Case Scenario: Identify the APCs and payment status indicators (SIs) for each scenario (Addendum B). Which APCs are not packaged and would yield reimbursement for the facility?
a. Repair of lower jaw fracture is performed (21470). X-rays of the jaw (70110) and facial bones (70150) are performed. List the APCs and SIs. Which APC(s) are separately payable?
b. Patient evaluated in the ED (99282) for a racoon bite to the arm. Rabies vaccine was given to the patient (90471 and 90675). List the APCs and SIs. Which APC(s) are separately payable?
c. Patient has a dermatology appointment. The physician drains a pilonidal cyst (10080) on the patient's lower back near the tailbone. Local anesthesia is provided (00300). Additionally, the physician removes a callus on the patient's big right toe (11055). Lastly, the physician removes 8 skin tags (11200). List the APCs and SIs. Which APC(s) are separately payable?
How could the facility/physician circumnavigate the APC packaging rules for scenario 7C in order to receive additional reimbursement?