Wiki Modifier 73


Fort Wayne, IN
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Has anyone ever filed a claim from the ASC with the modifier 73? The way I understand it is that even if the patient was not in the OR and not administerd anesthesia, maybe only in pre op I can add the modifier 73 to the CPT code I would have used as if the patient had the procedure. Dr. did not dictate anything but I have nursing notes in the chart documenting everything that was done up to the point of being discontinued. I have billed the 74 on a case that anesthesia had been given and in the OR but this is the first time I have attempted to code something that never received any anesthesia.
Any clarification would be appreciated.

Tracy CPC-A
I originally put this post on the ASC forum
Here is my understanding --- The patient must be in the room that the procedure is to take place - sterile measure has been taken - doc is ready to do procedure and something major happens (ie - patient has a seizure and becomes unstable; facility looses power)
Here are some notes that I have on the use of it ~ Hope they help! ;)

Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when provided), and been taken to the room where the procedure was to be performed, but prior to administration
of anesthesia.
• Do not use this modifier for the elective cancellation of a procedure.
• Do not use this modifier if the surgeon cancels or postpones the scheduled surgery because of a patient complaint suchas a cold or flu upon intake.
• The physician (operating surgeon) should not use this modifier - Operating physician should use a 53 modifier. This is only appropriate for use by the ASCs.

ASC claims that involve a terminated surgery should always be accompanied by an operative report that specifies the following:
  • Reason for termination of surgery
  • Description of services actually performed
  • Description of supplies actually provided
  • Services not performed that would have been if surgery had not been terminated
  • Supplies that would have been provided if the surgery had not been terminated
  • Time actually spent in each stage (e.g., pre-op, operative and post-op)
  • Time that would have been spent in each of these stages if the surgery had not been terminated
This is very helpful, thank you so much. Could you tell me where you came upon this information? I am sure that my administrator will want to see some sort of documentation if possible.

Also where do you look to find the most helpful information for use in and ASC?
Thank you,