Health Information Management

Using modifier -74

APCs Weekly Monitor, October 27, 2003

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Friday,
October 10, 2003
Vol. 4, No. 40



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THE MONITOR'S ADVISORY BOARD

Keith Siddel
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
RHIA, CCS, CPCH
president
Health Revenue Assurance Associates

Cheryl D'Amato
RHIT, CCS,
director, health information management
HSS, Inc.

Julie Downey
CPC, CPC-H,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino
RHIT, CPUR,
Independent
Consultant

Jeannie Gourgeot
RT, RHIT,
Director of HIMS
St. Joseph's Medical Center

Julia R. Palmer
MBA, RHIA, CCS,
president, Health Information Management Division
HRM

Valerie Rinkle
MPA
revenue cycle director
Asante Health System

On Himinfo.com

TIP OF THE WEEK

ASK THE EXPERT

Using modifier -74

The question from our reader this week concerns the proper use of modifier -74 when a procedure is cancelled after anesthesia is given. See below for our experts' resolution to this one coder's problem.

    Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

    The Monitor is a complimentary companion publication with a specific mission: to provide answers to your tough questions about the APC regulations.

    If you have a question about APC coding that you would like addressed in the Monitor, post it on our Web site at himinfo.com. Each week, our team of experts answers a question that will appeal to the majority of readers. The elected question and the corresponding answer are delivered to your inbox every Friday.

    TODAY'S TOPIC: Proper use of modifier -74

    QUESTION: A patient came in for declotting of a clotted vascular graft. The patient was anesthetized and the procedure was started. The radiologists stated on the operative report, "unable to access graft, procedure terminated." Would modifier -74 be appropriate in this case?

    ANSWER: Yes, reporting modifier -74 along with the code for the intended procedure is appropriate in this case because the procedure was terminated after administration of anesthesia and after the procedure started, and no procedure was completed. Modifier -74 is used for surgical procedures for which anesthesia (general, regional or local) has been started.

    Report the diagnosis for the procedure that was to be performed. Secondary diagnosis code,V64.1 or V64.3, should also be assigned to reflect that the procedure was terminated.

    Due to extenuating circumstances or circumstances that threaten the well being of a patient, the physician may terminate the procedure after the administration of anesthesia, or after the procedure was started. Under these circumstances the procedure can be coded with the addition of modifier -74.

    PAY PER VIEW: Create a query policy to streamline process

    In the fast-paced atmosphere of health care, when a coder has to stop to ask a physician for more detail, neither the coder nor the physician really wants the interruption. But unless your physician staff is on top of documentation every day, there are occasions when a query is necessary.

    Read more HERE. The cost is $10. Briefings on APCs subscribers have free access via their online subscriptions.

    ASK THE EXPERT: We are having a debate about whether a digital block should be charged separately in addition to a laceration repair. Is there a difference between starred and nonstarred? Some think it is included in the repair while others feel that if the block is more than a local, you charge for it.

    TIP OF THE WEEK: Use caution with the critical care level

    Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.



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