3M Health Information Systems
Frequently Asked Questions (FAQs)
Implementing the 3M™ Enhanced Ambulatory Patient Grouping System for
use by stand-alone clinics and ambulatory surgery centers (ASCs)
This document provides insight into using the 3M Enhanced Ambulatory Patient
Grouping System (3M Enhanced APGS) at your facility.
Key questions:
What is the 3M Enhanced APG (EAPG) System?
Who maintains the 3M EAPG System?
How often are there updates?
Does everyone use the most recent version of 3M EAPGs?
Who creates the weights?
Who defines and updates the payment policies?
What data elements are needed for 3M EAPGs?
How are the diagnosis codes used?
What about ICD-10?
What about the secondary diagnosis codes?
Is there any packaging within the 3M EAPG grouping?
Are any discounts applied in reimbursement?
Will I have to collect additional data to use the 3M Enhanced APGS?
Why would a payer adopt this new outpatient payment system?
What should my facility do to implement the 3M Enhanced APG System?
Which 3M solution is going to fit my facility?
What will happen if I do not prepare for this change?
What are the benefits to my clinic or surgery center?
How can I find out more about the 3M Enhanced APG System?
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What is the 3M™ Enhanced APG (EAPG) System?
The 3M Enhanced APGS is a patient classification system designed to explain the
amount and type of resources used in an ambulatory visit or series of related visits.
Patients in each 3M Enhanced APG category have similar clinical characteristics, as
well as similar resource use and cost.
 The 3M Enhanced APG System was developed to represent ambulatory care
across the entire patient population, not just Medicare patients.
 The system is also designed to cover a broad range of ambulatory settings, such
as hospital outpatient, emergency, and ancillary departments, covering
treatments such as medical and surgical services. Non-hospital settings, like
free-standing ambulatory surgery centers (ASC), dialysis centers, and other
diagnostic and treatment clinics, are also supported.
Who maintains the 3M EAPG System?
3M Health Information Systems updates and maintains the 3M EAPG system. This work is
performed by the Clinical and Economic Research (C&ER) team. It is a proprietary classification
system to 3M. As such, care should be taken to provide proper attribution for use of 3M EAPGs
and/or related materials.
How often are there updates?
3M EAPGs are updated quarterly: January, April, July and October. January is the largest and
most comprehensive update.
All updates include changes to HCPCS codes (i.e., CPT® HCPCS level I and/or HCPCS level
II). October also includes updates to the ICD diagnosis code set.
January is the largest update because of the major updates to CPT® and HCPCS level II code
sets, sometimes amounting to hundreds of new codes. The other quarters may include anywhere
from a half dozen code changes to several dozen new codes.
The January update is also when the 3M EAPG proprietary logic and functionality are reviewed
and updated. This update usually includes HCPCS code to 3M EAPG and ICD diagnosis code to
3M EAPG assignment changes, and the creation of new 3M EAPGs. It may also include
additions to logic, such as the impact of new modifiers and the inclusion of logic for the handling
of preventative services.
January is when a new version number is implemented. It is only the new version that supports
the 3M EAPG code assignment changes and the inclusion of new 3M EAPGs, and usually the
new functionality of the grouper.
3M supports six years of versions of 3M EAPGs. This is different from supporting six versions,
because 3M has had mid-year versions due to customer demand. When new codes are
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introduced, they are fit into existing 3M EAPGs rather than introducing new 3M EAPGs as is
done in the newest version with the January release. This means that all supported versions are
kept current with ICD diagnosis and HCPCS levels I and II code sets.
When a version exceeds the six-year limit, it is dropped from the grouper and is no longer
supported. Otherwise, all versions are available within the grouper.
Does everyone use the most recent version of 3M EAPGs?
In short, yes. However, 3M EAPG versions and weight sets are paired. If there are new 3M
EAPGs, weights need to be made for them. Creating weights can be a time-consuming process.
