Reader Question: Outpatient Services

Question: For outpatient services, can you use multiple ambulatory payment classifications (APCs) for the billing of a congestive heart failure clinic and cardiac rehabilitation?

William Schlagel
Enid, Okla.

Answer: Under APCs, facilities should continue to report services with HCPCS/CPT codes. Reimbursement is based on the APCs calculated by Medicare from the reported CPT/HCPCS codes.

Although facilities must be able to calculate APCs and the expected reimbursement, hospitals are not required to report the calculated APCs. The significant change to reporting of services under APCs is that more detail and accuracy will be necessary for both reimbursement and compliance.

The current focus should be on capturing all services rendered and reporting the services with the correct HCPCS codes and revenue codes. If multiple CPT codes are reported for a given encounter, then you can expect that reimbursement will be for multiple APCs, although the actual total reimbursement would depend on the status indicators for the APCs.

Source for Reader Questions is Laura Siniscalchi, RRA, CCS, CCS-P, CPC, education coordinator at Beth Israel Deaconess Medical Center in Boston.

- Published on 2000-10-01