AHA Coding Clinic® for HCPCS - 2018 Quarter 2; Clarifications
Clarification on the use of Modifier 52 versus Modifier 74
The Central Office on HCPCS continues to receive requests for clarification on the use of modifier 52, Reduced Services, versus modifier 74, Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia, for reduced services provided under Medicare OPPS. To assist in providing official guidance for the reporting of reduced services under Medicare OPPS, we are publishing instructions for the appropriate reporting of these modifiers, provided by CMS on December 22, 2016, in Transmittal 3685. This information can be found at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3685CP.pdf. These modifiers provide a way for hospitals to report and be paid for...
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Article Overview
This article summarizes official CMS guidance for hospitals and ambulatory surgical centers on reporting reduced services under Medicare OPPS. It focuses on the use of modifiers in cases where a procedure is partially reduced, discontinued, or terminated after anesthesia-related events, and it notes how CMS guidance relates to CPT reporting instructions. It is intended for coders, billing staff, and compliance professionals who need to understand the general scope of the policy update and its application context.
Why This Topic Matters
Correct modifier reporting affects how discontinued or reduced outpatient services are documented and paid under Medicare OPPS. The article helps coding and billing teams recognize the policy framework and distinguish the two modifiers discussed in the guidance.
What You Will Learn
- The Medicare OPPS context for reporting reduced or discontinued services
- The facility-side circumstances addressed by CMS guidance
- How the article frames the relationship between CMS guidance and CPT reporting instructions
- The types of outpatient settings covered by the guidance
Who Should Read This
- Medical coders
- Hospital outpatient billing staff
- Ambulatory surgical center billing staff
- Compliance professionals
- Revenue cycle teams
Modifiers Discussed
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