True or False: One PCM record is needed for each APC grouping.

True or False: One PCM record is needed for each APC grouping.

• A. True
• B. False
• C. Not Applicable
• D. Not Sure

Answer: (B)

Understanding how procedure codes map to payment groups is essential. APC groupings determine outpatient payment, and a PCM record holds the procedure code and its attributes. The relationship isn’t one-to-one; a single PCM code can map to multiple APC groupings depending on context like site of service, modifiers, and revenue codes. Therefore, you don’t need one PCM record for each APC grouping—the code can be placed into different APCs through the crosswalk based on those factors. In practice, the same procedure code can be billed under different APCs if it’s performed in different settings or with different modifiers. So the statement is false.

Understanding how procedure codes map to payment groups is essential. APC groupings determine outpatient payment, and a PCM record holds the procedure code and its attributes. The relationship isn’t one-to-one; a single PCM code can map to multiple APC groupings depending on context like site of service, modifiers, and revenue codes. Therefore, you don’t need one PCM record for each APC grouping—the code can be placed into different APCs through the crosswalk based on those factors. In practice, the same procedure code can be billed under different APCs if it’s performed in different settings or with different modifiers. So the statement is false.