Because the January update is when new 3M EAPGs are introduced and the release is not
available much before January 1, most payers choose to use a version that is a year or two old
until they can create new weights and introduce all the new 3M EAPGs.
An additional consideration, particularly for private payers, such as Blue Cross® Blue Shield®,
is that they specify the version to be used in the contracts they sign with hospitals in their
networks. These contracts often have a three-year duration. A new version cannot be introduced
until a new contract is negotiated.
To date New York Medicaid is the only payer that introduces use of the new version in January.
Who creates the weights?
3M does create a set of national weights. We make these available to any payer. That payer may
choose to use the 3M weights or other weights.
Usually weights are created by the payer who is implementing the 3M EAPG System. As such
they are their property. For state Medicaid agencies these become public. However, for private
payers, the weights represent intellectual property and are generally not publically available.
With the agreement of the payers, 3M will include their weights in it software.
Who defines and updates the payment policies?
The payment policies are under the control of the payer who designed them. 3M will update its
software with any changes made by the payer as they are communicated to 3M by the payer.
However, 3M does not initiate these changes.
What data elements are needed for 3M EAPGs?
This is really two questions that, while related and similar, are not the same. These questions are:
1. What data elements are needed to group a claim through the 3M EAPG grouper?
2. What data elements are needed to process a claim through the 3M application which
delivers the grouper?
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The application provides many services needed by the grouper as well as any user or electronic
interfaces. It also houses the mechanism for communicating any options selected by the payer for
grouping claims, such as controlling what 3M EAPGs will be included in the packaging list.
For the purposes of this document, the following list shows only those elements required for
grouping a claim, which is a subset of those needed by the product:
 Admit date (from date)
 Discharge date (through date)
 Age in years
 Sex
 Principal diagnosis
 Procedure HCPCS codes
 Modifier1
 Modifier2
 Modifier3
 Modifier4
 Revenue code
 Units of service
 Service date
 Action flag
 ICD Version Qualifier value
 Value code (if New York state)
 Value code amount (if New York state)
It is helpful for some other fields also be provided:
 Patient name
 Account number
 Medical record number
 Type of bill
 Condition code
 Discharge status
 Secondary diagnosis
 Reason for visit diagnosis
 Charges
 Occurrence code
 Professional service flag
 NDC code (national drug codes)
 External cause of injury diagnosis
Additional information about these data elements is available in separate documents.
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How are the diagnosis codes used?
The primary diagnosis code is the only required diagnosis code. It is used for 3M EAPG
assignment for medical visit 3M EAPGs.
What about the secondary diagnosis codes?
The secondary and external cause of injury codes are reviewed for determination if there is a
major sign symptom or finding. If one of these codes is on this list, it would be used to group the
medical visit into the major sign symptom of finding (MSSF) 3M EAPG. This is the highest
paying medical visit 3M EAPG.
There are two other times when a secondary diagnosis code might be used. If a payer has chosen
to use one of the following:
 Secondary diagnosis present list option, also referred to as the grouping acuity option
 The 3M EAPG conditional upon diagnosis option
The secondary diagnosis present list option is used to identify if there is a secondary diagnosis
code that identifies a chronic or complex condition. If a payer has chosen to use this option, a
flag would be set for the pricer to payer and additional amount for that patient claim.
The 3M EAPG conditional upon diagnosis option identifies a condition where a particular
diagnosis must be present for a specific 3M EAPG to pay—much like a medical necessity
requirement.
What about ICD-10?
ICD-10 and ICD-9 diagnosis codes are both available within the existing 3M EAPG grouper.
Claims with either code set can be processed by the grouper. However, it is not possible to
process claims with both code sets.
The ICD version qualifier flag is set to identify the version of the codes being sent in: A 0 for
ICD-10 codes and a 9 for ICD-9 codes.
This flag does not need to be populated at all times, but only when the code set is a mismatch to
the effective date of their use. Specifically, if ICD-10 codes are being sent in before October 1,
2015, then the flag needs to be populated. If ICD-9 codes are being sent in after October 1, 2015,
then it also would need to be populated. Otherwise, it can be sent as blank.
