Modifier 73, 74, 76

Modifier 73

Prior Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital

Instructions

When a surgical or diagnostic procedure is discontinued, prior to anesthesia administration in outpatient hospital or ASC only, physician may terminate the procedure with 73 facility modifier

Correct Use

• Due to extenuating circumstances or threaten patient well-being
• Prior to procedure started/patient's surgical preparation (including sedation or taken to procedure room)
• Prior to administration of anesthesia (local, regional block or general)
• Under these circumstances, intended service is prepared, but canceled and reported by the usual procedure number

Incorrect Use

Do not report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation

Append 53 modifier for physician reporting of discontinued 

procedure

Claim Coding Example

Treatment Description : Anesthesia for procedures on thoracic spine and cord; not otherwise specified

CPT 00620 /Modifier 73

Reduced Billing by Percentage: Provider performs 60% of service and appends modifier 73

Medicare Physician Fee Schedule (MPFS) allowed

Bill Reduced Amount ($200 x 60%) : $120

*Medicare recognizes that many providers use one standard fee schedule for all insurance carriers. Therefore, reducing the charge amount may differ from the example.

Modifier 74

After Anesthesia Administration - Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital

Instructions

When the surgical procedure is discontinued, after anesthesia administration in outpatient hospital or ASC only, due to extenuating circumstances or threat to patient well-being, the code is appended with a 74 modifier.

Correct Use

• Physician may terminate surgical/diagnostic procedure
• After procedure started (incision made, intubation started, scope inserted)
• After administration of anesthesia (local, regional block or general)
• Under these circumstances, intended service is prepared, but canceled and billed with usual procedure number

Incorrect Use

Do not report elective cancellation of patient service prior to administration of anesthesia and/or surgical preparation

Physician reporting of discontinued procedure, see modifier 53

Example

Treatment Description : Anesthesia for procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified

CPT 00320 /Modifier 74

Reduced Billing: Provider performs 60% of service and appends modifier 74

Medicare Physician Fee Schedule (MPFS) allowed : $200

Bill Reduced Amount ($200 x 60%) : $120

Modifier 76

Repeat procedure or service by same physician or other qualified health care professional

Instructions

Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service.

Correct Use

• Procedure or service is usually performed on the same day
• Append 76 modifier to the repeated procedure or service CPT code only
• When two physicians are within the same group or same specialty = same physician
• Used for surgeries, x-rays and injections

Incorrect Use

• Not appropriate with laboratory or pathology codes(append modifier 91)
• Not appropriate to use with equipment failure
• Should not be appended to an E/M service
• Does not replace modifiers such as RT, LT, 50, E1-E4, FA, F1-F9, TA, and T1-T9

Claim Example – Radiology