Health Information Management

Differentiating between modifiers -52, -73, -74

JustCoding News: Outpatient, August 22, 2012

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Q. When is it appropriate to append modifier -74 (procedures discontinued after anesthesia administration or after the procedure has begun) or -73 (procedures discontinued prior to anesthesia) instead of to modifier -52 (reduced service)? Is there more than anesthesia that determines their use? The report below was coded with CPT® 62311 (injection[s] of diagnostic or therapeutic substance[s]…; lumbar or sacral [caudal]). I asked the coder if modifier -74 should be appended, and the coder said that -52 should be appended. Is this correct?

Procedure: Attempted lumbar midline interlaminar epidural steroid injection L5-S1 with fluoroscopy

After identifying the L5-S1 interlaminar space fluoroscopically, the skin was sterilely prepped and draped. The skin and subcutaneous tissue were anesthetized with 1% lidocaine. Utilizing a loss of resistance technique and intermittent fluoroscopic guidance, an 18 gauge Tuohy needle was ­utilized to ­approach the epidural space. I was not able to ­successfully identify the epidural space secondary to ­encountered resistance. The needle depth was checked on lateral views and noted to be ­superficial to the epidural space when resistance was encountered. We were ­going to utilize a ­caudal approach, however skin breakdown was ­noted. At this point, I elected to have her return for care in 2 weeks and get the skin breakdown in the ­caudal area treated.


A. As per the documentation submitted here, the ­injection was not completed due to “encountered resistance.”

Modifier -52 reports that a “…procedure is partially reduced or eliminated at the physician’s discretion.”

Modifiers -73 and -74 are used when a procedure is stopped before (modifier -73) or after (modifier -74) ­anesthesia “due to extenuating circumstances or those that threaten the well being of the patient.” There is nothing in these notes that state the patient’s well-being was threatened. In this case, modifier -52 would be appropriate, not -74.
 
Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, Fla., answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, Wis. Email her at ssafian@embarqmail.com.
 
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
 
Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.



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