Case Review Overview for Candidates
Case Review requirements can be a bit confusing, but once candidates understand what, exactly, ABFAS reviewers are seeking in a case, the process becomes a lot more straightforward. On this page you'll find resources to help you navigate Case Review document upload.
Preparing for Case Review
ABFAS presented a webinar on February 9, 2021 to provide an overview of what, exactly, case reviewers are looking for, and to outline requirements for document and image upload. The presentation slide deck is available for candidates to review, as is the below video of the presentation.
Frequently Asked Case Review Questions
ABFAS has also prepared a question-and answer that lists several questions candidates frequently ask about Case Review.
General Case Review Questions
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Formerly I practiced with my now-ex-spouse. My ex-spouse will not release patient records to me. What should I do?Contact ABFAS.
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The facility is charging me a per-patient record fee as well as a per-X-ray fee. The charges are substantial. Is this legal?ABFAS cannot determine legality but believes charges for records should be reasonable.
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ABFAS selected a case in which I performed the surgery on a patient, but my associate did the progress notes and follow-up. Will this result in automatic failure?Contact ABFAS.
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My facility’s EMR system has the biller as the “finalized” signature. If I reopen the chart to sign it myself, it changes the “finalized” date to today. Does this represent a problem?Place a short note of explanation on the front of your H&P section.
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Where can I find information on ABFAS Case Review?On the ABFAS website, click “Become Board Certified,” then “Part II Case Review Overview.”
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My facility does not have EMR and uses paper charts. The operative report is typed, but all other records are hand-written. Is this a problem?Type the operative report. The other records can be uploaded as written records.
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What factors will contribute to a failed case?The most common cause for case review failure is failing to upload the required documents.
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Can I upload an explanation as to why a case turned out the way it did or why a patient did not follow up in order to justify a lack of all required information?No, do not upload additional explanatory material. All documentation uploaded should be part of the existing patient record.
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Can we circle or highlight portions of the uploaded documents to aid the reviewers in finding important information?Highlight your name as surgeon and the patient’s name in the intra-operative anesthesia/circulating nurses notes. If you think that highlighting other notes can assist the reviewer, you may do so.
History and Physical Exam
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Should I upload progress notes from encounters between a patient's initial H&P and their eventual surgery? These might include injections, physical therapy, immobilization, etc. but can also include more documentation of surgical thoughts and planning.Upload documents that directly support decision-making. ABFAS does not need all pre-op notes. Post-op notes should include all, from first post-op visit to discharge for the selected procedure.
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The pre-op H&P for one patient was not saved. How should I proceed?Submit the documentation you are able to locate.
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A bunion was selected for Case Review, but the patient had ankle fracture. Bunion discussion continued after the ankle healed, leading to bunion surgery. Is initial H&P the first discussion or when the discussion restarted after ankle surgery?If both include information pertinent to decision-making, upload both documents.
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What if I am the listed surgeon but I do not have an H&P (as when another physician performed it)?Include the H&P from the other physician, as ABFAS expects you will have documented reviewing that documentation.
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Does the initial H&P need to be the first time we saw the patient or the first time we discussed surgery with the patient? What if we saw the patient multiple times?You should upload all documents relevant to providing a complete pre-operative assessment. This may be only a pre-op H&P or may also include a progress note supporting your surgical decision-making.
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Should H&P documentation include the patient’s initial visits to the office, including conservative treatment such as orthotics/injections leading up to surgery?Include pre-operative visits supporting your surgical decision-making. You do not need to upload conservative care visits.
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Can I upload more than one office visit for a single patient for the H&P portion of the case review?Upload all documents relevant to providing a complete pre-operative assessment. This may be only a pre-op H&P or might include a progress note supporting your surgical decision-making.
Pre-op Labs
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Should I include pre-op EKG?No, pre-op EKG is not required.
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Should I include standard CBS, BMP, and EKG as part of pre-op labs for elective cases?No, you do not need to include standard pre-op labs.
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Should I upload labs/MRI/additional testing as one PDF in test date order or as separate, multiple PDFs?Labs can be a single or multiple PDFs. For MRIs and CTs, ABFAS requests you upload one-three images. Feel free to also upload reports as PDFs, if you wish.
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Is it ok that some of the elective surgeries did not have labs performed prior to surgery?Yes, pre-op labs are not required.
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In the labs section, should pre-operative EKG and chest X-rays be included?There is no need to provide EKG or chest X-rays.
