. [PR II.D.1.]
PROCEDURES/DIAGNOSES
ANORECTAL
Abscess I&D
Abscess, I&D, perirectal, any type
Total Abscess I&D Procedures
Congenital Disorders
Imperforate anus, perineal or sacral repair
Imperforate anus, abdominal or combined repair
Cloacal anomaly, perineal or sacral repair
Cloacal anomaly, abdominal or combined repair
Total Congenital Disorder Procedures
Fistula Procedures
Fistula, seton placement only
Fistula, seton/drain removal
Fistulotomy, primary, secondary, + seton, NOS
Fistula, advancement flap repair, skin or mucosal
Fistula, repair, fibrin glue
Fistulotomy, LIFT
Fistula, repair, ileoanal anastomosis, perineal any
Fistula, repair, ileoanal anastomosis,
abdominoperineal
Fistula, rectovaginal repair, transanal or transvaginal
Fistula, rectovaginal repair, abdominal
Fistula, rectovaginal repair, abdominal, ostomy
Total Fistula Procedures
Hemorrhoidectomy
Hemorrhoids, internal, rubber band ligation (RBL)
Hemorrhoidectomy, external, simple
Hemorrhoidectomy, internal
Hemorrhoidectomy, external, thrombosed
Hemorrhoids, injection sclerosing
Hemorrhoids, internal, thermal, includes IRC, cautery,
BICAP
Hemorrhoids, internal, suture ligation, includes Doppler
guided
Hemorrhoidopexy, stapled, includes PPH
Total Hemorrhoidectomy Procedures
Fecal Incontinence
Sphincter repair, sphincteroplasty
Sphincter repair, Thiersch loop
Sphincter repair, Thiersch removal
Sphincter repair, muscle transfer/gracilis or gluteal
Sphincter repair, muscle imbrication/plication including
Parks
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
CPT # Cases # Cases # Cases # Cases
46040
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
46730
#
#
#
#
46740
#
#
#
#
46744
#
#
#
#
46746
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
46020
#
#
#
#
46030
#
#
#
#
46280
#
#
#
#
46288
#
#
#
#
46706
#
#
#
#
46045
#
#
#
#
46710
#
#
#
#
46712
57300
57305
57307
CPT
46221
46250
46260
46320
46500
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
46930
#
#
#
#
#
46945
#
#
#
#
#
46947
CPT
46750
46753
46754
46760
46761
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Updated 5/2015
Page 16 of 27
PROCEDURES/DIAGNOSES
Sphincter repair, artificial sphincter
Injection of implant material for incontinence
Insertion of sacral nerve stimulator
Total Fecal Incontinence Procedures
Fissure
Fissure, sphincterotomy
Fissurectomy + flap
Fissure/spasm, sphincter chemodenervation injection
(Botox)
Fissure, cautery/curettage/dilate
Total Fissure Procedures
Hidradenitis
Hidradenitis/other skin infection, I&D
Hidradenitis/skin, perianal, unroofing/excision
Total Hidradenitis Procedures
Pilonidal Disease
Pilonidal ds, I&D, any
Pilonidal ds, excision/unroofing - open or closed
Total Pilonidal Disease Procedures
Rectal Excisions, Other
Parasacral excision of rectal tumor (Kraske or YorkMason approach)
Proctectomy, partial, parasacral (Kraske or YorkMason approach)
Proctectomy with anal excision, partial, without
anastomosis, perineal approach
Total Other Rectal Excision Procedures
Rectal Prolapse - Perineal
Rectal prolapse, perineal excision (Altemeier)
Rectal prolapse, mucosal, proctoplasty (ectropion,
Delorme)
Perirectal injection of sclerosing solution for prolapse
Reduction of procidentia (separate procedure) under
anesthesia
Total Rectal Prolapse-Perineal Procedures
Skin Lesions/Flaps
Skin biopsy
Wound infection I&D
Necrotizing fasciitis, debridement
Wound debridement +/- VAC
Excision/destruction benign skin lesion, trunk
Excision/destruction benign skin lesion, perineum or
genitalia
Excision/destruction malignant skin lesion, trunk
Excision/destruction malignant skin lesion, perineum or
