Friday, July 30, 2010

Modifier 74 - Discontinued Outpatient Hospital/Ambulatory Surgery Center

Modifier 74 Fact Sheet

Definition:

Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) procedure after administration of Anesthesia

Appropriate Usage:


Due to extenuating circumstances or those that threaten the wellbeing
of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia or after the procedure was started (incision made, intubation started, scope inserted.)

Inappropriate Usage:

• This modifier is not appropriate for the elective cancellation or postponement of a procedure based on the physician or patient’s choice.
• This modifier is not appropriate when the termination of the procedure occurs prior to the beginning of the procedure or the administration of anesthesia.
• This modifier is not for physician use. It is only appropriate for the ASC.

Additional Information:

• Medicare will make the full payment of the surgical procedure if a medical complication arises which causes the procedure to be terminated
• The claim must indicate the ASC has additional
documentation available upon request.
• The operative report and documentation should include the following:
o Reason for termination of the surgery
o Services actually performed
o Supplies actually provided
o Services not performed that would have been performed if surgery had not been terminated
o Supplies not provided that would have been provided if the surgery had not been terminated
o Time actually spent is each stage, e.g., pre-operative, operative, and post-operative,
o Time that would have been spent in each of these stages if the surgery had not been terminated, and
o HCPCS code for procedure had the surgery been performed.

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