Where did the service take place: You can add modifier 23 to many procedures that take place outside the OR if your doctor provides sufficient documentation.
Radiology coding: Radiologists carry out an ever-growing range of procedures, many of which require anesthesia because of their invasive nature. But then they might also need anesthesia for MRI procedures, which cross to 01922.
Cath lab: Even though technically part of the radiology department, the cath lab staff performs many involved procedures that could require anesthesia.
Which special circumstances existed: Many procedures that qualify for modifier 23 do not require anesthesia normally. Documentation of medical necessity – by the anesthesia provider and requesting doctor will help justify modifier 23.
What payer guidelines apply here: Take a look at your payer guidelines prior to submitting claims with modifier 23 to ensure you file right. 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. The physician or CRNA must administer general anesthesia – not monitored anesthesia care (MAC) – for the procedure prior to qualifying for modifier 23.
However remember that knowing the rules does not lead to automatic acceptance. Be ready 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.
