Wiki Modifier 73 for OPPS

[ANoel]

I have a question on the facility side of things.
The patient comes to the procedure room, is consented, on the table and the physician is ready to start the procedure. The patient becomes upset about something the physician has not done and leaves the procedure room.
For professional we could code 52. For facility Modifier 73 states there must be extenuating circumstances or the procedure threatens the well-being of the patient.

What would one consider extentuating circumstances. I was looking for a Q&A from a CMS site somewhere. If anyone could help out that would be great. My facility would look for some sort of a document rather than opinion so if anyone has anything that would be helpful.
Thanks!

 

[Pam Warren]

Here's what NHIC has to say...but nothing new here. I guess the question is "what is an extenuating circumstance? I would say that a patient that becomes upset and leaves the procedure room would be an extenuating circumstance, unless the provider could be perceived as being at fault.

Only facility charges related to a procedure approved by CMS may be reimbursed when performed in an ASC facility. The complete list of procedures can be found on the following website: http://[FONT=Book Antiqua,Book Antiqua][FONT=Book Antiqua,Book Antiqua]www.cms.gov/ascpayment[/FONT][/FONT].
-73 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to Administration of Anesthesia: Due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general).
[FONT=Book Antiqua,Book Antiqua][FONT=Book Antiqua,Book Antiqua]Note: [/FONT][/FONT]The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier -53.
-74 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia: Due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s) or general) or after the procedure was started (incision made, intubation started, scope inserted, etc.).
[FONT=Book Antiqua,Book Antiqua][FONT=Book Antiqua,Book Antiqua]Note: [/FONT][/FONT]The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier -53.



WPS has fact sheets on the -73 and -74. They give a bit more insight than CPT or HCPCS.


http://wpsmedicare.com/j8macpartb/resources/modifiers/modifier-73.shtml

http://wpsmedicare.com/j8macpartb/resources/modifiers/modifier-73.shtml


Keep us posted, this is a tricky one.