APCs 102 11152001

1
APCs 10211/15/2001

• Presented by
• Susan Magdall, CPC, CHC
• Institutional Compliance Program

2
APCs 102

• Modifiers
• Observation
• Inpatient only services
• Supplies
• Pass Thrus
• New Technologies

3
Modifiers
25 - Separately identifiable E/M service on
the same day as a procedure 27 - Multiple
E/M encounters on the same date 52 - Reduced
services
4
Observation

• Observation can be paid with certain diagnoses
• Chest Pain
• CHF
• Asthma
• Procedures Diagnostic services may be
  separately payable

5
In Patient Only

• Status indicator of C
• What is status C?
• Where can status C indicator
• be found?

6
Supplies .

• May be packaged
• Drugs ( administration)
• Blood/blood products
• ( infusion)

7
Pass Thrus

• Vendor/serial specific
• Drugs
• Pass through payments
• C Codes

8
New Technology

• Have own APCs (12)
• Supply all documentation

9
Example of E/M with non matching facility fee
Doctor sees established patient and documents a
99212 for evaluation of a wound. The doctor
orders the nurse to administer wound care. It
takes the nurse an additional 15 minutes to clean
and dress the wound. E/M Professional
99212 E/M Facility Fee 99213 0307
10
Example E/M with procedure
Patient was seen by the physician for a rash.
Physician finds suspicious lesion while
examining the rash and decides to remove it.
The physician injected the lesion with 50 cc of
Lidocaine HCl and excised the lesion.
11
Example of Claim