74 - JE Part B

After Anesthesia Administration - Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital

Instructions

In an Outpatient Hospital, or Ambulatory Surgical Center (ASC) if a procedure has to be terminated, due to unforeseen complications, after anesthesia has been administered use Modifier 74.

Contractors may make full payment for modifier -74 if the following met:

1. Modifier 74 appended to anesthesia or surgical procedures when discontinued
2. AFTER anesthesia administration induced or procedure initiated
3. ASC or outpatient hospital only
4. Due to medical complications, extenuating circumstances, or threat to patient well-being
5. Documentation requirements met

Correct Use

• Physician may terminate surgical/diagnostic procedure
  • After procedure started (incision made, intubation started, scope inserted)
  • After administration of anesthesia (local, regional block or general)
• Under these circumstances, intended service is prepared, but canceled and billed with usual procedure number

Incorrect Use

• Do not report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation
• Physician reporting of discontinued procedure, see modifier 53

Example

Reduced Billing4

Provider performs 60% of service and appends modifier 74.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6.4 - Use of Modifiers for Discontinued Services