Modifiers 73 and 74

20.6.4 - Modifiers 73 and 74 (Rev. 11937; Issued: 03-31-23; Effective: 04-01-23; Implementation: 04-03-23) 73: Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia 74: Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia A. General Modifiers 73 and 74 provide a way for hospitals to report and be paid for expenses incurred in preparing a patient for a procedure and scheduling a room for performing the procedure where the service is subsequently discontinued. This instruction applies to both hospital outpatient departments (HOPDs) and to ambulatory surgical centers (ASCs). Modifier 73 is used by the facility to indicate that a procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well- being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when provided), and been taken to the room where the procedure was to be performed, but prior to administration of anesthesia. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, or general anesthesia. This modifier code was created so that the costs incurred by the hospital to prepare the patient for the procedure and the resources expended in the procedure room and recovery room (if needed) could be recognized for payment even though the procedure was discontinued. Modifier 74 is used by the facility to indicate that a procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened the well-being of the patient. This modifier may also be used to indicate that a planned surgical or diagnostic procedure was discontinued, partially reduced or cancelled at the physician's discretion after the administration of anesthesia. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia. This modifier code was created so that the costs incurred by the hospital to initiate the procedure (preparation of the patient, procedure room, recovery room) could be recognized for payment even though the procedure was discontinued prior to completion. Coinciding with the addition of the modifiers 73 and 74, modifiers 52 and 53 were revised. Modifier 52 is used to indicate partial reduction, cancellation, or discontinuation of services for which anesthesia is not planned. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service. Modifier 53 is used to indicate discontinuation of physician services and is not approved for use for outpatient hospital services. Note that the elective cancellation of a procedure should not be reported. Modifiers 73 and 74 are only used to indicate discontinued procedures for which anesthesia is planned or provided. B. Effect on Payment Procedures that are discontinued after the patient has been prepared for the procedure and taken to the procedure room but before anesthesia is provided will be paid at 50 percent of the full OPPS payment amount. Modifier 73 is used for these procedures. As of January 1, 2016, for device-intensive procedures that append modifier 73, we will reduce the APC payment amount for the discontinued device-intensive procedure by 100 percent of the device offset amount prior to applying the additional payment adjustments that apply when the procedure is discontinued as modified in the CY 2016 OPPS/ASC final rule that was published in the November 13, 2015 “Federal Register” (80 FR 70424- 70426). Beginning January 1, 2017, device-intensive procedures are defined as those procedures requiring the insertion of an implantable device that also have a HCPCS-level device offset greater than 40 percent. From January 1, 2016, through December 31, 2016, device-intensive procedures were defined as those procedures that involve implantable devices that are assigned to a device-intensive APC (defined as those APCs with a device offset greater than 40 percent). Beginning January 1, 2019, device-intensive procedures are defined as procedures that involve the surgical implantation or insertion of an implantable device that is assigned a CPT or HCPCS code (including single-use devices) and has a device offset amount that exceeds 30 percent of the procedure’s mean cost. Procedures that are discontinued, partially reduced, or cancelled after the procedure has been initiated and/or the patient has received anesthesia will be paid at the full OPPS payment amount. Modifier 74 is used for these procedures. Procedures for which anesthesia is not planned that are discontinued, partially reduced, or cancelled after the patient is prepared and taken to the room where the procedure is to be performed will be paid at 50 percent of the full OPPS payment amount. Modifier 52 is used for these procedures.