Monday, June 7, 2010

Modifier 74: Discontinued Outpatient Hospital/ASC Procedure After Administration of Anesthesi

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


Modifier 74: Discontinued Outpatient Hospital/ASC Procedure After Administration 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 as started (incision made, intubation started, scope inserted, etc.). This procedure would be reported by its usual CPT code and the addition of modifier 74.

For CMS, when the procedure is reported with modifier 74, there is no payment reduction. This is because the resources of the facility are consumed in essentially the same manner to the same extent as they would have been had the procedure been completed. If this modifier is not used and the patient has to come back for the same procedure, then the subsequent procedure will be denied. You would only get paid for one, whereas the use of the modifier 74 would allow you to be paid for both. The same applies to the modifier 73.

For example: A 65-year-old man was taken to the operating room for a laparoscopic cholecystectomy. After making the portal entry incision, the anesthesiologist noticed the patient having ventricular fibrillation on the cardiac monitor. Defibrillation effort was tried two times, finally the arrhythmia abated. The procedure was cancelled pending further cardiac consultation. CPT code: 47562-74 laparoscopy, surgical: cholecystectomy.

Modifiers 73 and 74 should be used when possible to help streamline revenue. As discussed earlier, modifiers explain to the insurance carrier that the description of the code is the same, but something about the procedure or service was changed.
Some modifiers impact reimbursement, while others are only informational and help get the claim paid without costly delays.

Using a modifier does not guarantee reimbursement, however, if the medical record does not support the modifier billed by the provider, the provider risks denial of the claim and possible penalties for submitting an incorrect claim. The important issue is to understand how to use the modifiers appropriately and which modifier should be appended to the claim appropriately.

2 comments:

  1. When an insurance pays for an aborted surgical procedure. Are office visits after the aborted procedure paid in addition or are they considered global prior to completing the rescheduled procedure?

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  2. If you are involved in an incident and are not capable of working for a month or even more you may find that you're struggling with your salary or something like that.
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