AHA Coding Clinic® for HCPCS - 2007 Issue 1

Use of modifiers 52, 73, and 74 and anesthesia reporting under OPPS

Modifiers 52—Reduced services, 73—Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia, and 74—Discontinued Out- Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia, are used to report procedures or services that are reduced or discontinued at the physician’s discretion. Under the hospital outpatient prospective payment system (OPPS), anesthesia is defined by CMS to include local, regional block(s), moderate sedation/analgesia (conscious sedation), deep sedation/ analgesia, and general anesthesia, when services are furnished in the hospital outpatient setting. Under certain circumstances, procedures and services provided in the hospital outpatient department and...

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