The following guidance determines the appropriate ambulatory surgical center (ASC) facility payment for a scheduled surgical procedure that is terminated due to medical complications, which increase the surgical risk to the patient.
- Payment is denied when an ASC submits a claim for a procedure that is terminated before the patient is taken into the treatment or operating room
- If the surgery is canceled or postponed because the patient on intake complains of a cold or flu
- Payment is made at the rate of 50 percent if a surgical procedure is terminated due to the onset of medical complications after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced or the procedure initiated For example, If the patient develops an allergic reaction to a drug administered by the ASC prior to surgery. Modifier 73 should be utilized to indicate that the procedure was terminated prior to induction of anesthesia or initiation of a procedure.
- Full payment of the surgical procedure is made if a medical complication arises which causes the procedure to be terminated after anesthesia has been induced or the procedure initiated. Modifier 74 should be used to indicate that the procedure was terminated after administration of anesthesia or initiation of the procedure.
An ASC claim for payment for terminated surgery must include an operative report kept on file by the ASC and made available if requested. The operative report should specify the following: Reason for termination of surgery; Services that were actually performed; Supplies that were actually provided; Services not performed that would have been performed if surgery had not been terminated; Supplies not provided that would have been provided if the surgery had not been terminated; The time actually spent in each stage (pre-operative/ operative/ post-operative); Time that would have been spent in each of these stages if the surgery had not been terminated; Healthcare Common Procedure Coding System code for the procedure had the surgery been performed.
More About Modifier 73
As mentioned above modifier -73 is used by the facility to indicate that a 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.
For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, or general anesthesia. This modifier code was created so that the costs incurred by the hospital to prepare the patient for the procedure and the resources expended in the procedure room and recovery room (if needed) could be recognized for payment even though the procedure was discontinued.”
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