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Level 1 APCM diagnosis coding

S

srandolph11

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Local Chapter Officer
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7
Location
Park City, KS
I'm hoping to find someone who has some experience with billing APCM codes. More specifically how they bill a level 1 APCM (G0556).
A scenario - If there is no clear dx, is it possible to use a Z code from Z00-Z13 for the visit?
 
srandolph11 said:
I'm hoping to find someone who has some experience with billing APCM codes. More specifically how they bill a level 1 APCM (G0556).
A scenario - If there is no clear dx, is it possible to use a Z code from Z00-Z13 for the visit?
Click to expand...
We have been billing APCM since 2025, when the codes were released. We do not enroll anyone unless they have at least 1 chronic condition. A chronic condition is expected to last more than 12 months or until death. Why was the patient enrolled in APCM? When we bill G0556, G0557, or G0558, we use the diagnoses that are associated with their care plan.
 
This isn't a straightforward answer and I didn't find one on CMS or other sites regarding the patient who doesn't have a chronic condition (as is allowed in G0556's inclusion of one or fewer chronic conditions). Because the service includes a care plan (even if it is for an acute condition or preventive services), the diagnosis code(s) reported would ideally reflect what was addressed in each patient's care plan.

I hope you find a more straightforward answer.
Cindy
 
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