73 - JE Part B

Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital Services

Instructions

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

Correct Use

• Due to extenuating circumstances or threaten patient’s well-being
  • After patient has been prepared for the procedure and brought to the procedure room
  • Prior to administration of anesthesia (local, regional block or general)
• Under these circumstances, the costs incurred by the facility to prepare the patient, and the resources expended in the procedure room and recovery room (if needed), could be recognized for payment even though the procedure was discontinued
• For surgeries and certain diagnostic procedures requiring anesthesia (including colonoscopies), the hospital may receive 50 percent of the Outpatient Prospective Payment System (OPPS) payment amount for cases in which the procedure is discontinued after the beneficiary was prepared for the procedure and taken to the room where the procedure was to be performed

Incorrect Use

• Do not report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation

Claim Coding 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