ASC Coding Guidance: Modifier -73 and -74 — Know the Difference

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Modifier -73 — CPT guidelines state that the physician may cancel a surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed, but prior to the administration of anesthesia (local, regional block or general). This as a result of extenuating circumstances or those that threatens the well being of the patient.

 

The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported.

 

When none of the planned procedures are completed, then the first planned procedure is reported with the modifier -73. The others are not reported.

 

This modifier should be used to cover the expenses involved for the use of the facility.

 

Modifier -74 — CPT guidelines state that the physician may cancel a surgical or diagnostic procedure after the administration of anesthesia or after the procedure is started. This is a result of extenuating circumstances or those that threatens the wellbeing of the patient.

 

This procedure would be reported by the usual CPT code along with the modifier -74.


If this modifier is not used and the patient has to return to the center for the same procedure, then the subsequent procedure will be denied.

 

Learn more about Serbin Surgery Center Billing.

 

The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.


Read more practical guidance from Caryl Serbin:

 

- 8 Quick Tips for Picking the Best Insurance Plans for Your ASC

 

- 12 Best Practices for Analyzing Business Terminology in Payor Contracts

 

- What to Audit When You Audit Your ASC's Billing Process

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