Outpatient Facility Coding Alert

Question: I know you shouldn’t report modifier 73 for elective cancellation of a procedure. How do you handle that situation?

Nevada Subscriber

Answer: You’re correct in saying that modifier 73 (Discontinued outpatient hospital/ambulatory surgery center [ASC] procedure prior to the administration of anesthesia) does not apply when the surgery is canceled because the patient decides (for whatever reason) to not go through with the procedure. Explanatory notes in CPT^® state that modifier 73 applies when the surgeon cancels the procedure prior to anesthesia administration because of extenuating circumstances or because the patient’s wellbeing might be threatened.

Additional guidelines state, "The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported." You can, however, bill for any services that were provided to the patient up until that point, such as lab tests or X-rays.