genitalia
Flap closure of large perineal defect, includes skin
flaps (V-Y or S flaps) and myocutaneous flaps (gracilis,
TRAM/VRAM)
Total Skin Lesions/Flaps Procedures
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
46762
#
#
#
#
#
51715
#
#
#
#
#
64581
#
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
46080
#
#
#
#
#
46200
#
#
#
#
#
46505
46940
CPT
10060
11470
CPT
10080
11770
CPT
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
45160
#
#
#
#
#
45116
#
#
#
#
#
45123
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
45130
#
#
#
#
#
45505
#
#
#
#
#
45520
#
#
#
#
#
45900
#
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
11000
#
#
#
#
10180
#
#
#
#
11006
#
#
#
#
11042
#
#
#
#
11400
#
#
#
#
#
11420
#
#
#
#
#
11600
#
#
#
#
#
11620
#
#
#
#
#
14040
#
#
#
#
#
#
#
#
#
#
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©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Page 17 of 27
PROCEDURES/DIAGNOSES
Stricture, AR
Stricture, rectum, division
Stricture, rectal, proctoplasty
Dilation of anal sphincter, under anesthesia
Stricture, anal or rectal, dilation or division
Stricture, anoplasty
Total Stricture, AR Procedures
Transanal Excision
Excision of rectal tumor, transanal approach
Destruction of rectal tumor, transanal (cautery, laser
ablation, cryo)
TEM - Transanal Endoscopic Microsurgery
Total Transanal Excision Procedures
Trauma
Rectal trauma, repair, drainage
Rectal trauma, repair, drainage, colostomy
Total Trauma Procedures
Anorectal, Miscellaneous
Anorectal biopsy, transanal
Anorectal myomectomy
Proctoplasty; for prolapse of mucous membrane
Rectocele repair, any type
Anorectal impaction/FB removal
Anorectal EUA, no other procedure
Papilla or tag, anal, excision
Condyloma/other lesions, perianal, office treatment
Condyloma/other lesions, perianal, excision/cautery,
under anesthesia
Presacral tumor excision
Unlisted procedure, rectum
Unlisted procedure, anus
Total Anorectal Miscellaneous Procedures
GRAND TOTAL ANORECTAL PROCEDURES
ABDOMINAL
Appendectomy
Appendectomy, open
Laparoscopic appendectomy
Total Appendectomy Procedures
Small Bowel
Small bowel resection with anastomosis, separate from
colon
Small bowel resection; with ostomy
Small bowel bypass to SB or colon
Laparoscopic, small bowel resection, any type/number
Small bowel perforation, sutured closure
Stricturoplasty
Small bowel resection for congenital atresia
Total Small Bowel Procedures
Transplantation
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
CPT # Cases # Cases # Cases # Cases
45150
#
#
#
#
#
45500
#
#
#
#
#
45905
#
#
#
#
#
45910
#
#
#
#
#
46700
#
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
45170
#
#
#
#
#
45190
0184T
CPT
45562
45563
CPT
45100
45108
45505
45560
45915
45990
46220
46900
46924
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
49215
45999
46999
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
44950
#
#
#
#
44970
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
#
#
#
#
#
#
44120
#
44125
44130
44202
44602
44615
44126
CPT
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
Updated 5/2015
Page 18 of 27
PROCEDURES/DIAGNOSES
Donor enterectomy for transplantation
Intestinal allotransplantation; recipient
Total Transplantation Procedures
Segmental Colectomy
Colon resection, anastomosis
Colon resection, stoma
Colon resection, Hartmann procedure
Colon resection, stoma & mucous fistula
Colectomy total, stoma &/or ileo-rectal anastomosis IRA
Colectomy total, continent Ileostomy
Colon resection, ileocolic & anastomosis
Laparoscopic colectomy, partial, anastomosis
Laparoscopic ileocolic resection
Laparoscopic colectomy, Hartmann procedure
