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Modifier 23

  1. #1
    Default Modifier 23
    Medical Coding Books
    I am currently reading the anesthesia RVG. They are mentioned the use of modifier 23. Can anyone give me an or a few examples of how it is used on procedure. I ask this question is because I never use it. But would like to know and how to use it correctly. Thanks

  2. #2
    Location
    Charleston, WV
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    Modifier 23 is used when anesthesia is required for a service that usually does not require anesthesia. An example might be a child who needs a BAEP (CPT 92585) but for whatever reason needs to be sedated. You would add -23 to your primary procedure code. In all my years of anesthesia coding, I probably used this less than 5 times.

  3. #3
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    So can I assume that any procedure with the assignment of ASA code we usually does not assign modifier 23? However, if ASA code is not assigned to a procedure and patient has under go type of anesthesia, we will assign the modifier 23? So we need to use an unlisted code 01999 with modifier 23. Am I correct? Please enlighten me here.

  4. #4
    Location
    Charleston, WV
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    That has been my experience. Some other coders have told me they use it with codes like 00740 or 00810 when the procedure was an endoscopy which, according to CPT includes moderate sedation because some payers have stopped allowing anesthesia for these. I personally have not done this. I don't know that it's wrong but I'm not comfortable with it.

  5. #5
    Default
    I don't think they should do it that way as 00740 or 00810 included moderate sedation because these type of procedure usually under MAC. However, if the type of anesthesia is General, it fits into the description of modifier 23 - " 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 basic service."

    Am I in the correct chain of thought?

  6. #6
    Location
    Charleston, WV
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    As I understand it, yes.

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