Understanding when and how to use CPT modifiers 53, 73 and 74 is critical for accurate physician, ambulatory surgery center, and hospital outpatient coding. This Coding Tip breaks down the key differences between these discontinued procedure modifiers, explains which settings they apply to, and clarifies how anesthesia timing impacts reporting. With clear examples and current CMS and CPT Assistant guidance, this resource helps coding professionals avoid common errors, support compliant billing, and ensure appropriate reimbursement when procedures are discontinued due to circumstances that threaten patient well-being.
CPT modifiers are two-character codes appended to certain CPT Level I and HCPCS Level II codes to provide more information about the circumstances under which the procedure or service was provided. Modifiers indicate the service or procedure was modified in some way without changing the basic definition of the code.
Some modifiers are approved for use with both physician reporting and for ASC or hospital outpatient reporting. However, some modifiers are only approved for use by physicians OR in the facility outpatient setting. This is because some components of a service are applicable to only the physician or only the facility. For example, the costs associated with provision of the operating room are only applicable to the facility.
Modifier 53 is only for use by physicians; it is not on the list of modifiers approved for ASC or hospital outpatient use.
Modifiers 73 and 74 are only found on the list of modifiers approved for ASC or hospital outpatient use. This means it is not appropriate to use these modifiers for physician reporting.
| Modifiers Approved for Use - By Setting | |
| Physician | 53 |
| ASC/Hospital Outpatient | 73, 74 |
Modifier 73 is titled: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia.
Modifier 73 was specifically established to assist facilities in reporting the use of outpatient resources associated with a surgical or diagnostic procedure which is cancelled due to extenuating circumstances or those that threaten the well-being of the patient. Modifier 73 is appropriate for use if the procedure is discontinued after:
Modifier 74 is titled: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia.
Modifier 74 was also established specifically to assist facilities in reporting the use of outpatient resources associated with a surgical or diagnostic procedure which is cancelled due to extenuating circumstances or those that threaten the well-being of the patient. Modifier 74 is appropriate for use if the procedure is discontinued after anesthesia has been administered after the procedure was started (e.g., scope inserted, intubation started, incision made).
For Medicare billing, CMS has indicated, “If the procedure is discontinued after the beneficiary has received anesthesia or after the procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia.” More information from CMS about the use of modifiers 73 and 74 can be found here https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r442cp.pdf
Modifier 53 is titled: Discontinued Procedure
When reporting for their services, physicians also have a need to indicate when a procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient. Since modifiers 73 and 74 are specific to facility reporting, they may not be used in physician billing. Rather, modifier 53 is appended to the code for the discontinued procedure. Modifiers used for billing for physician services do not need to distinguish whether anesthesia had been administered prior to discontinuation of the procedure because the physician reporting the service is not billing for the anesthesia services component of the procedure.
Summary of Modifiers Indicating Discontinuation of Procedure Due to Circumstances Threatening the Well-Being of the Patient
| Discontinuation of Procedure | ASC/Hospital Coding | Physician Coding |
| Pre-Anesthesia | 73 | 53 |
| Post-Anesthesia | 74 | 53 |
Modifiers 53, 73, and 74 are NOT used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite.
Modifiers 53, 73, and 74 are also applicable when a procedure is discontinued for circumstances that threaten the patient’s well-being but are not due to the patient’s condition such as equipment failure. This is supported by the advice in CPT Assistant, October 2024, Volume 34, Issue 10, page 16.
The following scenarios illustrate the use of modifiers 53, 73, and 74.
Scenario
A male patient is brought to the operating room in ABC Hospital for repair of an incarcerated recurrent inguinal hernia to be performed by Dr. Smith. The usual surgical preparation was performed. Prior to the administration of general anesthesia, the patient complains of chest pain and EKG indicates concerning abnormalities. The procedure is cancelled due to possible cardiac issues.
CPT Coding for Dr. Smith
49521-53 Repair of recurrent inguinal hernia, incarcerated or strangulated: Discontinued Procedure.
CPT Coding for ABC Hospital
49521-73 Repair of recurrent inguinal hernia, incarcerated or strangulated: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia.
Scenario
A male patient is brought to the operating room in ABC Hospital for repair of an incarcerated recurrent inguinal hernia to be performed by Dr. Smith. The usual surgical preparation was performed. After the administration of general anesthesia, the patient complains of chest pain and EKG indicates concerning abnormalities. The procedure is cancelled due to possible cardiac issues.
CPT Coding for Dr. Smith
49521-53 Repair of recurrent inguinal hernia, incarcerated or strangulated: Discontinued Procedure.
CPT Coding for ABC Hospital
49521-74 Repair of recurrent inguinal hernia, incarcerated or strangulated: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia.
The following CPT® Assistants provide guidance in the use of modifiers 53, 73, and 74.
CPT Modifiers
CPT Assistant, October 2024, Volume 34, Issue 10, page 16
CPT Modifiers
CPT Assistant, May 2024, Volume 34, Issue 5, page 24
Surgery: Female Genital System
CPT Assistant, January 2023, Volume 33, Issue 1, page 31
Reporting Stomal Endoscopy (44380-44408)
CPT Assistant, November 2014, Volume 24, Issue 11, page 3
Terminated Procedure
CPT Assistant, Special Issue 2005, page 6
Coding Brief: Medicare Coding of Incomplete Screening Colonoscopies
CPT Assistant, October 2003, Volume 10, Issue 13, page 9
Coding Update: Hospital Outpatient Reporting Part IV: Use of the CPT Modifiers '52,' '58,' '59,' '73,' '74,' '76,' '77,' '78,' and '91'
CPT Assistant, September 2003, Volume 09, Issue 13, pages 3-10
For the past 30 years, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.