Wiki APC group definitions/examples?

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Mrsrpc

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I've been trying to find SOME resource, anywhere, that gives some guidance on how to code certain outpatient procedures. For example APC group 5362 is "Level II Laparoscopy and Related Services", but it doesn't give any parameters to define what constitutes a Level II lap and related services vs a Level I lap and related services. Where can I find this?
 
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APC groups are assigned by Medicare each year when they create the OPPS final rule, and they often issue quarterly updates to these files as well. These are reimbursement categories only, though - there is no coding guidance involved with APCs. You should code your procedures according to CPT guidelines as you would for any other place of service.

If you want to know what APC group a given CPT falls into, you can look these up in the OPPS sections of the CMS web site - see the link below. Look for 'Addendum B' which has a list of covered CPT codes and the APC that they are assigned to. For your example of APC 5362, you can see that in the January 2021 file, CPT codes 49654, 49655, 49656, 49657 are some of the codes that are assigned to this group (and there are more codes for this APC if you scroll down further.) The APC assignment doesn't affect how you code procedures - these are just a tool that Medicare uses to price hospital outpatient claims.

 
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As Thomas said, you don't code for the APC assignment. You code the procedures according to the appropriate coding guidelines.

You can view the relevant data files to see how Medicare is pricing the claims under OPPS., but that data shouldn't affect your coding decisions.
 
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