Friday, June 11, 2010

Discontinued outpatient hospital procedure - Modifier 73

Part - A  Level I Modifiers 73

Description Discontinued outpatient hospital procedure PRIOR to the administration of anesthesia.

Required for Claims Hospital Outpatient Prospective Payment System (OPPS)

Type of Bill: 13X

Coding Guidelines Applies to surgical procedures (CPT 10000-69999) and some diagnostic services (CPT 90780-99091)

General Guidelines

A. 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.

B. 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.

C. 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.

D. If none of the planned procedures were completed, report the first procedure that was planned with modifier –73 if prior to anesthesia being administered. No other procedure codes should be reported.

Payment Implications:
A terminated procedure with modifier –73 will be discounted at 50%.

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