Imaging
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If both AP and lateral radiograph projections were taken on the same plate, can that single image be submitted, or should I separate the image into the two different projections? What if identifying patient information is not included on both images?You do not need to separate images that are on the same film. If images do not have any information on them, you may insert a text box into the image and type in the name and date.
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Can I only upload immediate images day of surgery and final images, or could I include post-operative X-rays that are not immediate or final to show progression?You may submit intermediate images up to the limit of ten.
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Do first ray amputations need to have final weight-bearing post-operative X-rays?No, they do not.
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How can I copy and upload plain film X-rays?Use a good digital or phone camera and take a picture using a light box. The picture should be as clear and easy-to-read as the original; be sure to check. Save the image in one of the formats required and upload. Do not scan the plain film.
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Is the immediate post-op X-ray the one taken at the first post-op visit? Or is this the intra-op X-ray?I could be either image. If intra-op, be sure the image is clear and shows the procedure.
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What shall I do if the patient's facility did not produce weight-bearing images?ABFAS expects weight-bearing images where indicated. If they are not available, submit what you have.
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May I submit more than ten images per case?Only ten images are allowed per case.
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Can I upload multiple images for a given date if there were multiple surgeries involved for the patient?Only ten images are allowed per case. Images for the selected procedure should be uploaded, including complications, but not for additional, unrelated procedures.
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If radiograph equipment does not include both patient's name and surgeon's name, should I label it accordingly on each radiograph or just the file name?Images should be labeled with patient name and date, if possible.
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Can I submit multiple images from one date as a single JPG file?It's ok to include two images in one file, but be careful they are not too small to read.
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What X-ray time frames does ABFAS require?Please refer to the Board Certification document for imaging guidelines.
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What if patient did not get final WB X-rays? I put in the order but they were not completed.Submit the case without the final X-rays. Review will be based on submitted material. Include documentation of non-compliance by patient, if available. Do not create a new note or addendum.
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For a case such as an amputation/limb salvage, where the immediate post-op images are also the final images taken, should these images be added to category B or C?Only one post-op set of films is required for amputations in immediate post-op.
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Should we upload MRI reports in labs, or upload images as well?We prefer you upload one to three pertinent images (as space allows), but you may also upload an MRI report.
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What if a complication necessitates more than ten images?Currently, ten is the maximum number of images the system can accommodate. Upload the ten images that best demonstrate the procedure and its outcome.
Logging
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If Lapidus is logged in PLS as 2.1.6 or 2.2.5 or 2.3.3 but the operative note splits it into two procedures, will this be cause for failure of case?No. ABFAS focuses on the procedure selected and the PLS logging category. How it is coded/listed for other purposes is not a focus of the review.
Consultations
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Are medical clearances by the primary doctor necessary for the Consultations category?No, medical clearance is not required.
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Do physical therapy, medical, and cardiac clearance fall under consults?ABFAS does not require upload of PT and pre-op clearance.
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Should I include pre-operative medical or cardiology clearance in the consultations document upload?No, consultation uploads are only required when the consult is related to the direct care of the foot/ankle condition.
Progress Notes
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My facility’s EMR includes my name, the date of service, and the patient name on the notes, but not the hospital name or logo. How should I proceed?Submit notes as they are.
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My patient did not follow up or show for the post-op visit, but has an upcoming appointment. Should I include that note?Upload all notes related to the selected procedure, including those occurring after the case selection date. You cannot add addenda to notes from before the selection date.
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I changed practices and another provider took over care. Should I submit their documents, and for how long?Include progress notes through the final outcome.
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If the patient sees another physician, either before or after the patient sees me, should I upload the other physician's note in the Progress Notes section or the under the Consultation section?Include the other physician's note in chronological order in the progress note section.
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If I left the practice where the chosen patient was being seen, should I collect only the notes that I personally did thereafter, or collect all the notes from the different provider(s) that continued to follow the patient through post-op period?Collect the notes from the different provider who continued to follow the patient through the post-op period.
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If the pandemic mandated a mix of in-person and telehealth visits, should I upload an explanation?Send all available notes from telehealth.
Surgeon of Record
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My facility’s nursing intra-op notes are very lengthy. The first page lists the patient name, date of surgery, and primary surgeon. Should I attach the entire document, or just this first page? I will also upload handwritten anesthesia notes.ABFAS needs only the intra-op note, either from the anesthesia record or the nurse’s note.
