Reporting Modifier 23? Justify the Use with This 4-Step Plan
Posted on 24. Jan, 2012 by dchandhok in Hot Coding Topics
Your anesthesiologist renders service which is more than the average, so you would append modifier 23 (Unusual anesthesia) to the procedure code. Though this doesn’t affect your reimbursement, payers do have rules regarding modifier 23’s use. These four steps will help you make sure that your claim meets certain criteria and won’t get you a denial.
1. Know the Descriptor
The abbreviated descriptor of modifier 23 in CPT®’s front cover is basic enough: It’s just “Unusual anesthesia.” But if you would read the full description in Appendix A more closely, you’ll get more details that you should consider:
“Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. This circumstance may be reported by adding the modifier -23 to the procedure code of the basic service.”
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What it means: Before you append modifier 23, you must make sure that the claim in question meets the following three criteria:
- Anesthesia used when it’s normally not necessary for that procedure;
- Anesthesia used because of unusual circumstances;
- General anesthesia (instead of monitored anesthesia care, or MAC).
2. Check the Unusual Circumstances
In case the other physician requests anesthesia for the procedure, be sure your provider documents why the patient needed anesthesia. Underlying conditions that help justify anesthesia range from Parkinson’s disease (332.x) and mental retardation (317-319) to claustrophobia (300.29, Other isolated or specific phobias) and cerebral palsy (343.x, Infantile cerebral palsy; or 437.8, Other ill-defined cerebrovascular...
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