N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 329-2.4

Current through Register Vol. 46, No. 53, December 31, 2024

Section 329-2.4 - Diagnostic coding and rate computation

(a) Facility shall assign ICD-10 diagnostic and HCPCS/CPT-4 procedure codes for each visit and shall utilize the claim coding information to assign the applicable APG. The facility shall use the APG software system to determine the significant procedure APG, applicable ancillary services APGs and the final weight for a visit. The APG software system shall incorporate methodologies for consolidation, packaging and discounting to be reflected in the final weight to be assigned to the claim.

(b) Other applicable adjustments shall be made by the facility.

(c) Bill in accordance with APG requirements and WCB adjustments submitted for reimbursement to Payer with a copy to WCB.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 329-2.4

Adopted New York State Register December 30, 2015/Volume XXXVII, Issue 52, eff. 12/30/2015