Julio, a student from the local Bachelor of Science in Health Information Management Program, is working on a clinical assignment at your facility. The assignment that you gave Julio requir

CASE 2-43
Ambulatory Payment Classification (APC)
Julio, a student from the local Bachelor of Science in Health Information Management Program,
is working on a clinical assignment at your facility. The assignment that you gave Julio required
that he do some calculations of your ambulatory payment classification (APC) reimbursement,
working with the other coders.
He went back to his workstation to begin but returned about 30 minutes later. He was at a
complete loss, Julio knew the basics of the APC system-for example, that it was a hospital
outpatient reimbursement system for Medicare and that a patient could have multiple APC—-but
he was having trouble with the details that he needed to know for the project, especially the
concept of discounting. So you decided to give Julio an additional assignment to help prepare
him for the clinical assignment.
You provide Julio with a list of APCs to investigate. He is to identify the status indicator for the
APC and determine if discounting applies to the APC. He is instructed to go to the CMS website
(www.cms.gov hint: addendum A and D) to research the APCs in Table 2-31.
For each APC in Table 2-31, identify the status indicator for the APC and indicate if discounting
applies to the APC.
APCs with the Status Indicator and Discounting Status
APC Status Indicator Subject to Discounting
APC. Status Indicator. Subject to Discounting
0004
0077
0170
0238
0428
0617
0890
1419
1555
1841

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