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Append modifier -74 to cancelled procedures after anesthesia

APCs Weekly Monitor, August 26, 2005

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Append modifier -74 to cancelled procedures after anesthesia

QUESTION: If a provider decides to cancel an outpatient surgery, what charges can the hospital bill? Example: A patient comes in for the removal of ovaries. A nurse gives her anesthesia and wheels her into the surgery room, and staff have trouble tubing her because her throat opening is too small. As a result, they put her into the recovery room until she comes out of the anesthesia.

Can we bill the recovery room along with the anesthesia, lab work, and pharmacy? Can we not bill the procedure because it was cancelled?

ANSWER: You can code the primary procedure that the provider intended to perform for patients who are "brought into the room in which the surgical procedure is to be performed," and who have had anesthesia administered prior to the decision to cancel the procedure for medically necessary reasons. Append CPT modifier -74 to the code, which will give full payment for that procedure under the hospital OPPS.

If the same scenario occurs prior to the administration of anesthesia, code the procedure as if the provider actually performed it, but append modifier -73. You will receive 50% of the OPPS payment. In addition, when the patient returns to your facility to have the procedure and the provider actually completes the procedure, you should once again code the procedure but don't use modifier -73 or -74, and you will be paid for the completed procedure.

Note: You may still bill recovery room, laboratory, and pharmacy items, as well as other ancillary charges, even though the physician stopped the procedure due to medical reasons.

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