AHA Coding Clinic® for HCPCS - 2005 Quarter 4
CMS modifies payment policies for interrupted procedures
Since the implementation of the Outpatient Prospective Payment System (OPPS) in 2000, modifiers -52, -73, and -74, have been reported by hospitals to indicate procedures that were terminated before their completion. These modifiers serve the purpose of identifying a reduction or discontinuation of a procedure or service. In the November 10, 2005 final rule, the Centers for Medicare & Medicaid Services (CMS) issued changes to the payment policies for modifiers -52, -73, and -74. CMS stated that the current OPPS policy requires providers to use modifier -52 to indicate that a service not requiring anesthesia was partially reduced or...
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Article Overview
This article covers CMS policy changes affecting outpatient hospital payment for interrupted procedures under the OPPS. It discusses the agency’s review of hospital claims data, related guidance on reporting interrupted or discontinued procedures, and the broader payment-policy context for hospitals and coders working with outpatient claims.
Why This Topic Matters
Hospitals and coding professionals need to understand how CMS updates payment policy and reporting expectations for interrupted procedures so claims can be coded consistently and payment can be assigned appropriately.
Article Sections
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OPPS background and interrupted-procedure modifiers
Introduces the outpatient payment context and the modifiers used to identify procedures that were not completed as planned.
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CMS final rule and payment policy changes
Summarizes CMS’s announced changes to outpatient payment policy based on analysis of hospital claims data.
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Usage patterns and reporting clarification
Describes CMS observations about modifier use across hospital claims and references prior clarification guidance.
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Current policy for other interrupted procedures
Outlines the status of payment policy for other interrupted-procedure reporting and CMS’s stated focus on ongoing review and guidance.
What You Will Learn
- The outpatient payment context for interrupted-procedure reporting
- How CMS policy changes can affect hospital payment treatment
- The role of claims data in policy review
- The importance of consistent reporting guidance for hospitals
Who Should Read This
- Hospital coders
- Outpatient billing staff
- Revenue cycle professionals
- Compliance teams
- Physician coding and reimbursement staff
Codes Discussed
Modifiers Discussed
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