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Article: Billing as a Primary or Secondary Procedure Affects Payment under APCs.
- Article from:
- Healthcare Financial Management
- Article date:
- April 1, 2000
CopyrightCOPYRIGHT 2000 Healthcare Financial Management Association. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)
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The outpatient prospective payment system based on ambulatory payment classifications (APCs) is probably the least understood provision of the Balanced Budget Act of 1997. It therefore poses a significant financial threat to healthcare organizations that do not understand its nuances.
One such nuance is the difference in payment depending upon whether a procedure is billed as a primary or secondary procedure. A procedure will be a secondary procedure if it is billed with another surgical procedure with a higher acuity weight. If any APG is performed within 72 hours of an inpatient admission, the procedure will be billed as part of the inpatient DRG assigned to ...