Distinguish between modifiers -73 and -74 for discontinued procedures

January 19th, 2016

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers hospital outpatient and ambulatory surgery center reporting for discontinued procedures, with emphasis on the circumstances that distinguish two modifiers, related documentation and compliance considerations, and how interrupted services may be reported in facility claims. It is aimed at hospital coders, outpatient revenue cycle staff, and others responsible for procedure coding and claim submission.

Why This Topic Matters

Accurate handling of interrupted outpatient procedures affects facility payment, claim reporting, documentation expectations, and compliance review. The article helps readers understand the topic at a high level while preserving the need to consult the full guidance for exact application details.

Article Sections

  1. Overview

    Introduces the topic of discontinued outpatient procedures and the general use of related billing modifiers in hospital settings.

  2. Application of modifier -73 or anatomically compatible CPT codes

    Reviews the outpatient hospital and ASC context for one modifier, including broad procedural circumstances, documentation considerations, and payment-related notes.

  3. Modifier -73 coding tips or abbreviated description for anatomically compatible CPT codes

    Summarizes general coding considerations, claim reporting issues, and compliance reminders associated with this modifier.

  4. Application of modifier -74 or anatomically compatible CPT codes

    Reviews the outpatient hospital and ASC context for the other modifier, including broad procedural circumstances, documentation considerations, and payment-related notes.

  5. Modifier -74 coding tips or abbreviated description for anatomically compatible CPT codes

    Summarizes general coding considerations, claim reporting issues, and compliance reminders associated with this modifier.

  6. For an example, see the following operative report

    Presents a brief operative-report example used to illustrate the outpatient discontinued-procedure topic in a real-world setting.

What You Will Learn

  • How the article frames interrupted outpatient procedure reporting
  • What broad circumstances are discussed for hospital and ASC discontinued services
  • What documentation and compliance themes are highlighted
  • What general payment and claim-form issues are associated with the topic
  • How the article uses an operative example to illustrate the subject

Who Should Read This

  • Hospital coders
  • Outpatient facility billing staff
  • ASC coding personnel
  • Revenue cycle professionals
  • Compliance staff

Codes Discussed

  • HCPCS Level II: G0105
  • HCPCS Level II: G0121
  • CPT: -53
  • CPT: -73
  • CPT: -74

Modifiers Discussed

  • CPT: -53
  • CPT: -73
  • CPT: -74

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