A way of classifying hospital outpatient procedures for reimbursement purposes that is similar to the DRG system for inpatient services. Ambulatory patients are grouped according to clinical characteristics, resource use, and costs. 3M Health Information Systems developed the system for HCFA.
A way of classifying hospital outpatient procedures for reimbursement purposes that is similar to the DRG system for inpatient services. Ambulatory patients are grouped according to clinical characteristics, resource use, and costs. Acting under the Omnibus Budget Reconciliation Act (OBRA), the Healthcare Financing Administration (HCFA) employed 3M Health Information Systems to develop the system. APG Version 1 was adopted in 1990 and has been used by certain third-party payers, including Iowa Medicaid. APG Version 2.0 was released in September 1995 and is under Congressional review. The system is based on payment of facility costs per visit; it does not include physician services, telephone contacts, home visits, nursing home care, or inpatient care. Reimbursement is based on ICD-9-CM and CPT codes. In Version 2.0 there are 290 APGs, which are distributed into 46 ambulatory patient categories (APCs), which are similar to major diagnostic categories (MDCs) in the diagnosis related group (DRG) system. The Version 2.0 manual may be purchased from3M/HIS.