Anesthesia Coding Alert

Question: We are having problems with Medicare when we attach modifier 74 to claims. Our billers are telling us (coders) that Medicare is directing them to leave this modifier off because “they don’t like it,” but I’m not sure what that means. We only use modifier 74 after anesthesia was started but the surgery was cancelled for one reason or another. We are billing for a CRNA and are contracted with the hospital. Should we be doing something different?

Connecticut Subscriber

Answer: Modifier 74 (Discontinued out-patient hospital/ambulatory surgery center [ASC] procedure after administration of anesthesia) is correct for the facility reimbursement, but you are not billing for the facility. Because you are only billing for the provider (in this case, the CRNA), you should append modifier 53 (Discontinued procedure) instead of 74. Also note that modifier 74 is only applicable to procedures in an outpatient setting.

Another point to remember: If the case had been canceled before the CRNA administered anesthesia, you would submit the appropriate E/M code to cover the work of the pre-op evaluation. No modifier is needed when you report a canceled case. You can append a secondary diagnosis code to describe why the case was canceled. Be forewarned that you’ll be paid less for the procedure than usual because of the reduced anesthesia time.