Now’s the Time to Refresh Your “Reduced Services” Coding

Modifier 52 becomes legitimate for POS 24 in 2008
Until now, facilities billing services under the OPPS payment system and ASCs have followed different guidelines when reporting interrupted or incomplete procedures. The new year will bring a significant change, however, and now’s the time to ready yourself.

Apply 52 for Procedures Not Requiring Anesthesia

Beginning Jan. 1, 2008, you will be able to report modifier 52 (Reduced services) for a "partially reduced or discontinued" procedure in the ASC setting, but only if the planned procedure or service does not require anesthesia, according to CMS’s "Revised Payment System Policies for Services Furnished in Ambulatory Surgical Centers (ASCs) Beginning in CY 2008" (ASC 2008 Final Rule). The change makes ASC coding instructions consistent with OPPS (outpatient prospective payment system) guidelines currently in use for hospital outpatient facilities.
CMS explains this change in policy by noting, "with the significant expansion of procedures eligible for ASC payment under the revised ASC payment system, it is possible that some of the additional procedures payable in the ASC setting beginning in CY 2008 may not always require anesthesia." Therefore, CMS concludes, "we believe that the revised ASC payment system should also allow ASCs to report interrupted services not requiring anesthesia with modifier 52."
When you report a covered surgical procedure or covered ancillary service (such as ancillary radiology services that are integral to performing covered surgical procedures) with modifier 52, CMS will reduce payment by half. The reduced payment reflects an assumption that -- because the service or procedure was reduced or discontinued -- the facility will not have incurred the usual, full costs.
As an example, you might report modifier 52 for a discontinued procedure if a patient is scheduled to undergo an upper gastrointestinal radiological exam, but could not tolerate the barium. In this case, you would report 74240 (Radiologic examination, gastrointestinal tract, upper; with our without delayed films, without KUB) with modifier 52. Note that under the 2008 Final Rule, 74240 is approved for payment in an ASC as "an ancillary service integral to covered surgical procedures" (see "ASCs Can Look Forward to Reporting Integral Services" on page 4, for more information).
Stick With 73 and 74 for Anesthesia Procedures

If the physician discontinues a procedure that requires anesthesia (either before or after the patient has received the anesthesia), you’ll continue to report either modifier 73 (Discontinued outpatient hospital/ambulatory surgery center [ASC] procedure prior to the administration of anesthesia) or 74 (Discontinued outpatient hospital/ambulatory surgery center [ASC] procedure after administration of anesthesia), as appropriate, notes Joyce L. Jones, CPC, CPC-H, CCS-P, CNT, director of business operations at [...]

- Published on 2007-11-27