Assignment

  

Case 2-43

Ambulatory Payment Classification (APC)

Julio, a student from the local Bachelor of Science in Health Information Management Program, is working on a clinical assignment at your facility. The assignment that you gave Julio required that he do some calculation of your ambulatory payment classification (APC) reimbursement, working with the other coders.

He went back to his workstation to begin but returned about 30 minutes later. He was at a complete loss. Julio knew the basics of the APC system – for example, that it was a hospital outpatient reimbursement system for Medicare and that a patient could have multiple APCs – but he was having trouble with the details that he needed to know for the project, especially the concept of discounting. So you decided to give Julio an additional assignment to help prepare him for the clinical assignment.

You provide Julio with a list of APCs to investigate. He is to identify the status indicator for the APC and determine if discounting applies to the APC. He is instructed to go to the CMS website (www.cms.gov) to research the APCs in Table 2-31. 

For each APC in Table 2-31, identify the status indicator for the APC and indicate if discounting applies to the APC.

Table 2-31

  

Ambulatory Payment Classification   (APC) with the Status Indicator and Discounting Status

 

APC

Status Indicator

Subject to Discounting

 

0001

N/A

N/A

 

0077

 

0171

 

0236

 

0429

N/A

N/A

 

0617

 

0891

 

1011

 

1555

 

1820