How to bill Incomplete Surgical procedure in ASC setup and how much payment would get

 Incomplete Surgical Procedures'.

When ASCs bill Texas Medicaid for an incomplete surgical procedure, one of the following must be included on the claim:

• Modifier 73 for a discontinued outpatient procedure after anesthesia administration or 74 for a discontinued outpatient procedure prior to anesthesia administration.

• At least one of the following diagnosis code(s):eV641, V642, or V643.

Claims billed with diagnosis codes V641, V642, V643 or modifier 73 or 74 suspend for review of the medical documentation submitted with the claim. Providers must submit the operative report, the anesthesia report, and state why the operation was not completed. Reimbursement to ASC facilities for canceled or incomplete surgeries because of patient complications, is made according to the following criteria, based on the extent to which the anesthesia or surgery proceeded:

• Reimburse at 0 percent of ASC group payment schedule for a procedure that is terminated for nonmedical or medical reasons before the facility has expended substantial resources

• Reimburse at 33 percent of ASC group payment schedule up to the administration of anesthesia

• Reimburse at 67 percent of ASC group payment schedule after the administration of anesthesia but before incision

• Reimburse at 100 percent of ASC group payment schedule after incision Surgeries canceled because of incomplete preoperative procedures are not reimbursed.


Drugs and Supplies

Benefits do not include drugs and biologicals taken home by the client. Take-home drugs and supplies are a benefit for patients when prescribed through the Vendor Drug Program (VDP).