Is there any packaging within the 3M EAPG grouping?
Packaging is referred to as the inclusion of a defined set of 3M EAPGs in the payment of other
3M EAPGs on the claim. They are still assigned and 3M EAPGs, but a flag is set that no dollars
should be paid for the specific 3M EAPG.
There are two types of packaging: Ancillary packaging and significant procedure consolidation.
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Ancillary packaging
Ancillary packaging applies only to ancillary services, 3M EAPGs with a 3M EAPG type of 4,
specifically to a set of pre-defined 3M EAPGs that are on the uniform packaging list, or on a list
of 3M EAPGs that has been defined by the payer to be added to the packaging list. The payer can
also remove 3M EAPGs from the uniform packaging list.
Significant procedure consolidation
Significant procedure consolidation (consolidation) refers only to significant procedures,
3M EAPGs with a type of 2, 21, 22, 23, 24, or 25. There are two methods of consolidation: Same
3M EAPG and clinical 3M EAPG.
Same 3M EAPG consolidation refers to the situation when there are two of the same 3M EAPGs
on the claim. This does not mean the same HCPCS code. When two lines group to the same
significant procedure 3M EAPG, one is paid and the second is not paid separately.
Clinical 3M EAPG consolidation is when there are two 3M EAPGs that are defined based on a
relationship table that defines which 3M EAPGs consolidate in the presence of another specific
3M EAPG. When the qualifications are met, the 3M EAPG that is subordinate in the table is
consolidated and not paid separately.
Certain modifiers, if turned on, can cause consolidation to not be applied.
Other
It should also be noted services that are on the incidental list, 3M EAPG type 5, are never paid
separately. While this does not meet the definition used to define packaging, it is a set of services
that are not paid separately.
Are any discounts applied in reimbursement?
While this is a topic for reimbursement, and not grouping, a brief discussion is appropriate, since
the grouper will set a flag designating something should be discounted. Also, actual discounting
percentages are defined by the payer. In most cases there are two levels: 100 percent and 50
percent. In some cases there are three levels, such as 100 percent, 75 percent, and 50 percent. For
our discussion, the normal, most common discounting method will be used. Just be aware that
there may be other implementations.
There is discounting within an outpatient prospective payment system (OPPS) that uses
3M EAPGs. This includes a number of different situations when discounting would apply:
 Multiple unconsolidated significant procedure 3M EAPGs
 Multiple same ancillary 3M EAPGs
 Modifier initiated
 Other miscellaneous
Multiple unconsolidated significant procedure 3M EAPGs discounting
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When there are more than one significant procedure 3M EAPG that are not consolidated and are
therefore paid separately, the one with the highest weight is paid at 100 percent and all others at
50 percent. It should be noted that there is a flag set on all significant procedures when
discounting may be appropriate. This is different than with other discounting.
The reason that all unconsolidated 3M EAPGs are flagged is because the grouper does not have
the weight information to assign the flag to only those significant procedure 3M EAPGs that
should receive a discount. It is up to the pricer to determine of all the 3M EAPGs, which has the
highest weight and should be paid at 100 percent and the others at 50 percent
Multiple same ancillary 3M EAPG
In this situation the first occurrence of the 3M EAPG is to be paid at 100 percent. All others are
assigned a flag indicating a discount should be calculated, usually 50 percent.
It should be noted that if there are two ancillary 3M EAPGs present, but they are different, no
discounting is applied.
Modifier imitated discounting
The presence of some specific modifiers will initiate some form of discounting. The most
common are:
 Modifier 50 – 150% discount
 Modifiers 52 & 73 – 50% discount
Other miscellaneous discounting
This is actually a special case of the modifier initiated discounting. Some payers have special
conditions for which they want to apply some kind of discount, greater or less than 100%. In
these situations, they will usually define a modifier to be used to designate the application of the
discount.
On rare occasions this is also defined by a diagnosis code.
