Gastroenterology Coding Alert

Question: Recently at our ASC, our gastroenterologist planned a diagnostic endoscopic procedure for a patient. In the pre-op room, all the pre-admission work was done and the IV line was in. Before the patient could be shifted out of the room for the procedure, the patient's heart rate dropped. The anesthetist attended the patient and administered medications to stabilize the patient. Due to the patient's heart condition, the procedure was cancelled. Can the procedure be claimed using modifier73 as the patient was not sedated and was not shifted to the procedure room?

Wisconsin Subscriber

Answer: Yes, you can use modifier 73 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia) in this scenario, as the procedure was discontinued as extenuating circumstances threatened the wellbeing of the patient if the gastroenterologist had continued with the procedure. This modifier can be used even though the patient had not been shifted over to the procedure room because all other preparations for the procedure had been done in the pre-op room.

In this scenario, you will now have to report the procedure using 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) with modifier 73 and V64.1 (Surgical or other procedure not carried out because of contraindication) to specify that the procedure was cancelled due to extenuating circumstances. The modifier 73 can be used to report ASC services only. The reimbursement for these services will be at fifty percent of the reimbursement that would have been paid out if the procedure was completed successfully.

Note: You cannot report this modifier if the procedure had been cancelled by your gastroenterologist prior to surgical preparation of the patient. Also, you cannot use this modifier if the procedure was cancelled because the patient was not ready to undergo the procedure or if your gastroenterologist just postponed the procedure due to some circumstances and scheduled the procedure for another day. In these case scenarios, you will have to use V64.2 (Surgical or other procedure not carried out because of patient's decision) or V64.3 (Procedure not carried out for other reasons) and not V64.1.