Terminated Ambulatory Surgical Center Procedures


Required Documentation
ASC claims that involve a terminated surgery must be accompanied by an operative report that specifies all of the following:
  • Reason for termination of surgery
  • Description of services actually performed
  • Description of supplies actually provided
  • Services not performed that would have been if surgery had not been terminated
  • Supplies that would have been provided if the surgery had not been terminated
  • Time actually spent in each stage (e.g., pre-op, operative, post-op)
  • Time that would have been spent in each of these stages if the surgery had not been terminated
  • CPT codes for procedures that were scheduled to be performed  
Reimbursement
Surgical procedures scheduled to be performed in an ASC that are terminated are subject to specific reimbursement rules:
  • Procedure terminated before administration of anesthesia, 50 percent of fee schedule
  • Procedure terminated after administration of anesthesia, 100 percent of fee schedule
  • Procedures terminated before the ASC has expended substantial resources will not be covered
  • If intraocular lens (IOL) insertion is terminated, the allowance for the unused IOL will be deducted prior to payment
  • Not otherwise classified (NOC) procedure codes may not be submitted for terminated ASC procedures
Applicable Modifiers
  • CPT modifiers 73 & 74 (for ASC use only)
    • Use CPT modifier 73 for ASC procedures that are discontinued prior to the administration of anesthesia
    • Use CPT modifier 74 for ASC procedures that are discontinued after the administration of anesthesia
  • CPT modifier 53 is for physician use only and may not be submitted by ASCs

References





Last Updated: 05/29/2020