Thursday, July 7, 2016

When to use Modifier 59, 73, 74 IN Anesthesia billng?

59 Distinct Procedural Service — Services with modifier 59 may be subject to review of medical records. Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Modifier 25 should be used only if a more descriptive modifier is not available, and the use of modifier 59 best explains the circumstances. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.

73 Discontinued Outpatient Hospital/ASC procedure prior to the administration of anesthesia — Due to extenuating circumstances or those that threaten the wellbeing of
the patient, the physician may cancel a surgical or diagnostic procedure subsequent to  the patient’s surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia [local, regional block(s) or general]. Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure code and the addition of modifier 73. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.


74 Discontinued Outpatient Hospital/ASC procedure after the administration of anesthesia — Due to extenuating circumstances or those that threaten the wellbeing of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia [local, regional block(s), general] or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure code and the addition of modifier 74. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.

No comments:

Post a Comment

Popular Posts