American Academy of Professional Coders (AAPC) Practice Exam

Which classification is used by outpatient facility coders?

1. Medicare Payment Classification

2. Ambulatory Payment Classification

3. Diagnosis-Related Group

4. Healthcare Common Procedure Coding System

The correct answer is: Ambulatory Payment Classification

Outpatient facility coders utilize the Ambulatory Payment Classification (APC) system for categorizing services and procedures. The APC system is specifically designed to facilitate reimbursement for outpatient hospital services under the Medicare program. Each service provided in an outpatient setting is classified into an APC, which standardizes payment rates for similar services, ensuring equitable reimbursement based on resource use. APCs are integral to billing for outpatient services, as they encompass a wide range of procedures and diagnostic tests performed in an outpatient setting. This classification reflects the nature of care delivered, allowing coders to efficiently correlate services with corresponding payment rates. In contrast, the other classifications do not apply specifically to outpatient facilities: - Medicare Payment Classification primarily relates to inpatient facilities. - Diagnosis-Related Groups (DRGs) are utilized for inpatient hospital coding, categorizing cases to determine hospital payment for inpatient services. - The Healthcare Common Procedure Coding System (HCPCS) is a coding system that includes both outpatient and non-outpatient services; however, it does not specifically categorize the payment structure for outpatient services. Understanding the distinctions among these classifications is essential for proper coding and billing practices in various healthcare settings.