Prior Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital

Instructions

When a surgical or diagnostic procedure is discontinued, prior to anesthesia administration in outpatient hospital or ASC only, physician may terminate the procedure with 73 facility modifier

Correct Use

• Due to extenuating circumstances or threaten patient well-being
  • Prior to procedure started/patient's surgical preparation (including sedation or taken to procedure room)
  • Prior to administration of anesthesia (local, regional block or general)
• Under these circumstances, intended service is prepared, but canceled and reported by the usual procedure number

Incorrect Use

• Do not report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation
• Append 53 modifier for physician reporting of discontinued procedure

Claim Coding Example

Reduced Billing by Percentage

Provider performs 60% of service and appends modifier 73.

Note: Medicare recognizes that many providers use one standard fee schedule for all insurance carriers. Therefore, reducing the charge amount may differ from the example.

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