Wiki ASC question for modifier 73


Fort Wayne, IN
Best answers
Has anyone ever billed for an out patient sugery that was discontinued before they ever got to the operating room? I did get another answer in the modifier forum but I need to be able to go to my administrator with some clarification on if and how to bill for this. It was a discontinued sx before the pt was administered anesthesia, they were in pre op, one was d/c because of a fever, one because they had eaten toast before surgery. Any where I can find the info would be most appreciated.
Tracy H CPC-A
• Medicare Services may pay 50 percent of the rate if the surgical procedure terminated due to the onset of medical complication after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced (use modifier – 73).

• Surgical procedures terminated due to medical complications that cause the procedure to be terminated after induction of anesthesia may be reimbursed at 100 percent of the ASC rate (use modifier – 74).
I'm pretty sure you cannot bill for the patient who ate before surgery or the patient that had a fever. Neither one had been taken to the operating room, they were in the pre-op area. Even with the modifier.
The use of modifiers 53, 73 and 74 requires that the patient be in the room where the procedure is to be performed when it is then decided to discontinue. In the facility 73 will give a 50% reimbursement and the 74 a 100% reimbursement. An operative note is required in all cases to show what was planned at at what point the decision to discontinue is made and the reason why, and of course that the patient is in the OR/procedure room at that time.
Thank you for all the reply's, they have helped alot. I knew there had to be some sort of information or someone would know more that I did.