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The only note that has my name is the “PACU handoff note.” Is this document sufficient?In this case, contact ABFAS.
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My hospital has blank spaces for “surgeon” on the intra-op report. We do not have a surgeon blank on the RN note. Do you have a recommendationABFAS does not substitute cases. Please contact ABFAS for guidance on the intra-op report.
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VA residents are listed as surgeons for all case, with the attending as the primary surgeon. Should we clarify this for non-VA reviewers?No, ABFAS is aware of the VA listing and accepts it.
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Should I highlight the surgeon name and date or the surgeon name and patient's name?Highlight your name and the patient's name.
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I note an additional surgeon of record is not allowed. Is an assistant surgeon allowed?Yes, an assistant surgeon is allowed.
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Should I upload all pages of the RN intra-op document, or just the single page that validates the surgeon of record?ABFAS only wants the pertinent page or pages that provide the required information.
Complications
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If a patient has a second surgery to correct a complication, should I upload the original X-rays or the second surgery X-rays as final?Include final X-rays from the second surgery.
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What are the requirements for cutoff date for a currently-active patient, as in the example of revision surgery?Include complications and their treatment as part of the case documentation. Include everything up to document submission.
Staged Procedures
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How much prior history should I include for a staged/revision case? Should I include prior imaging in the pre-operative section?Generally, start with the documentation that is immediately pre-op to the selected procedure, including imaging.
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Staged Procedures The case requested was the second stage of a charcot reconstruction. Do you want the X-rays with the ex-fix on just before the requested second stage case or the first X-rays when the patient presented with problem?In this case, provide X-rays just before the requested procedure.
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If just one surgery of a staged, two-surgery approach is selected for review, should I include documentation for both surgeries or just the documentation in the immediate pre-operative period as it applies to the selected surgery?Focus on the case being reviewed. Submit images required for the indexed procedure, the procedure selected for scoring. With your ten images, include pre-op, post-op, and final, and then add any others available. For your documentation, include all pertinent information from the prior case.
Bilateral Procedures
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As case selection indicates a specific laterality, does ABFAS want radiographs only from the indicated side, despite bilateral procedures?ABFAS wants documentation related to the selected procedure.
HIPAA
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My former place of employment does not want to release the records of my former patient or wants to do so with patient identifiers redacted. How can I proceed?ABFAS has a letter you can send requesting un-redacted records. In addition, ABFAS staff can contact the facility. Contact ABFAS to discuss these options.
Operative Report
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The patient had a hardware removal after the procedure selected for review. Should I include the op report for the second case in the progress notes or in the op report section? Same question applies to the circulator’s notes for the second case.Include the second op report behind the first. You do not need to upload the second circ nurse note.
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In the case of multiple op reports, should I submit all, or just the first one, and then upload the subsequent op reports with the progress notes?Place all in the op reports section.
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What should I do if the patient name is not listed on the operative report?The patient name is expected on the dictated operative report. In this instance, submit the document as-is; do not add the name.
Missing Material
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I do not have follow-up notes because I performed surgery on the patient while inpatient for specific procedures, and the regular doctor is unavailable. The patient passed away. Should I include a progress note to this effect?You can submit the discharge summary from the hospital to help support your comments that the patient was scheduled with a different provider (their primary DPM) for follow-up.
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Following an amputation I performed, the patient had BKA at another facility. I do not have privileges there, so I cannot obtain the op report. Do you have a recommendation?You may reach out to the patient's primary care physician and request the PCP's progress note from a follow-up visit closest to the date post-BKA to help the reviewers understand why the patient did not follow up. Contact ABFAS if you are unable to get the notes.
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How should I handle a situation in which a patient was lost to follow-up and was not documented in a progress note prior to the case selection date?If an entry from scheduling software is available, please include it. If not, submit the case as-is. Do not add addenda.
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If a patient did not schedule any follow-ups and had no final X-rays, should I include a screenshot that shows no appointments made and include a memo about it?Include the screenshot but do not add a memo.
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What if a case has been selected from a facility that has closed down before I could obtain all the necessary medical records?Please contact ABFAS for assistance prior to the case submission due date. Each case is handled on an individual basis.
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What is the best way to show patients who failed to follow up with appointments?A progress note indicating “fail to follow up” or a copy of an appointment list showing no show/cancellation are the best ways.