Q&A: New C-APCs in 2019

Q: Are there any new comprehensive APCs (C-APC) in 2019?

A: CMS is moving forward with three new C-APC for 2019, with no change from its proposals:

• C-APC 5163, Level 3 Ear, Nose, and Throat (ENT) Procedures
• C-APC 5183, Level 3 Vascular Procedures
• C-APC 5184, Level 4 Vascular Procedures

C-APC 5163 creates a lower-level C-APC to join the Level 4 (C-APC 4164) and Level 5 ENT Procedures (C-APC 5165). C-APCs 5183 and 5184 become the first two C-APCs in the Vascular Procedures clinical family (VASCX).

This brings the total number of C-APCs to 65 and will change 144 procedures to status indicator J1, as well as increasing the number of code pairs that lead to complexity adjustments.

CMS noted that numerous commenters suggested changes to the methodology for determining C-APC complexity adjustments, such as removing the 25-claim frequency threshold and considering adjustments for procedures with status indicators S or T. However, CMS said that it believes the current methodology is sufficient and finalized no additional changes.

Editor's note: For more information on the 2019 OPPS final rule, listen to this webinar with expert speakers Jugna Shah, MPH, and Valerie A. Rinkle, MPA. This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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