Laparoscopic colectomy, total, stoma &/or ileo-rectal
anastomosis - IRA
Laparoscopic stoma closure, complex, resection or
Hartmann closure
Stoma closure, complex, with resection
Stoma closure, Hartmann
Laparoscopic rectal prolapse repair, resection +/rectopexy (Frykman)
Rectal prolapse, abdominal resection +/- rectopexy
(Frykman)
Total Segmental Colectomy Procedures
Low Anterior Resection
LAR, anastomosis
LAR, anastomosis, stoma
LAR, combined abdominoperineal AP approach
Laparoscopic LAR
Laparoscopic LAR, with stoma
Proctectomy, partial, abdominal
Proctectomy, coloanal anastomosis - CAA
Proctectomy, combined abdominal and trans-sacral
approach
Proctectomy, coloanal anastomosis - CAA, with colonic
pouch
Proctectomy, for congenital megacolon,
abdominoperineal AP approach with pull-through (e.g.,
Swenson, Duhamel, or Soave)
Proctocolectomy, for congenital megacolon, including
total colectomy with pull-through (e.g., Swenson,
Duhamel, or Soave)
IPAA, excision, Ileostomy
Laparoscopic proctectomy, coloanal anastomosis CAA, with colonic pouch
Proctectomy, coloanal anastomosis - CAA, for
Hirschsprung's disease, any type
Total Low Anterior Resection Procedures
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
44132
#
#
#
#
#
44135
#
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
44140
#
#
#
#
#
44141
#
#
#
#
#
44143
#
#
#
#
#
44144
#
#
#
#
#
44150
#
#
#
#
#
44151
44160
44204
44205
44206
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
44210
#
#
#
#
#
44227
#
#
#
#
#
44625
44626
#
#
#
#
#
#
#
#
#
#
45402
#
#
#
#
#
45550
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
44145
#
#
#
#
44146
#
#
#
#
44147
#
#
#
#
44207
#
#
#
#
44208
#
#
#
#
45111
#
#
#
#
45112
#
#
#
#
#
45114
#
#
#
#
#
45119
#
#
#
#
#
45120
#
#
#
#
#
45121
#
#
#
#
#
45136
#
#
#
#
#
45397
#
#
#
#
#
45120
#
#
#
#
#
#
#
#
#
#
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PROCEDURES/DIAGNOSES
Abdominoperineal Resection
Proctectomy , APR, Colostomy
Proctectomy , APR, Colostomy, laparoscopic
Pelvic exenteration
Total Abdominoperineal Resection Procedures
Proctocolectomy, Total - TPC
TPC - total proctocolectomy, Ileostomy
TPC - total proctocolectomy, continent Ileostomy
Laparoscopic TPC - total proctocolectomy, Ileostomy
Total Proctocolectomy, Total-TPC Procedures
Ileoanal Anastomosis
TPC, IAA - ileo-anal anastomosis, straight
TPC, IPAA - ileal pouch-anal anastomosis
Laparoscopic TPC, IPAA - ileal pouch-anal
anastomosis
IPAA - ileal pouch-anal anastomosis, with completion
proctectomy (prior colectomy)
Total Ileoanal Anastomosis Procedures
Prolapse Repair - Abdominal
Laparoscopic rectal prolapse repair, resection +/rectopexy (Frykman)
Rectal prolapse, rectopexy, abdominal, c or s mesh
Rectal prolapse, abdominal resection +/- rectopexy
(Frykman)
Laparoscopic rectopexy, for prolapse
Total Prolapse Repair-Abdominal Procedures
Stoma Creation
Gastrostomy, any type
Ileostomy/Jejunostomy creation
Ileostomy, continent (Kock)
Colostomy/cecostomy creation
Laparoscopic Ileostomy/Jejunostomy
Laparoscopic colostomy
Total Stoma Creation Procedures
Stoma Repair
Ileostomy, revision, simple/local/scar release
Ileostomy, revision, complex
Colostomy, revision, simple/scar release
Colostomy, revision, complex
Colostomy or ileostomy, parastomal hernia repair
Total Stoma Repair Procedures
Stoma Closure
Laparoscopic stoma closure, complex, resection or
Hartmann closure
Ileostomy closure
Colostomy closure
Stoma closure, Hartmann
Total Stoma Closure Procedures
Liver
CODE SITE #1
CPT # Cases
45110
#
45395
#
45126
#
#
CPT # Cases
44155
#
44156
#
44212
#
#
CPT # Cases
44157
#
44158
#
SITE #2