Will I have to collect additional data to use the 3M Enhanced APGS?
No. The data elements needed to use the 3M Enhanced APGS are limited to information
currently collected on your 837 claim submission. These include diagnosis and procedure codes
and others as noted above.
Why would a payer adopt this new outpatient payment system?
There are a number of reasons why a payer might implement an outpatient prospective payment
system, and EAPGs in particular. Here are a number of those reasons:
 Some method to manage the growing cost of outpatient care
 Fairness of:
o Payment for complexity of services provided
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
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o Payment among hospitals
o Payment among the many care settings (e.g., hospitals, ASCs, etc.)
Provide incentive for efficiency
Cover the full range of care settings
Address services provided to the whole population, not just Medicare patients
Medical visits are based on clinically meaningful groups
What should my facility do to implement the 3M Enhanced APG System?
1. Train the clinicians, coders, and others in your facility who generate or use codes to
understand the procedures, bundling, consolidation and packaging contained in the 3M
Enhanced APGS. There are different categories of 3M Enhanced APG codes,. including:
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Significant procedure or therapy (e.g., skin excision)
Medical (e.g., visit for diabetes)
Routine ancillary (e.g., chest x-ray)
Non-routine ancillary (e.g., MRI)
Incidental procedures (e.g., finger stick blood sample)
Drugs (e.g., chemotherapy)
Supplies (e.g., diabetes supplies)
Anesthesia
2. Understand how accurate documentation, coding and capture of all services provided will
impact your reimbursement.
3. Determine the type of output and reporting your clinic will need to understand and track the
impact the 3M Enhanced APGS may have on your reimbursement.
4. Purchase the 3M software solution that best fits your systems and requirement.
Which 3M solution is going to fit my facility?
The 3M Enhanced APG System is available on multiple platforms and may be used in batch or
interactive modes. Because each facility has different people, information systems and processes,
it is important to consider which solution best fits your specific needs.
The interactive product works with and integrates into the 3M™ Coding and Reimbursement
System. This means it can easily be implemented within the HIM department because it is
similar to existing products, allowing existing users to begin using the application with minimal
training. This helps reduce implementation times and challenges.
Most clinics and surgery centers can use the 3M™ Core Grouping Software, because it can be
interfaced with many billing systems and also run stand-alone in an interactive mode. 3M can
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provide the purchaser's billing software vendor with the specifications it will need to create the
proper interface.
Contact your claims management systems vendors to determine whether and if they have
developed an interface to the 3M Core Grouping Software.
What will happen if I do not prepare for this change?
Clinics and surgery centers do not need to purchase the 3M Enhanced APGS. The state of New
York will group your claims for you. However, obtaining the software will let you check for
accuracy and completeness prior to claim submission. Upon receipt of payment, the software
also lets you compare actual to expected reimbursement.
What are the benefits to my clinic or surgery center?
The 3M Enhanced APG System provides information that:
 Allows a facility to calculate expected compensation for each claim
 Identifies edits so they can be addressed prior to claim submission to help you check the
claim for completeness, accuracy and compliance with payer requirements
 Allows facilities to compare expected to actual reimbursement on remittance advice
 Facilitates retrospective business analysis of your facility
 Promotes understanding of claim service items that are packaged and consolidated
How can I find out more about the 3M Enhanced APG System?
For more information, contact your 3M representative or call us toll-free at 800-367-2447.
About 3M Health Information Systems
3M Health Information Systems works with providers, payers, and government agencies to anticipate and navigate a
changing healthcare landscape. 3M provides healthcare data aggregation, analysis, and strategic services that help clients
move from volume to value-based health care, resulting in millions of dollars in savings, improved provider performance, and
higher quality care. 3M’s innovative software is designed to raise the bar for computer-assisted coding, clinical
documentation improvement, performance monitoring, quality outcomes reporting, and terminology management. For more
information, visit http://www.3Mhis.com or follow us on Twitter at @3MHISNews.
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Published 04/15
70-2011-6562-1