Modifier 74 | Discontinued Outpatient Procedures After Anesthesia Administration
Modifier 74 describes a discontinued outpatient hospital or ambulatory surgery center procedure after the administration of anesthesia. In this article, we will explain modifier 74, including its definition, appropriate usage, documentation requirements, billing guidelines, common mistakes, related modifiers, and additional tips for medical coders.
1. What is modifier 74?
Modifier 74 indicates that a provider terminated a surgical or diagnostic procedure after administering anesthesia due to extenuating circumstances threatening the patient’s well-being.
The provider must have prepared the patient for the procedure and taken the patient to the procedure room before terminating the procedure. Anesthesia can include local, regional blocks, and general anesthesia.
The circumstances supporting the termination can include unexpected changes in the patient’s blood pressure, sudden chest pain, or other circumstances that the provider believes put the patient at risk if the procedure continues.
2. When to use modifier 74?
Modifier 74 should only be used for a discontinued procedure after administering anesthesia.
The procedure must have been terminated due to extenuating circumstances that threatened the patient’s well-being.
It is important to note that elective cancellations of a service or procedure before anesthesia administration and/or surgical preparation of the patient should not use modifier 74. Instead, to report a discontinued procedure, refer to modifier 53.
The official description of modifier 74 is “Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia.”
Examples of procedures that may require modifier 74 include a colonoscopy, endoscopy, or other diagnostic procedures that require anesthesia. If the provider terminates the procedure due to extenuating circumstances threatening the patient’s well-being, modifier 74 should be appended to the procedure code.
Documentation requirements for modifier 74 include a clear and concise explanation of the extenuating circumstances that led to the termination of the procedure.
The documentation should also include the time the procedure was terminated, the type of anesthesia administered, and the patient’s response to the anesthesia. The documentation should be included in the patient’s medical record and available for review upon request.
Once anesthesia administration begins, the procedure is classified as a surgical procedure, and many payers reimburse the full amount for the discontinued procedure.
When billing for a discontinued procedure with modifier 74, the provider should bill for the procedure code with modifier 74 appended. The provider should also include the time the procedure was terminated and the reason for the termination in the billing documentation.
7. Common mistakes
One common mistake when using modifier 74 is appending it to a procedure that was not terminated due to extenuating circumstances that threatened the patient’s well-being.
Another common mistake is using modifier 74 for elective cancellations of a service or procedure before anesthesia administration and/or surgical patient preparation.
To avoid these mistakes, it is essential to carefully review the documentation and ensure that the circumstances supporting the termination meet the criteria for using modifier 74.
8. Other modifiers related to modifier 74
Other modifiers related to modifier 74 include modifier 53, used to report a discontinued procedure before anesthesia administration and/or surgical preparation of the patient.
Another similar modifier is modifier 73, which is used to report a discontinued procedure before administering anesthesia.
When using modifier 74, ensure that the documentation supports the use of the modifier. In addition, the documentation should include a clear and concise explanation of the extenuating circumstances that led to the termination of the procedure.
It is also important to review the billing documentation to ensure that the procedure code and modifier are correctly appended, the time the procedure was terminated, and the reason for the termination are included.