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Modifier 23 for ASC

  1. Default Modifier 23 for ASC
    Medical Coding Books
    I know I can't use this modifier, but what should I use. Benign scalp excision 11422 with layered closure 12031, done in ASC due to young age. I'm at a loss. Thanks for the help.

  2. #2
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    ENGLEWOOD/DENVER
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    2,338
    Default
    why do you feel you need to use a modifier?
    Mary, CPC, CANPC, COSC

  3. Default
    These codes are not payable in an ASC by Medicaid.

  4. #4
    Location
    ENGLEWOOD/DENVER
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    2,338
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    there are no appropriate modifiers that will bypass Medicaid. I'm afraid that your ASC will end up "eating" this case.
    Mary, CPC, CANPC, COSC

  5. #5
    Default
    I would bill the codes without the modifier and if (or when) the claim denies attempt an appeal/reconsideration with a letter explaining the special circumstances as to why it had to be done in an ASC. Maybe even a letter from the surgeon would help.

    Good luck.

  6. #6
    Location
    Columbia, MO
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    12,836
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    I really doubt that that will work, if they are not ASC approved then it should have been performed in a hosp outpatient OR or physician office. I agree with Mary there is no way to override this. The list of non approved ASC procedures is well published and this would have been set up as an elective procedure so the physician could have been informed that this could not be performed in your facility.

    Debra A. Mitchell, MSPH, CPC-H

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