Are you an ambulatory surgical center (ASC) or outpatient hospital struggling with the facility billing requirements and proper modifier application? We have got you covered with this guide!
Do not let unexpected procedure cancellations take a toll on your healthcare facility’s revenue cycle. Understand how modifier 73 can help you get paid for the initial patient preparation and preoperative medication administration.
From clinical scenarios to accurate usage guidelines, we will discuss everything. So, continue reading!
What is Modifier 73?
Modifier 73 indicates a discontinued outpatient hospital or ASC procedure before the administration of anesthesia. The termination of the procedure must be due to extenuating circumstances, such as the patient’s condition or equipment failure.
Appropriate Use Cases for Modifier 73
Let’s review a few real-world clinical scenarios where this modifier applies:
Unstable Cardiac Rhythm
Picture a patient who has been brought to the operating room, scrubbed, and hooked up to the monitor for a scheduled insertion of a permanent pacemaker. Besides, preoperative antibiotics have also been administered.
However, the patient develops uncontrolled atrial fibrillation just as the nurse was about to call the anesthesiologist. As a result, the procedure was cancelled because the patient required immediate advanced cardiac life support protocol (such as synchronized cardioversion) and transfer to the ICU for monitoring.
Here, you should report the procedural code with modifier 73.
Essential Supply Contamination
Imagine a patient who was scheduled for an arthroscopic anterior cruciate ligament (ACL) reconstruction. He is in the operating room, ready for the surgery. However, during the final count and review of the supplies, the staff identified that the specialized tissue graft had expired. Besides, no replacement is available.
Thus, the procedure is cancelled due to a lack of essential, safe equipment before anesthesia administration. So, modifier 73 applies here.
Accurate Usage Guidelines for Modifier 73
The following are the appropriate modifier usage guidelines to ensure coding specificity and accurate payment:
Understand When You Should Use Modifier 73
Discussed below is the eligibility criteria checklist for the appropriate application of 73:
Who Can Report this Modifier?
Physicians cannot report this modifier; only facilities can. You can only use it for hospital outpatient or ASC procedures.
The Location Matters
Was the patient shifted to the operating room for the performance of the procedure? If yes, you are on the right path to consider applying modifier 73 to the claim.
Were the Procedure’s Prerequisites Completed?
You should have prepared the patient physically for the procedure. This includes positional adjustments, procedural preoperative medications, etc.
A Valid Termination Reason is a Must
The termination of the procedure must be due to unexpected, non-routine events outside the provider’s or patient’s immediate control. For example, a severe spike in the patient’s blood pressure, etc.
Timing is Key
The cancellation of the procedure must occur prior to the administration of local, regional, or general anesthesia.
Know When You Should NOT Append Modifier 73
Avoid using this modifier if any of the following is true:
- You are billing for the operating physician’s services.
- It was an elective cancellation. That is, the surgeon decided to reschedule due to administrative reasons, the patient decided they do not want the service anymore, etc.
- The procedure was terminated due to a minor illness/complaint. For instance, the physician cancels the procedure because the patient complained about a flu or a cold.
- Anesthesia administration was performed (even if it was just local sedation).
Fulfill Documentation Requirements
A detailed operative report by the facility is what you need to submit with the medical claim to ensure timely reimbursement. Below are the details you must include to support the use of modifier 73:
- Explain the reason why the procedure was terminated.
- Describe the services rendered before termination, e.g., patient prep, positioning, draping, etc.
- List the provided supplies, e.g., IV fluids administered, sterile procedural kit opened, etc.
- State details related to all the primary services that were left unperformed due to the termination.
- Mention the time spent at each stage, e.g., pre-op, operative room time, and post-op.
Final Thoughts on Modifier 73
With modifier 73, you indicate that the scheduled procedure was terminated before anesthesia administration. However, patient preparation and preoperative medication were completed.
But why is it so important to notify the payer? It is a pricing modifier that will help you get reimbursed at 50% of the applicable rate for the facility.
In case you do not append it and bill for the service directly, it will result in a denial due to a lack of supporting documentation and may also trigger audit risks.
Yes, we understand that ensuring the proper application of modifiers is not simple. Thus, if you want professional help, feel free to outsource medical billing and coding services to NeuraBill.
