Ambulatory Surgical Center Terminated Procedures
The following guidance outlines how payment is determined for ambulatory surgical center (ASC) procedures terminated due to medical complications that increase patient risk.
- Payment is denied when a procedure is terminated before the patient is taken into the treatment or operating room.
- Example: If the surgery is cancelled or postponed because the patient on intake complains of a cold or flu.
- Payment is made at 50% of the applicable ASC rate when a procedure is terminated due to medical complications after the patient has been prepared for surgery and taken to the operating room, but before anesthesia is administered or the procedure begins.
- Example: If the patient develops an allergic reaction to a drug administered by the ASC prior to surgery
Modifiers
- Modifier 73 is used to indicate the procedure was terminated prior to induction of anesthesia or initiation of a procedure.
- Full payment of the surgical procedure is made if a medical complication arises which causes the procedure to be terminated after anesthesia has been induced or the procedure initiated.
- Modifier 74 is used to indicate a procedure was terminated after administration of anesthesia or initiation of the procedure.
Documentation
When billing for a terminated procedure, the ASC must maintain an operative report on file and provide it upon request. The report must clearly document:
- Reason for termination of surgery
- Confirmation services were performed
- Supplies provided
- Planned services not performed due to termination
- Planned supplies not provided due to termination
- Time spent in each stage:
- Pre-operative
- Intra-operative
- Post-operative
- Expected time in each stage if the procedure had not been terminated:
- Pre-operative
- Intra-operative
- Post-operative
- HCPCS code for the procedure if the surgery had been completed
Reference