Trauma/SCC Coding Information

Major Organ Trauma, No Operation Required (MOTNOR)

  • Graduates must have a minimum of 30 trauma cases for graduation.
  • Of the 30 required cases, 10 will be the minimum number of operative trauma cases; 20 will be the minimum number of non-operative cases.
  • The CPT code for recording nonoperative trauma is 99199.

Guidelines include:

  • The category, major organ trauma, no operation required, is defined as patients with major organ trauma who were admitted to a specialty care unit in the hospital, ie, SICU, CCU, Burn Unit, etc.
  • The most senior resident on the trauma service should claim credit for the MOTNOR case. In the instance where there is no trauma service, a fourth or fifth year general surgery resident may claim credit.
  • If the patient subsequently requires a general surgery operative procedure that may be claimed in the defined category.


  1. The Critical Care Index Cases (CCIC) log was developed to provide documentation of resident management of a broad scope of critical care patients as follows:
  2. Each resident will develop a log of at least twenty critical care patients who represent the broad scope of critical care index management. (NB: do not submit 20 of the same conditions) CPT code 99292 will map to all seven of the surgical critical care conditions listed below.
  3. Each of the patients listed in the log should include the management of at least 2 of the 7 categories listed in #4 below.
  4. The completed logs should include experience, with at least one patient in all seven of the categories.

The categories are:

  • 8410 - Ventilatory Management (>24 hours on a ventilator)
  • 8420 - Bleeding (a non trauma patient requiring more than 3 units of blood/products and monitoring in ICU settings)
  • 8430 - Hemodynamic Instability (requiring inotropic/pressor support)
  • 8440 - Organ Dysfunction/Failure (etiology/mode of management, i.e. renal, hepatic, cardiac failure)
  • 8450 - Dysrhythmias (requiring drug management)
  • 8460 - Invasive Line Management and Monitoring (Swan-Ganz, A-lines, etc)
  • 8470 - Parenteral/Enteral Nutrition

The residents are to maintain their own logs on the ACGME Web site.

The program director must sign off on the completed