Modifier 73

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

Treatment Description CPT/Modifier
Anesthesia for procedures on thoracic spine and cord; not otherwise specified 00620 73

 

Reduced Billing by Percentage: Provider performs 60% of service and appends modifier 73

Description Amount
Medicare Physician Fee Schedule (MPFS) allowed $200
Bill Reduced Amount ($200 x 60%) $120

*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

 

Last Updated Wed, 12 Feb 2020 15:44:07 +0000