Health Information Management

Tip: New Composite EAM APC introduced as levels are collapsed

APCs Insider, February 21, 2014

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CMS finalized its proposal to replace the two Composite APCs 8002 (Level I extended assessment and management [EAM] composite) and 8003 (Level II EAM composite) with a single new Composite APC in the 2014 OPPS Final Rule.
To generate the new EAM Composite APC 8009, the following criteria must be met:
  • The single new HCPCS clinic visit code G-code, G0463, a Level 4 or 5 Type A ED visit, or a Level 5 Type B ED visit must be present along with eight or more hours of observation time
  • The HCPCS code for a direct admission to observation and the CPT codes for critical care remain in place
  • There can be no procedure with status indicator T (significant procedure, multiple reduction applies) on the same claim
CMS has set the 2014 payment rate for the new EAM APC at $1,199, compared to existing payment rates of $440 for APC 8002 and $798 for APC 8003.
Although this is a significantly higher payment rate, providers should note that this is in part due to the fact that CMS has now packaged many other services, which means they will no longer generate separate payment, so financial impact has to be carefully analyzed.
This tip is adapted from “CMS replaces clinic E/M visit levels with single G-code, collapses EAM levels” in the February issue of Briefings on APCs.

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