AHA Coding Clinic® for HCPCS - 2007 Quarter 1
Use of modifiers 52, 73, and 74 and anesthesia reporting under OPPS
A patient is taken to a minor procedure room for a planned hemorrhoid banding with anesthesia, and after examination of hemorrhoids and “pinch test” by the physician, the procedure was not performed at the physician’s discretion. The dictated operative report states under the operation performed “Rectal examination under anesthesia;” however, according to nursing monitoring documentation, no anesthesia of any type was administered. Since no anesthesia was administered, would the planned procedure be coded with modifier 52, or would it be inappropriate to assign a procedure code in this situation? ...
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Article Overview
This article covers facility-level reporting guidance for reduced, discontinued, and cancelled outpatient procedures in the context of OPPS and anesthesia reporting. It is aimed at coders, billers, and outpatient facility staff who need to understand when these situations arise and what general documentation and reporting issues are involved. The discussion includes anesthesia-related definitions, planned-multiple-procedure situations, and narrative examples that illustrate the topic.
Why This Topic Matters
Outpatient facilities often need to report procedures that are not completed as planned, and the reporting approach depends on whether anesthesia was administered and whether the procedure was started. Understanding the article helps coding and billing staff recognize the relevant facility reporting concepts and documentation considerations.
Article Sections
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Overview of reduced and discontinued outpatient procedures
Introduces the general topic of reduced or discontinued services in hospital outpatient and ASC settings. It frames the article around facility reporting under OPPS and related documentation concerns.
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Anesthesia reporting under OPPS
Describes the broad anesthesia concepts referenced in the article for the outpatient setting. It explains the general context in which outpatient anesthesia reporting is discussed.
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Discontinued procedure scenarios and modifier use
Covers facility reporting situations in which planned procedures are discontinued or cancelled. It addresses multiple procedural scenarios and the documentation issues associated with those situations.
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Example of an aborted planned procedure
Provides a practical example involving a planned outpatient procedure that was not completed as intended. The example illustrates how the article applies the broader reporting discussion in a specific scenario.
What You Will Learn
- How outpatient facility reporting addresses reduced or discontinued procedures
- How anesthesia status factors into OPPS reporting discussions
- How multiple planned procedure scenarios are handled at a high level
- What types of documentation are relevant when procedures are stopped or cancelled
- How narrative examples are used to illustrate outpatient reporting concepts
Who Should Read This
- Medical coders
- Outpatient facility billing staff
- ASC coding staff
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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