Section title: Requests for Interpretation
RFI #
1935
Clarify RFI 1794 APR-DRG EAPG
Description

The answer to 1794 stated APR-DRG would be supported on 6020. Will EAPG by supported as a type of DRG or in another way? In the meantime, is it recommended to report EAPG in the 2110 REF Service Identification with REF01 = 1F Ambulatory Patient Group APG with EAPG returned in REF02?

RFI Response

While there is a solution planned for 0070next (2100 REF – Payment Determination Methodology with qualifier 1S – APG), it is more relevant to review CR1047. In this new version, the payment methodologies are moved to CLP11 and qualifier AX is available for APG. Additional qualifiers are being reviewed for EAPG. As an interim solution in 005010, the 2110 REF includes qualifier 1S for APG. Note that in version 005010, a qualifier 1F for APG is not permitted in the 2110 REF segment and should not be used.

DOCUMENT ID
005010X221