Reporting Reduced, Discontinued and Cancelled Procedures

on Wednesday, 06 June 2012. All News Items | Billing

 

 

In the January 2012 OPPS Update, CMS revised the guidance for the use of modifiers 52, 73 and 74 for discontinued and reduced services in outpatient hospitals and ambulatory surgical centers. The choice of an appropriate modifier is based on whether the reduced, discontinued or cancelled procedure requires the use of anesthesia or not.

  • Modifiers 73 and 74 are used for procedures that require anesthesia.
  • Modifier 52 is used for procedures that do not require the use of anesthesia.

Anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, or general anesthesia.

Discontinued / Cancelled Procedures

For procedures that are terminated due to extenuating circumstances or circumstances that threatened the well being of the patient,

  • Use modifier 73 if:
    • Anesthesia is planned for the procedure
    • The procedure is terminated prior to the administration of anesthesia,
    • The patient had been prepared for the procedure and taken to the room where the procedure was to be performed.
  • Use modifier 74 if:
    • Anesthesia is planned for the procedure
    • The procedure is terminated after the induction of anesthesia or after the procedure has been started (incision made, scope inserted, etc.)
    • A planned surgical or diagnostic procedure is discontinued or cancelled at the physician’s discretion after administration of anesthesia
  • Use modifier 52 if:
    • Anesthesia is not planned for the procedure
    • The patient had been prepared for the procedure and taken to the room where the procedure was to be performed.

*Do not report procedures that are electively cancelled.

Note that the patient must be taken to the room where the procedure is to be performed in order to report these modifiers.

Multiple Procedures Planned - If any procedures of multiple planned procedures are completed, report only the completed procedure(s). If none of multiple planned procedures are completed, report only the first planned procedure with the appropriate modifier.

Reduced Procedures

  • Use modifier 74 for services that are partially reduced after the administration of anesthesia
  • Use modifier 52 for services that are partially reduced for which anesthesia was not planned.

Effect on Payment

Services appended with modifier 73 or modifier 52 will be paid at 50% of the full OPPS payment amount. Services appended with modifier 74 will be paid at the full OPPS payment amount.

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