Modifier -73, Discontinued procedure prior to the administration of anesthesia; Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia
Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may cancela surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of the modifier 73.
Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
Modifier -73 is used when a physician cancels a surgical procedure due to the onset of medical complications subsequent to the patient’s preparation, but prior to the administration of anesthesia. Payment will be at 50% of the maximum allowable fee for the primary procedure only. Multiple and bilateral procedure pricing will not apply.
Modifier -74, Discontinued procedure after administration of anesthesia - Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after aministration of anesthesia
Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of the modifier 74.
Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
Modifier -74 is used when a physician terminates a surgical procedure due to the onset of medical complications after the administration of anesthesia or after the procedure was started. Payment will be at 85% of the maximum allowable fee. Multiple and bilateral procedure pricing may apply to this if appropriate to the circumstances.
Use of Modifiers -52, -73, and -74 for Reduced or Discontinued Services - Hospital Outpatient facility billing
Policy: This manual revision clarifies use of modifiers -52, -73 and -74. These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circumstances. For billing under the OPPS, modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. For surgeries and certain diagnostic procedures requiring anesthesia (including colonoscopies), the hospital may receive 50 percent of the OPPS payment amount for cases in which the procedure is discontinued after the beneficiary was prepared for the procedure and taken to the room where the procedure was to be performed. If the procedure is discontinued after the beneficiary has received anesthesia or after the procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia. This manual revision also clarifies that discontinued radiology procedures that do not require anesthesia may not be reported using modifiers -73 and -74.
Modifiers -73, and -74 apply only to certain diagnostic and surgical procedures that require anesthesia.
Medicare Guidelines to Use modifier 72 and Modifier 73 - Use of Modifiers for Discontinued Services
Modifiers provide a way for hospitals to report and be paid for expenses incurred in preparing a patient for surgery and scheduling a room for performing the procedure where the service is subsequently discontinued. This instruction is applicable to both outpatient hospital departments and to ambulatory surgical centers. Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when provided), and been taken to the room where the procedure was to be performed, but prior to administration of anesthesia. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, or general anesthesia. This modifier code was created so that the costs incurred by the hospital to prepare the patient for the procedure and the resources expended in the procedure room and recovery room (if needed) could be recognized for payment even though the procedure was discontinued.
Modifier -74 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened the well being of the patient. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia. This modifier code was created so that the costs incurred by the hospital to initiate the procedure (preparation of the patient, procedure room, recovery room) could be recognized for payment even though the procedure was discontinued prior to completion. Prior to January 1, 1999, modifier -53 was used for reporting these discontinued services
Modifiers -73 and -74 are used to indicate discontinued surgical and certain diagnostic procedures only. They are not used to indicate discontinued radiology procedures.
Effect on Payment
Surgical or certain diagnostic procedures that are discontinued after the patient has been prepared for the procedure and taken to the procedure room for which modifier -73 is coded, will be paid at 50 percent of the full OPPS payment amount.
Surgical or certain diagnostic procedures that are discontinued after the procedure has been initiated and/or the patient has received anesthesia for which modifier -74 is coded, will be paid at the full OPPS payment amount.
Termination Where Multiple Procedures Planned
When one or more of the procedures planned is completed, the completed procedures are reported as usual.
When one or more of the procedures planned is completed, the completed procedures are reported as usual. The other(s) that were planned, and not started, are not reported. When none of the procedures that were planned are completed, and the patient has been prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73. If the first procedure has been started (scope inserted, intubation started, incision made, etc.) and/or the patient has received anesthesia, modifier -74 is used. The other procedures are not reported.
If the first procedure is terminated prior to the induction of anesthesia and before the patient is wheeled into the procedure room, the procedure should not be reported. The patient has to be taken to the room where the procedure is to be performed in order to report modifier -73 or -74.
Specifications:
Modifier -73 is used by outpatient facilities to specify a surgical or diagnostic same day outpatient procedure, requiring anesthesia. Certain outpatient procedures are usually covered by Aetna if they are performed on an outpatient basis. Reimbursement for these outpatient services is primarily made on a flat fee service and coded with Revenue code 490. Per coding guidelines, Modifier 73 indicates a surgery cancellation prior to anesthesia.
Reimbursement Guidelines - Aetna
1) For surgeries and certain diagnostic same day procedures requiring anesthesia (including colonoscopies), the hospital may receive fifty percent (50%) of the OPPS payment amount for cases in which the procedure is discontinued after the beneficiary was equipped for the procedure and taken to the room where the procedure was to be implemented.
2) If the procedure is withdrawn after the beneficiary has received anesthesia or after the same day procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure.
3) Providers do not use a modifier if the narrative definition of a code indicates several incidences.
4) If the patient has multiple procedures that were planned and not begun, they are not reported. When no procedure was planned or completed, and the patient was prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73.
Codes/Condition of Coverage
Outpatient CPT Codes:
99201-99205, 99211, 99213-99215
Revenue Codes:
510, 514, 515, 517
Does Provider can Use this modifier 73 and 74 in office visite and other setup?
No , This modifier is approved for ambulatory surgery center (ASC) hospital outpatient use Services and Modifiers Not Reimbursable to Healthcare Professionals.
Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may cancela surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of the modifier 73.
Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
Modifier -73 is used when a physician cancels a surgical procedure due to the onset of medical complications subsequent to the patient’s preparation, but prior to the administration of anesthesia. Payment will be at 50% of the maximum allowable fee for the primary procedure only. Multiple and bilateral procedure pricing will not apply.
Modifier -74, Discontinued procedure after administration of anesthesia - Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after aministration of anesthesia
Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of the modifier 74.
Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
Modifier -74 is used when a physician terminates a surgical procedure due to the onset of medical complications after the administration of anesthesia or after the procedure was started. Payment will be at 85% of the maximum allowable fee. Multiple and bilateral procedure pricing may apply to this if appropriate to the circumstances.
Use of Modifiers -52, -73, and -74 for Reduced or Discontinued Services - Hospital Outpatient facility billing
Policy: This manual revision clarifies use of modifiers -52, -73 and -74. These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circumstances. For billing under the OPPS, modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. For surgeries and certain diagnostic procedures requiring anesthesia (including colonoscopies), the hospital may receive 50 percent of the OPPS payment amount for cases in which the procedure is discontinued after the beneficiary was prepared for the procedure and taken to the room where the procedure was to be performed. If the procedure is discontinued after the beneficiary has received anesthesia or after the procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia. This manual revision also clarifies that discontinued radiology procedures that do not require anesthesia may not be reported using modifiers -73 and -74.
Modifiers -73, and -74 apply only to certain diagnostic and surgical procedures that require anesthesia.
Medicare Guidelines to Use modifier 72 and Modifier 73 - Use of Modifiers for Discontinued Services
Modifiers provide a way for hospitals to report and be paid for expenses incurred in preparing a patient for surgery and scheduling a room for performing the procedure where the service is subsequently discontinued. This instruction is applicable to both outpatient hospital departments and to ambulatory surgical centers. Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when provided), and been taken to the room where the procedure was to be performed, but prior to administration of anesthesia. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, or general anesthesia. This modifier code was created so that the costs incurred by the hospital to prepare the patient for the procedure and the resources expended in the procedure room and recovery room (if needed) could be recognized for payment even though the procedure was discontinued.
Modifier -74 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened the well being of the patient. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia. This modifier code was created so that the costs incurred by the hospital to initiate the procedure (preparation of the patient, procedure room, recovery room) could be recognized for payment even though the procedure was discontinued prior to completion. Prior to January 1, 1999, modifier -53 was used for reporting these discontinued services
Modifiers -73 and -74 are used to indicate discontinued surgical and certain diagnostic procedures only. They are not used to indicate discontinued radiology procedures.
Effect on Payment
Surgical or certain diagnostic procedures that are discontinued after the patient has been prepared for the procedure and taken to the procedure room for which modifier -73 is coded, will be paid at 50 percent of the full OPPS payment amount.
Surgical or certain diagnostic procedures that are discontinued after the procedure has been initiated and/or the patient has received anesthesia for which modifier -74 is coded, will be paid at the full OPPS payment amount.
Termination Where Multiple Procedures Planned
When one or more of the procedures planned is completed, the completed procedures are reported as usual.
When one or more of the procedures planned is completed, the completed procedures are reported as usual. The other(s) that were planned, and not started, are not reported. When none of the procedures that were planned are completed, and the patient has been prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73. If the first procedure has been started (scope inserted, intubation started, incision made, etc.) and/or the patient has received anesthesia, modifier -74 is used. The other procedures are not reported.
If the first procedure is terminated prior to the induction of anesthesia and before the patient is wheeled into the procedure room, the procedure should not be reported. The patient has to be taken to the room where the procedure is to be performed in order to report modifier -73 or -74.
Specifications:
Modifier -73 is used by outpatient facilities to specify a surgical or diagnostic same day outpatient procedure, requiring anesthesia. Certain outpatient procedures are usually covered by Aetna if they are performed on an outpatient basis. Reimbursement for these outpatient services is primarily made on a flat fee service and coded with Revenue code 490. Per coding guidelines, Modifier 73 indicates a surgery cancellation prior to anesthesia.
Reimbursement Guidelines - Aetna
1) For surgeries and certain diagnostic same day procedures requiring anesthesia (including colonoscopies), the hospital may receive fifty percent (50%) of the OPPS payment amount for cases in which the procedure is discontinued after the beneficiary was equipped for the procedure and taken to the room where the procedure was to be implemented.
2) If the procedure is withdrawn after the beneficiary has received anesthesia or after the same day procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure.
3) Providers do not use a modifier if the narrative definition of a code indicates several incidences.
4) If the patient has multiple procedures that were planned and not begun, they are not reported. When no procedure was planned or completed, and the patient was prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73.
Codes/Condition of Coverage
Outpatient CPT Codes:
99201-99205, 99211, 99213-99215
Revenue Codes:
510, 514, 515, 517
Does Provider can Use this modifier 73 and 74 in office visite and other setup?
No , This modifier is approved for ambulatory surgery center (ASC) hospital outpatient use Services and Modifiers Not Reimbursable to Healthcare Professionals.
No comments:
Post a Comment