Here are some tips to help you get rid of modifier 23 confusions.
First, you need to know where the service took place. You can add modifier 23 to many procedures that take place outside the OR if your physician provides sufficient documentation. Radiologists carry out an ever-growing range of procedures, many of which require anesthesia because of their invasive nature. But then they might also require anesthesia for MRI procedures, which cross to 01922.
Even though technically part of the radiology department, the cath lab staff carries out many involved procedures that could require anesthesia.
Anesthesia during a cast change or removal is an exception more than the rule; however it could be important for small children. You should choose the anesthesia code based on the cast site, such as 01490 or 01680.
Second, you should know which special circumstances existed. Many procedures that qualify for modifier 23 doesn't normally need anesthesia. Documentation of medical necessity will help justify modifier 23. You should keep a watch for circumstances such as this:
Parkinson's disease, mental retardation, claustrophobia and cerebral palsy are all valid diagnoses for anesthesia during MRIs, line removals, or other seemingly simple procedures.
For anesthesia services during non-invasive or invasive radiological procedures and pain management services, children are often considered as special circumstances. Even though the procedure may be relatively painless from an adult perspective, a young child may not be able to remain still or may have been poked and prodded so many times they must be sedated for the procedure.
Third, you should be aware of what payer guidelines apply. Just like in all cases, you need to check your payer guidelines prior to submitting claims with modifier 23 to see to it that you file right. Modifier 23 definition indicates a procedure which normally requires no anesthesia or local anesthesia, however because of unusual circumstances must be done under general anesthesia coding. The physician or CRNA must administer general anesthesia and not monitored anesthesia care (MAC) – for the procedure prior to qualifying for modifier 23.
Remember: It's not enough to know the rules. It does not lead to automatic acceptance. Gear up to appeal any claims with modifier 23 with documentation of medical necessity. What's more include a letter of medical necessity from the patient's primary care physician or surgeon to help boost your position.
First, you need to know where the service took place. You can add modifier 23 to many procedures that take place outside the OR if your physician provides sufficient documentation. Radiologists carry out an ever-growing range of procedures, many of which require anesthesia because of their invasive nature. But then they might also require anesthesia for MRI procedures, which cross to 01922.
Even though technically part of the radiology department, the cath lab staff carries out many involved procedures that could require anesthesia.
Anesthesia during a cast change or removal is an exception more than the rule; however it could be important for small children. You should choose the anesthesia code based on the cast site, such as 01490 or 01680.
Second, you should know which special circumstances existed. Many procedures that qualify for modifier 23 doesn't normally need anesthesia. Documentation of medical necessity will help justify modifier 23. You should keep a watch for circumstances such as this:
Parkinson's disease, mental retardation, claustrophobia and cerebral palsy are all valid diagnoses for anesthesia during MRIs, line removals, or other seemingly simple procedures.
For anesthesia services during non-invasive or invasive radiological procedures and pain management services, children are often considered as special circumstances. Even though the procedure may be relatively painless from an adult perspective, a young child may not be able to remain still or may have been poked and prodded so many times they must be sedated for the procedure.
Third, you should be aware of what payer guidelines apply. Just like in all cases, you need to check your payer guidelines prior to submitting claims with modifier 23 to see to it that you file right. Modifier 23 definition indicates a procedure which normally requires no anesthesia or local anesthesia, however because of unusual circumstances must be done under general anesthesia coding. The physician or CRNA must administer general anesthesia and not monitored anesthesia care (MAC) – for the procedure prior to qualifying for modifier 23.
Remember: It's not enough to know the rules. It does not lead to automatic acceptance. Gear up to appeal any claims with modifier 23 with documentation of medical necessity. What's more include a letter of medical necessity from the patient's primary care physician or surgeon to help boost your position.
