Health Information Management

Understand the difference between modifiers -73 and -74

HIM Connection, May 25, 2010

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Coders should use modifiers -73 and -74 to report discontinued outpatient procedures. Modifier -73 indicates procedures discontinued prior to anesthesia, whereas modifier -74 is appropriate for procedures discontinued after anesthesia administration or after the procedure has begun (e.g., the physician made the incision or inserted a scope).

“For the purposes of Medicare billing, [anesthesia] includes local and regional blocks, both moderate and deep sedation, and general anesthesia,” said Sarah L. Goodman, MBA, CPC-H, CCP, FCS, president/CEO and principal consultant at SLG, Inc., headquartered in Raleigh, NC. Goodman spoke during the February 23 HCPro, Inc., audio conference, “Advanced Hospital-Based Modifier Clinic: Identify Risks and Ensure Accurate Reimbursement.”
 
Thorough documentation is critical for coders who report these modifiers. Documentation must list why and when the physician canceled the procedure, she said. Appending modifier -73 to a code means the reimbursement is 50% of the normal amount, whereas providers receive full reimbursement for a procedure coded with modifier -74. The difference can be significant, so timing and documentation are critical, said Goodman.
 
In addition, coders must know that they cannot report procedures terminated prior to anesthesia and before the patient enters the procedure room.
 
“The patient actually has to be wheeled into the room,” Goodman said. “That’s why it’s key to make sure you have the wheels-in time recorded on the chart.”
 
Many times, documentation lists the procedure start time, but it doesn’t always clearly reflect when the patient was wheeled into the procedure room, she said. But if the procedure is canceled prior to anesthesia and the wheels-in time is undocumented, the coder can’t report the code.  
 
Editor’s note: For more information on what the questions you need to be asking, see the May issue of Medical Records Briefing.



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