Ambulatory Coding & Payment Report
Reader Question: Patient-Cancelled Procedure
Question: A patient who was scheduled for an outpatient endoscopic procedure was in the outpatient surgery suite with sedation administered. But before the patient was taken into the endoscopy room she changed her mind and was discharged. I have read that because the patient did not make it to the room where the procedure was to be carried out, there is no intended procedure code or modifier to report. Would it be appropriate to code this cancelled procedure with modifier -73?
Idaho Subscriber
Idaho Subscriber
Answer: Modifier -73 (discontinued outpatient hospital/ambulatory surgery center [ASC] procedure prior to the administration of anesthesia) attached to a procedure code indicates that the procedure is performed in an outpatient or ambulatory surgery center. It is used prior to anesthesia (which CPT defines as general anesthesia), so even though sedation was given in this case, it still falls into the timing for which this code was developed. But in this case, the patient decided to cancel the procedure.
CPT notes that modifier -73 requires the physician to decide to cancel the procedure "due to extenuating circumstances or those that may threaten the well-being of the patient." You cannot, therefore, code the intended procedure and add modifier -73 in this case. You cannot use modifier -52 (reduced services) because this code also requires "the physician's discretion" in the decision. You could code an E/M based on the documentation provided and add the injections given for the sedation.
- Published on 2001-08-01
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