How to Bill Terminated procedures - How much insurance would pay

Terminated Procedures

A bill submitted for reimbursement of a terminated surgery must include documentation that specifies the following:

1. Reason for termination of surgery;

2. Services, reported by CPT®

3. Supplies actually provided; and code, that were actually performed;

4. CPT® code(s) for the procedure(s) had the scheduled surgery been performed.

Modifier 73 or 74 must be added to the procedure codes actually performed to identify the circumstances under which the services were terminated as described below.

Reimbursement for Terminated Procedures

Terminated Procedures shall be reimbursed as follows:

1. No reimbursement shall be made for a procedure that is terminated either for medical or non-medical reasons before the pre-operative procedures are initiated by staff.

2. Reimbursement shall be fifty percent (50%) of the amount allowed for the procedure(s) if a procedure is terminated due to the onset of medical complications after the patient has been taken to the operating suite, but before anesthesia has been induced. Bill using modifier 73.

3. Reimbursement shall be one hundred percent (100%) of the amount allowed for the procedure(s) if a procedure is terminated due to a medical complication that arises causing the procedure to be terminated after induction of anesthesia. Bill using modifier 74.

4. Multiple surgery pricing reduction rules do not apply to terminated surgeries.