Outpatient Diagnostic and ASC grouping types

Principal CPT

All Outpatient Diagnostic and ASC encounters can be benchmarked based upon their principal CPT Code. This means that expected values are based upon patients who had the same principal CPT(s) as the patient population you are analyzing for a given metric. Principal CPT is determined based on the CPT with the highest charge amount.

Principal ICD procedure

All Outpatient Diagnostic and ASC encounters can be benchmarked based upon their principal ICD procedure code. This means that expected values are based upon patients who had the same principal procedure(s) as the patient population you are analyzing for a given metric.

Principal APC

All outpatient encounters are run through the Centers for Medicare and Medicaid Services (CMS) Ambulatory Payment Classification (APC) grouper and are assigned a principal APC based on CMS's standard APC weightings. These APCs can then be used for benchmarking and opportunity calculations, profile filtering, and other analysis through the Details Section and the Clinical Case Summary.