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Thread: discontinued procedure outpt hospital

  1. #1
    Join Date
    Apr 2007
    Spokane, WA

    Question discontinued procedure outpt hospital

    AAPC: Back to School
    I just started working at a Spine Center that does pain management. One of our doctors attempted to to a TFESI (transforaminal epidural steroid injection) of the lumbar spine. Pt's lumbar area was anesthetized and under fluoroscopic guidance "multiple attempts were made unsuccessfully secondary to bony overgrowth. A decision was then made to provide the epidural steroid injection from a caudal approach..."

    So, Mod 74 states that procedure was d/c'd, after anesthesia (ASC or Outpt facility) due to "extenuating circumstances" or "threat to patient's well being". What constitutes "extenuating circumstances?" The doctor didn't know, going into the procedure, that it would be "reduced" (didn't plan a reduced procedure) so I don't think that 52 fully describes the situation... but I want to verify if a patient's abnormal anatomy can be considered an appropriate "extenuating circumstance" to justify modifier 74.

    any words of wisdom?

    Thanks for your help.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    It looks like though a procedure was doen via a different approach, If a procedure was completed then you may code the procedure that was discontinued as an additional. The claim amy contain one or the other all completed or all discontinued. If nothing was completed in your example then it would be the 74, plus as a secondary dx code you need a V64.x code.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Although perhaps a patient's abnormal anatomy may at a stretch justify an 'extenuating circumstance, take a second look at modifier 74's description. The use of "anesthesia" in the ASC and Outpatient settings means general anesthesia and not simply numbing the area.

    Also, modifier 74 (and 73) are both for the ASC/Outpatient center facility billing.

    Was this for physician billing?


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