Friday, July 30, 2010

Modifier 73 - Discontinued Outpatient/Hospital Ambulatory Surgery Cente

Modifier 73 Fact Sheet

Definition:

Discontinued Outpatient/Hospital Ambulatory Surgery Center (ASC) Procedure prior to the administration of anesthesia

Instructions

When a surgical or diagnostic procedure is discontinued, prior to anesthesia administration in outpatient hospital or ASC only, physician may terminate the procedure with 73 facility modifier

Correct Use

    Due to extenuating circumstances or threaten patient well-being
        Prior to procedure started/patient's surgical preparation (including sedation or taken to procedure room)
        Prior to administration of anesthesia (local, regional block or general)
    Under these circumstances, intended service is prepared, but canceled and reported by the usual procedure number

Incorrect Use

    Do not report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation
    Append 53 modifier for physician reporting of discontinued procedure

Claim Coding Example

Treatment Description


CPT/Modifier

Anesthesia for procedures on thoracic spine and cord; not otherwise specified


00620 73

Reduced Billing by Percentage: Provider performs 60% of service and appends modifier 73

Medicare Physician Fee Schedule (MPFS) allowed

$200

Bill Reduced Amount ($200 x 60%)

$120

Appropriate Usage:


Due to extenuating circumstances or those that threaten the wellbeing
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 the anesthesia.

Inappropriate Usage:

The physician cancelled the surgical or diagnostic procedure prior to administration of anesthesia and/or surgical preparation of the patient.

Additional Information:

• Do not use this modifier for the elective cancellation of a procedure.
• Do not use this modifier if the surgeon cancels or postpones the scheduled surgery because of a patient complaint suchas a cold or flu upon intake.
• The physician should not use this modifier. This is only
appropriate for use by the ASCs.
• Medicare’s reimbursement is 50 percent of the ASC rate for the procedure.


• Modifier 73 is used when a procedure is discontinued and anesthesia WAS NOT administered. A 50 percent reduction is applied to the allowable charge.

• Modifier 74 is used when a procedure is discontinued and anesthesia WAS administered. Blue Cross applies the full allowed amount (no reduction is applied).



Modifier -73 is used by the facility to indicate that a 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.

Effect on Payment

Procedures that are discontinued after the patient has been prepared for the procedure and taken to the procedure room but before anesthesia is provided will be paid at 50 percent of the full OPPS payment amount. Modifier -73 is used for these procedures. As of January 1, 2016, for procedures that append modifier -73 and that involve implantable devices that are assigned to a device-intensive APC (defined as those APCs with a device offset greater than 40 percent), we will reduce the APC payment amount for the discontinued device-intensive procedure, by 100 percent of the device offset amount prior to applying the additional payment adjustments that apply when the procedure is discontinued as modified by means of a final rule with comment period and published in the November 13, 2015 “Federal Register”


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