AHA Coding Clinic® for HCPCS - 2005 Issue 4

CMS modifies payment policies for interrupted procedures

Since the implementation of the Outpatient Prospective Payment System (OPPS) in 2000, modifiers -52, -73, and -74, have been reported by hospitals to indicate procedures that were terminated before their completion. These modifiers serve the purpose of identifying a reduction or discontinuation of a procedure or service. In the November 10, 2005 final rule, the Centers for Medicare & Medicaid Services (CMS) issued changes to the payment policies for modifiers -52, -73, and -74. CMS stated that the current OPPS policy requires providers to use modifier -52 to indicate that a service not requiring anesthesia was partially reduced or...

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