Monday, May 31, 2010

ASC Procedure Prior to the Administration of Anesthesia - 73 modifier

Some of the most common modifiers used in the ASC are: 

Modifier 73: Discontinued Outpatient Hospital/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 cancel a 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). The elective cancellation of a service prior to the administration of anesthesia and/ or surgical preparation of the patient should not be reported. Physicians can report this using modifier 53. The facility cannot.

For CMS, if modifier 73 is reported and the procedure is an approved ASC service, payment will be 50 percent of the facility rate, subject to the ASC payment calculation. When one or more of the procedures planned is completed, the completed procedures are reported as usual. When none of the planned procedures is completed, then the first planned procedure is reported with modifier 73. The others are not reported.

A lot of revenue is lost because physicians do not want to bill for this or they do not understand the cost involved in this situation. This modifier should be used to cover the expenses involved for the use of the facility. This modifier is for use of facilities only.

For example: A 65-year-old man was brought to the operating room for repair of a recurrent inguinal hernia. The patient was prepped and positioning was carried out. Before the administration of anesthesia, the patient complained of chest pain, with cardiac monitor revealing ST segment changes. The procedure was cancelled. CPT codes: 49520-73 Repair recurrent inguinal hernia, any age, reducible.

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