Modifiers 52—Reduced services, 73—Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia, and 74—Discontinued Out- Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia, are used to report procedures or services that are reduced or discontinued at the physician’s discretion.
Under the hospital outpatient prospective payment system (OPPS), anesthesia is defined by CMS to include local, regional block(s), moderate sedation/analgesia (conscious sedation), deep sedation/ analgesia, and general anesthesia, when services are furnished in the hospital outpatient setting.
Under certain circumstances, procedures and services provided in the hospital outpatient department and ambulatory surgical center may be discontinued.
Therefore, in the event a procedure or service is discontinued, modifiers 73 and 74 would be appended to the procedure code, in order for the facility to recover any expenses incurred. These modifiers are defined as follows:
- Modifier 73 is used by the facility to report that a patient was prepared for a surgical or diagnostic procedure, which was discontinued prior to the administration of anesthesia. The patient must have been taken to the operating room (e.g., endoscopy suite, gastrointestinal lab, etc.) and may have received preprocedural medication. If the procedure has been started, append modifier 74. The medical record documentation should reflect the reason for the cancellation.
- Modifier 74 is used by the facility to report that a patient’s surgical or diagnostic procedure was discontinued after the administration of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted).
- Modifier 52 is used to indicate a partial reduction or discontinuation of procedures and other services that do not require anesthesia. (Modifier 53, Discontinued Procedure, is for physician use only and not appropriate for facility reporting.)
a. When one or more planned procedures are completed, report the completed procedures. Any other procedure(s) that were planned, and not started, are not reported.
b. When none of the planned procedures are started and no anesthesia is administered, the first planned procedure is reported with modifier 73. In this instance, the patient must have been prepared and taken to the procedure room.
c. If anesthesia has been administered or the first procedure has been started (e.g., scope inserted, intubation started, incision made, etc.) modifier 74 should be reported with the first procedure. The other procedures are not reported.
d. If the first procedure is terminated prior to the administration of anesthesia and before the patient is taken into the procedure room, the procedure should not be reported.
e. If the first procedure is completed and a second procedure is started but not completed, the second procedure is reported with modifier 74 and the first procedure is reported with no modifier.
Keep in mind that in order to report modifiers 73 or 74, the patient has to be taken to the room where the procedure is to be performed. The following are some examples of how to correctly append modifiers 73 and 74:
A patient is taken to a minor procedure room for a planned hemorrhoid banding with anesthesia, and after examination of hemorrhoids and “pinch test” by the physician, the procedure was not performed at the physician’s discretion. The dictated operative report states under the operation performed “Rectal examination under anesthesia;” however, according to nursing monitoring documentation, no anesthesia of any type was administered. Since no anesthesia was administered, would the planned procedure be coded with modifier 52, or would it be inappropriate to assign a procedure code in this situation?
Report CPT code 46221, Hemorrhoidectomy, by simple ligature (e.g., rubber band), for the scheduled hemorrhoidal banding that was aborted. Modifier 73 would be appended to code 46221 to show that the procedure was aborted and only the rectal examination was performed. For hospital outpatient reporting of a scheduled procedure or service that is either partially reduced or cancelled due to extenuating circumstances before the administration of anesthesia, the procedure would be reported with modifier 73.
Can hospitals use modifiers 73 and 74 to indicate a terminated procedure when another procedure has been completed during the same operative session? Can hospitals submit 35474-74 for a terminated percutaneous angioplasty of the femoral artery while also submitting a CPT code for the selective catheter placement and/or a CPT code for the completed angiography of the leg? Or should hospitals code only the completed catheterization and imaging and code nothing for the attempted intervention?
Yes, hospitals can use modifiers 73 and 74 to indicate a procedure/ service was terminated or cancelled. When multiple procedures are planned, and one or more are completed, those completed are reported as usual. The other procedure( s) that were planned, and not started, are not reported. When none of the planned procedures are completed, the first planned procedure is reported with the appropriate modifier of 73 or 74. If the first procedure is terminated prior to the administration of anesthesia but before the patient is taken to the procedure room, the procedure should not be reported.
A patient was seen at our facility for a planned femoral angioplasty and angiography. The angiography was completed but the angioplasty was not started because the physician could not cross the lesion with the wire. Would it be appropriate to append modifier 74 in this instance?
Report CPT code 75710, Angiography, extremity, unilateral, radiological supervision and interpretation, for the angiography performed. Although, the angioplasty was planned, it was not started, and therefore, would not be reported.