Health Information Management

Tip: CMS proposes extensive APC reconfiguration in 2016 OPPS proposed

APCs Insider, September 4, 2015

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For 2015, CMS finalized changes to reconfigure and consolidate ophthalmology and gynecology APCs. The agency is proposing to expand that to include nine new clinical families for 2016:
  • Diagnostic tests and related services
  • Endoscopy procedures
  • Gastrointestinal procedures
  • Imaging services (specifically diagnostic radiology and nuclear medicine)
  • Incision and drainage and excision/biopsy procedures
  • Orthopedic procedures
  • Skin-related procedure (combining debridement and destruction with skin procedure APCs)
  • Urology and related procedures
  • Vascular procedures
Providers should anticipate continued changes as CMS continues to move through clinical families.
This tip is adapted from “CMS proposes massive APC reconfiguration, updates 2-midnight rule" in the September issue of Briefings on APCs.

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