Ambulatory Surgical Center Terminated Procedures

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Ambulatory Surgical Center Terminated Procedures

• The following guidance determines the
  appropriate ambulatory surgical center (ASC)
  facility payment for a scheduled surgical
  procedure that is terminated due to medical
  complications, which increase the surgical risk
  to the patient.
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• Payment is denied when an ASC submits a claim for
  a procedure that is terminated before the patient
  is taken into the treatment or operating room
• If the surgery is canceled or postponed because
  the patient on intake complains of a cold or flu
• Payment is made at the rate of 50 percent if a
  surgical procedure is terminated due to the onset
  of medical complications after the patient has
  been prepared for surgery and taken to the
  operating room but before anesthesia has been
  induced or the procedure initiated For an
  example, If the patient develops an allergic
  reaction to a drug administered by the ASC prior
  to surgery. Modifier 73 should be utilized to
  indicate that the procedure was terminated prior
  to induction of anesthesia or initiation of a
  procedure.
• Full payment of the surgical procedure is made if
  a medical complication arises which causes the
  procedure to be terminated after anesthesia has
  been induced or the procedure initiated. Modifier
  74 should be used to indicate that the procedure
  was terminated after administration of anesthesia
  or initiation of the procedure.

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Ambulatory Surgical Center Terminated Procedures

An ASC claim for payment for terminated surgery
must include an operative report kept on file by
the ASC and made available if requested. The
operative report should specify the following
Reason for termination of surgery Services that
were actually performed Supplies that were
actually provided Services not performed that
would have been performed if surgery had not been
terminated Supplies not provided that would have
been provided if the surgery had not been
terminated The time actually spent in each stage
(pre-operative/ operative/ post-operative) Time
that would have been spent in each of these
stages if the surgery had not been terminated
Healthcare Common Procedure Coding System code
for the procedure had the surgery been
performed. More about Modifier 73 As mentioned
above modifier -73 is used by the facility to
indicate that a procedure requiring anesthesia
was terminated due to extenuating circumstances
or to circumstances that threatened the well
being of the patient after the patient had been
prepared for the procedure (including procedural
pre-medication when provided), and been taken to
the room where the procedure was to be performed,
but prior to administration of anesthesia. For
purposes of billing for services furnished in the
hospital outpatient department, anesthesia is
defined to include local, regional block(s),
moderate sedation/analgesia (conscious
sedation), deep sedation/analgesia, or general
anesthesia. This modifier code was created so
that the costs incurred by the hospital to
prepare the patient for the procedure and the
resources expended in the procedure room and
recovery room (if needed) could be recognized for
payment even though the procedure was
discontinued.
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Ambulatory Surgical Center Terminated Procedures

When it comes to ASC medical billing, MedicalBille
rsandCoders (MBC) is one of the best service
providers. With our 15 years of experience in
the medical billing domain and with our proven
ASC medical billing services, many surgical
centers across the country have overcome denials
and underpayments. Our billing professionals not
only specialize in ASC coding and billing but
also incorporate the knowledge throughout the
process for offering end-to-end solutions. To
know more about our ASC medical Billing services
you can contact us at 888-357-3226/ info_at_medicalbi
llersandcoders.com   Reference Medicare Claims
Processing Manual