Anesthesia Coding and Ways to Wield Modifier 23

It's very important that you know the proper use of modifier 23 while coding for your anesthesia practice. Here are three things you should ask yourself prior to deciding when to append 23.


First, you need to enquire where did the service take place? You can add modifier 23 to many procedures that take place outside the OR if your physician provides enough documentation.


Radiologists carry out an ever-growing range of procedures. Many of these require anesthesia owing to their invasive nature. But then, they might also need anesthesia for MRI procedures, which cross to 01922. As far as the cath lab is concerned, even though technically it's part of the radiology department, the cath lab staff carries out many procedures that could need anesthesia.


As far as emergency department is concerned, anesthesia during a cast change or removal is an exception more than the rule. However it could be necessary for small children. You should opt for the anesthesia code based on the cast site such as 01490 or 01680.


Second, you should find out which special circumstances existed? Many procedures that normally qualify for modifier 23 does not require anesthesia. Documentation of medical necessity by the anesthesia provider and requesting physician will help justify modifier 23. You should watch for circumstances such as underlying conditions and patient age.


You should also ask what payer guidelines apply? Just like in all instances, you should check your payer guidelines prior to submitting claims with modifier 23 to make certain you file the proper way.


Modifier 23 indicates a procedure which normally requires no anesthesia or local anesthesia; however because of unusual circumstances must be carried out under general anesthesia. Remember that the CRNA or physician must administer general anesthesia for the procedure prior to qualifying for modifier 23.


This instance will help your understanding: During a procedure, Aetna requests modifier 23 for "unusual positioning. You need to check your local payer's policy to ensure you meet the latest requirements. You should check with the payer prior to submitting the claim to find out about their guidelines.


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