In 2011 OPPS, CMS restated its position on "Triage-only" visits confirming that it does not specify the type of staff who may provide services. As such, there is no definitive strong correlation between facility and professional coding and thus no rational basis for the application of one set of derived codes, either facility or professional, to the determination of the other on a case-by-case basis. Facility coding reflects the volume and intensity of resources utilized by the facility to provide patient care, whereas professional codes are determined based on the complexity and intensity of provider performed work and include the cognitive effort expended by the provider. For further information about APC's, see the Frequently Asked Questions on the ACEP website.įacility coding guidelines are inherently different from professional coding guidelines. APC's apply only to hospitals, and have no impact on physician payments under the Medicare Physician Fee Schedule. ![]() APC's or "Ambulatory Payment Classifications" are the government's method of paying for facility outpatient services for the Medicare program. A part of the Federal Balanced Budget Act of 1997 required HCFA (now CMS) to create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services analogous to the Medicare prospective payment system for hospital inpatients known as "Diagnosis Related Groups" or DRG's.
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