# Cases
#
#
#
#
# Cases
#
#
#
#
# Cases
#
#
SITE #3
# Cases
#
#
#
#
# Cases
#
#
#
#
# Cases
#
#
SITE #4 TOTAL
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
44211
#
#
#
#
#
45113
#
#
#
#
#
CPT
#
#
#
#
# Cases # Cases # Cases # Cases
#
45402
#
#
#
#
#
45540
#
#
#
#
#
45550
#
#
#
#
#
45400
CPT
43830
44310
44316
44320
44187
44188
CPT
44312
44314
44340
44345
44346
CPT
#
#
#
#
#
#
#
#
# Cases # Cases # Cases # Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
44227
#
#
#
#
#
44620
44625
44626
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
CPT
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 20 of 27
PROCEDURES/DIAGNOSES
Liver hepatectomy partial lobe
Liver needle biopsy
Liver wedge resection
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
47120
#
#
#
#
#
47001
#
#
#
#
#
47100
#
#
#
#
#
Total Liver Procedures
#
#
#
#
#
Hernia
CPT
#
#
#
#
#
Hernia, ventral/incisional, any kind, open
49560
#
#
#
#
#
Hernia, umbilical, any kind
49585
#
#
#
#
#
Hernia repair, ventral, incisional, laparoscopic, any
49654
#
#
#
#
#
kind
Hernia repair, laparoscopic NOS
49659
#
#
#
#
#
Total Hernia Procedures
#
#
#
#
#
Abdominal, Miscellaneous
CPT
#
#
#
#
#
Colon, perforation, sutured closure
44604
#
#
#
#
#
Colon, perforation, sutured closure, colostomy
44605
#
#
#
#
#
Colotomy, for exploration, biopsy or foreign body
44025
#
#
#
#
#
removal
Excision of Meckel's diverticulum (diverticulectomy) or
44800
#
#
#
#
#
omphalomesenteric duct
Fistula, enteric, open repair, without resection
44650
#
#
#
#
#
Fistula, enterocutaneous, open repair, without
44640
#
#
#
#
#
resection
Fistula, enterovesical fistula repair, with resection
44661
#
#
#
#
#
Fistula, enterovesical fistula repair, without resection
44660
#
#
#
#
#
Fistula, rectourethral repair, abdominal, without
45820
#
#
#
#
#
resection
Fistula, rectourethral repair, no resection, with stoma
45825
#
#
#
#
#
Fistula, rectovesical repair, abdominal, without
45800
#
#
#
#
#
resection
Fistula, rectovesical repair, no resection, with stoma
45805
#
#
#
#
#
Laparoscopy, lysis of adhesions for SBO, separate
44180
#
#
#
#
#
procedure
Laparotomy for volvulus, intussusception, internal
44050
#
#
#
#
#
hernia
Laparotomy, abscess, I&D, peritoneal
49020
#
#
#
#
#
Laparotomy, abscess, I&D, retroperitoneal
49060
#
#
#
#
#
Laparotomy, correction of malrotation
44055
#
#
#
#
#
Laparotomy, dehiscence, abdominal closure
49900
#
#
#
#
#
Laparotomy, exploratory, separate procedure
49000
#
#
#
#
#
Laparotomy, lysis of adhesion for SBO, separate
44005
#
#
#
#
#
procedure
Laparotomy, tumor debulking, e.g. carcinomatosis,
58957
#
#
#
#
#
HIPEC
Neoplasm destruction/excision, abdominal e.g. cyst,
49203
#
#
#
#
#
endometriosis
Neoplasm excision, abdominal wall e.g. desmoid
22900
#
#
#
#
#
Pelvic exclusion + mesh
44700
#
#
#
#
#
Unlisted laparoscopy procedure, intestine
44238
#
#
#
#
#
Unlisted procedure, abdomen
49999
#
#
#
#
#
Unlisted procedure, intestine
44799
#
#
#
#
#
Total Abdominal. Miscellaneous Procedures
#
#
#
#
#
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 21 of 27
PROCEDURES/DIAGNOSES
GRAND TOTAL ABDOMINAL PROCEDURES
ENDOSCOPY/PELVIC FLOOR EVALUATION
Anoscopy
Anoscopy - Diagnosis/decompress
Anoscopy - Dilation
Anoscopy - Cold biopsy
Anoscopy - Remove foreign body
Anoscopy - Hot biopsy X1
Anoscopy - Snare X1
Anoscopy - Multiple lesions
Anoscopy - Bleeding
Anoscopy - Other ablation/laser
Total Anoscopy Procedures
Rigid Proctoscopy/Sigmoidoscopy
Rigid sigmoidoscopy - Diagnosis/decompress
Rigid sigmoidoscopy - Dilation
Rigid sigmoidoscopy - Cold biopsy
Rigid sigmoidoscopy - Remove foreign body
Rigid sigmoidoscopy - Hot biopsy X1
