Ambulatory Surgical Center Terminated Procedures

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Ambulatory Surgical Center Terminated Procedures

The following guidance determines the appropriate ambulatory surgical center (ASC) facility payment for a scheduled surgical procedure that is terminated due to medical complications, which increase the surgical risk to the patient.

• Payment is denied when an ASC submits a claim for a procedure that is terminated before the patient is taken into the treatment or operating room
• If the surgery is canceled or postponed because the patient on intake complains of a cold or flu
• Payment is made at the rate of 50 percent if a surgical procedure is terminated due to the onset of medical complications after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced or the procedure initiated For example If the patient develops an allergic reaction to a drug administered by the ASC prior to surgery. Modifier 73 should be utilized to indicate that the procedure was terminated prior to the induction of anesthesia or the initiation of a procedure.
• Full payment for the surgical procedure is made if a medical complication arises that causes the procedure to be terminated after anesthesia has been induced or the procedure initiated. Modifier 74 should be used to indicate that the procedure was terminated after the administration of anesthesia or initiation of the procedure.