Tip: Determining comprehensive APC reimbursement
APCs Insider, May 29, 2015
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Providers need to take multiple steps to determine the reimbursement for a comprehensive APC (C-APC) and whether a complexity adjustment will be applied if multiple applicable procedures appear on the same claim.
The first step is identifying which service will serve as the primary C-APC. The J1 procedures and codes are located in Addendum J of the 2015 OPPS final rule, and include a column called "Rank Used for Primary Assignment." When multiple J1 procedures or services appear on the same claim, the procedure with the highest rank in that category is assigned to the C-APC.
For example, a claim contains the following codes:
- 35472, transluminal balloon angioplasty, percutaneous; aortic
- 35475, transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel
The first code, 35472, has a rank of 180 according to Addendum J, while 35475 has a rank of 187. As a result, 35472 is the primary service and leads to C-APC 0083 (level I endovascular procedures). Providers need to look to another tab in Addendum J to determine if a complexity adjustment applies to the claim.
This tip is adapted from “CMS releases update to correct and clarify comprehensive APC payments" in the May issue of Briefings on APCs.
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Related Products
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- The consequences of an incomplete medical record
- OB services: Coding inside and outside of the package
- Complications from immobility by body system
- Q&A: Primary, principal, and secondary diagnoses
- Practice the six rights of medication administration
- Nursing responsibilities for managing pain
- Differentiate between types of wound debridement
- Skills of effective case managers
- E-mailed
-
- Correctly bill ancillary bedside procedures in addition to the room rate
- Q/A: Coding infusions to correct low potassium levels
- Q&A: Utilization Review Committee Membership
- Q&A: Bill blood administration the same way for inpatient and outpatient accounts
- Q&A: A second look at encephalopathy as integral to seizures/CVA
- OB services: Coding inside and outside of the package
- Know the medical gas cylinder storage requirements
- Intravenous therapy guidelines
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Watch for different codes for SI joint injections
- Searched