Rigid sigmoidoscopy - Snare X1
Rigid sigmoidoscopy - Multiple lesions
Rigid sigmoidoscopy - Bleeding
Rigid sigmoidoscopy - Other ablation/laser
Rigid sigmoidoscopy - Volvulus
Rigid sigmoidoscopy - Stent placement
Total Rigid Proctoscopy/Sigmoidoscopy
Procedures
Flexible Sigmoidoscopy
Sigmoidoscopy, flexible - Diagnostic
Sigmoidoscopy, flexible - Cold biopsy
Sigmoidoscopy, flexible - Remove foreign body
Sigmoidoscopy, flexible - Hot biopsy
Sigmoidoscopy, flexible - Control of bleeding
Sigmoidoscopy, flexible - Submucosal injection
Sigmoidoscopy, flexible - Volvulus
Sigmoidoscopy, flexible - Snare technique
Sigmoidoscopy, flexible - Other ablation/laser
Sigmoidoscopy, flexible - Dilation
Sigmoidoscopy, flexible - endoscopic ultrasound
Sigmoidoscopy, flexible - Stent placement
Total Flexible Sigmoidoscopy Procedures
Ileoscopy
Ileostomy, stoma or ileal pouch, diagnostic
Ileostomy, stoma or ileal pouch, therapy
Total Ileoscopy Procedures
Colonoscopy
Colonoscopy via colostomy - Diagnosis/decompress
Colonoscopy via colostomy - Cold biopsy
Colonoscopy via colostomy - Remove FB
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
46600
#
#
#
#
46604
#
#
#
#
46606
#
#
#
#
46608
#
#
#
#
46610
#
#
#
#
46611
#
#
#
#
46612
#
#
#
#
46614
#
#
#
#
46615
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
45300
#
#
#
#
45303
#
#
#
#
45305
#
#
#
#
45307
#
#
#
#
45308
#
#
#
#
45309
#
#
#
#
45315
#
#
#
#
45317
#
#
#
#
45320
#
#
#
#
45321
#
#
#
#
45327
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
45330
#
#
#
#
45331
#
#
#
#
45332
#
#
#
#
45333
#
#
#
#
45334
#
#
#
#
45335
#
#
#
#
45337
#
#
#
#
45338
#
#
#
#
45339
#
#
#
#
45340
#
#
#
#
45341
#
#
#
#
45345
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
44385
#
#
#
#
44386
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
44388
#
#
#
#
44389
#
#
#
#
44390
#
#
#
#
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Updated 5/2015
Page 22 of 27
PROCEDURES/DIAGNOSES
Colonoscopy via colostomy - Control bleeding
Colonoscopy via colostomy - Hot biopsy
Colonoscopy via colostomy - Other ablation/laser
Colonoscopy via colostomy - Snare
Colonoscopy via colostomy - Stent placement
Colonoscopy - Diagnosis/decompress
Colonoscopy - Remove FB
Colonoscopy - Cold biopsy
Colonoscopy - Submucosal injection/dye
Colonoscopy - Control bleeding
Colonoscopy - Other ablation/laser
Colonoscopy - Hot biopsy
Colonoscopy - Snare
Colonoscopy - Balloon dilation
Colonoscopy - Stent placement
Total Colonoscopy Procedures
Pelvic Floor Evaluation
EMG, anal sphincter, any tech
Defecography, performance or reading
Endorectal ultrasound
Biofeedback, any tech
Rectal balloon testing (compliance, expulsion)
Anorectal manometry
Pudendal nerve latency
Unlisted procedure, GI diagnostic
Total Pelvic Floor Evaluation Procedures
GRAND TOTAL ENDOSCOPY/PELVIC FLOOR
EVALUATION PROCEDURES
DISEASE MANAGEMENT
Abdominal Disorder, Other
Abscess, intestine
Endometriosis
Fistula, enteric
Fistula, interovesical
Gastroenteritis, NOS
Intussusception, intestine
Mesenteric ischemias, any type
Perforation, intestine
Peritonitis
Toxic colitis, with or without megacolon
Unspecified disorder of intestine
Total Abdominal Disorder, Other
Anorectal Abscess
Abscess/cellulitis, anorectal
Total Anorectal Abscess
Anal Fissure
Fissure, anal
Total Anal Fissure
Anal Fistula
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
44391
#
#
#
#
#
44392
#
#
#
#
#
44393
#
#
#
#
#
44394
#
#
#
#
#
44397
#
#
#
#
#
45378
#
#
#
#
#
45379
#
#
#
#
#
45380
#
#
#
#
#
45381
#
#
#
#
#
45382
#
#
#
#
#
45383
#
#
#
#
#
45384
#
#
#
#
#
45385
#
#
#
#
#
45386
#
#
#
#
#
45387
