I need the significant procedures consolidation list for APG (either
1.0 or 2.0). I believe they did away from significant procedures
consolidation for APG (Ambulatory Patient Groups) in version 2.0.
However, some providers might still use it. APG methodology and
consolidation list was developed by 3M health systems.. APG 1.0 came
about in 1990 and version 2.0 was established in 1995/1996.
CPTs are grouped into an APG. Providers are then paid by the
established rate x relative weight of each APG. (Rate x weight =
payment). There are multiple discount logics and payment options.
For instance, if there is multiple occurances of a APG, then the APG
is considered 1 and only paid once. however, there are some APGs that
are consolidated into other APGS (so, if on a medical claim, there's
apg 2,3,5 and 12, in theory APG 2,3,and 5 are consolidated into APG
12. And only APG 12 will be paid).
Real Data: APGs 3, 4, 6, 7, 8, 10, and 58 are consolidated within APG 11
I need the list that contains all of the significant procedure consolidation.