#
#
#
#
#
#
#
#
#
#
CPT # Cases # Cases # Cases # Cases
51784
#
#
#
#
#
76120
#
#
#
#
#
76872
#
#
#
#
#
90901
#
#
#
#
#
91120
#
#
#
#
#
91122
#
#
#
#
#
95900
#
#
#
#
#
91299
#
#
#
#
#
#
#
#
#
#
#
ICD9 # Cases
569.50
#
617.9
#
569.81
#
596.10
#
558.9
#
560
#
557.9
#
569.83
#
567
#
558.2
#
569.9
#
#
ICD9 # Cases
566.00
#
#
ICD9 # Cases
565.00
#
#
ICD9 # Cases
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
# Cases
#
#
# Cases
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
# Cases
#
#
# Cases
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
# Cases
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Updated 5/2015
Page 23 of 27
PROCEDURES/DIAGNOSES
Fistula, anorectal
Fistula, entero-vaginal/recto-vaginal
Total Anal Fistula
Anorectal, Perineal, Miscellaneous
Skin tag, anal
Stenosis, anorectal
Anal sphincter tear, old/healed
Hypertrophied anal papillae
Proctitis, NOS
Pruritus ani
Foreign body, AR
Pilonidal disease
Pilonidal with abscess
Hidradenitis
Total Anorectal, Perineal, Miscellaneous
Appendix
Appendicitis
Total Appendix
Bleeding
Bleeding, intra-abdominal
Diverticulosis, colon, bleeding
Bleeding, anorectal
Angiodysplasia, intestine, uncomplicated
Angiodysplasia, intestine, bleeding
Bleeding, stools/melena
Bleeding, GI, NOS
Total Bleeding
Complications
Pouchitis
Pouch, other cx
Wd, abdominal, complicated
Wd, anus/perineum, complicated
Cx, bleeding
Cx, infection, graft or mesh
Cx, anastomosis, leak
Cx, infection, internal or wd
Cx, fistula, postop, persistent
Cx, intestinal/anastomotic stricture
Total Complications
Congenital Disorders
Meckel's diverticulum
Malrotation
Hirschsprung's disease
Cong abns, NOS - duplication, microcolon, cloaca
Imperforate anus/atresia/stenosis, NOS
Total Congenital Disorders
Diverticular Disease
Diverticulosis, small bowel
CODE SITE #1
565.10
#
619.10
#
#
ICD9 # Cases
455.90
#
569.20
#
569.43
#
569.00
#
569.49
#
698.00
#
937.00
#
685.10
#
685.00
#
705.83
#
#
ICD9 # Cases
541
#
#
ICD9 # Cases
459.00
#
562.12
#
569.30
#
569.84
#
569.85
#
578.10
#
578.90
#
#
ICD9 # Cases
569.71
#
569.79
#
879.30
#
879.70
#
998.11
#
996.60
#
997.4
#
998.59
#
998.60
#
997.90
#
#
ICD9 # Cases
751
#
751.4
#
751.30
#
751.5
#
751.20
#
#
ICD9 # Cases
562.00
#
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
SITE #2
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
# Cases
#
SITE #3
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
# Cases
#
SITE #4 TOTAL
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
Updated 5/2015
Page 24 of 27
PROCEDURES/DIAGNOSES
Diverticulitis, small bowel
Diverticulosis, colon
Diverticulitis, colon
Diverticulosis, colon, bleeding
Meckel's diverticulum
Total Diverticular Disease
Hemorrhoids
Hemorrhoids, internal, uncomplicated
Hemorrhoids, internal, thrombosed
Hemorrhoids, internal, complicated
Hemorrhoids, external, uncomplicated
Hemorrhoids, external, thrombosed
Hemorrhoids, external, complicated
Hemorrhoids, complicating pregnancy
Total Hemorrhoids
Hernia/Obstruction
Adhesions, peritoneal, obstruction
Hernia, incisional
Hernia, umbilical
Obstruction, acute pseudo-obstruction/Ogilvie's
Obstruction, NOS
Volvulus
Total Hernia/Obstruction
Inflammatory Bowel Disease
Crohn's, small intestine
Crohn's, colon/rectum
Crohn's, SB & colon
Ulcerative proctitis
Ulcerative colitis
Pyoderma gangrenosum
Erythema nodosum
Total Inflammatory Bowel Disease
Infection, Specified
Clostridium difficile enteritis
HIV/AIDS
Herpes, anogenital – HSV
Condyloma – HPV
Cytomegalovirus – CMV
Venereal disease, NOS
Total Infection, Specified
Neoplasia
Ca, duodenum
Ca, small intestine
Ca, appendix
Ca, colon
Ca, rectum
Ca, anal canal
Ca, liver
CODE SITE #1
562.01
#
562.10
#
562.11
#
562.12
#
751
#
#
ICD9 # Cases
455.00
#
455.10
#
455.20
#
455.30
#
455.40
#
455.50
#
671.80
#
#
ICD9 # Cases
560.81
#
553.21
#
553.10
#
560.89
#
560.90
#
560.2
#
#
ICD9 # Cases
555.00
#
555.10
#
555.20
#
556.20
#
556.60
#
686.01
#
695.2
#
#
ICD9 # Cases
8.45
#
042
#
54.10
#
78.11
#
78.50
#
99.80
#
#
ICD9 # Cases
152
#
152.8
#
153.5
#
153.90
#
154.10
#
154.20
#
155.20
#
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
SITE #2
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
SITE #3
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
SITE #4 TOTAL
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
# Cases
#
#
#
#
#
#
#
#
#
#
#
#
#
#
Updated 5/2015
Page 25 of 27
PROCEDURES/DIAGNOSES
Ca, peritoneum
Ca, perianal skin
Ca, disseminated
Polyp,/benign neoplasm, duodenum or small intestine
Polyp/benign neoplasm, colon
Polyposis coli - FAP, Gardner’s, Turcot
Inherited neoplastic disorders, other (HNPCC, other
polyposis syndromes)
Polyp/benign neoplasm, rectal
Ca-in-situ, perianal
Dysplasia, any
Screening for neoplasia
Genetic risk for malignancy, NOS
Total Neoplasia
Ostomies
Ileostomy, attention to
Colostomy, attention to
Ostomy, infection
Ostomy, mechanical problem, NOS
Ostomy, hernia/fistula/prolapse
Total Ostomies
Pelvic and Physiologic Disorders
Ileus
Impaction, fecal
Constipation, NOS
Constipation - Incomplete evacuation
Constipation, slow transit
Constipation, pelvic outlet
Irritable bowel syndrome
Proctalgia fugax/AR spasm
Megacolon
Functional GI disorder; atony, NOS
Rectal prolapse
SRUS-solitary rectal ulcer / stercoral ulcer
Pain, anorectal
Anal sphincter tear, old/healed
Cystocele
Rectocele
Perineocele
Rectocele + uterine prolapse
Prolapse, uterovaginal, posthysterectomy
Enterocele
Laceration, old, obstetrical
Prolapse, genital, NOS
Coccydynia/other coccyx disorder
Fecal incontinence, full
Fecal soiling
Fecal urgency
Total Pelvic and Physiologic Disorders
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
158.80
#
#
#
#
#
173.50
#
#
#
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199.00
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211.20
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211.30
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211.90
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V18.51
211.40
232.5
569.44
V76.51
V84.09
ICD9
V55.2
V55.3
569.61
569.62
569.69
ICD9
560.1
560.32
564.00
787.61
564.01
564.02
564.10
564.60
564.70
564.89
569.10
569.41
569.42
569.43
618.01
618.04
618.05
618.40
618.50
618.60
618.70
618.90
724.70
787.6
787.62
787.63
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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Page 26 of 27
PROCEDURES/DIAGNOSES
Personal & Family History
Personal history of colon malignancy
Personal history of AR malignancy
Personal history of colonic polyps
Family history of malignant neoplasm of
gastrointestinal tract
Total Personal and Family History
Radiation
Radiation enteritis
Radiation dermatitis
Late effects of radiation
Personal history of radiation exposure
Total Radiation
Screening
Screening for malignant neoplasms of the intestine
Total Screening
Trauma
Abdominal trauma, any
Anorectal trauma, any
Total Trauma
GRAND TOTAL DISEASE MANAGEMENT
CODE SITE #1 SITE #2 SITE #3 SITE #4 TOTAL
ICD9 # Cases # Cases # Cases # Cases
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692.82
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V15.3
ICD9
V76.50
ICD9
959.12
877
Colon and Rectal Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
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