Modifier 23 | Unusual Anesthesia Explained

Modifier 23 can be used for procedures that require general anesthesia due to unusual circumstances, such as a patient with a severe phobia of needles who requires general anesthesia for a blood draw, a patient with a severe allergy to local anesthesia which requires general anesthesia for a dental procedure, and a patient with a severe mental illness who requires general anesthesia for a minor surgical procedure. It is important to ensure that the physician has documented the reason(s) why they administered general anesthesia and that medical documentation supporting the use of unusual anesthesia is included when submitting claims to the payer.

1. What is modifier 23?

Modifier 23, also known as unusual anesthesia, is a modifier used in medical billing and coding to indicate that the provider administered general anesthesia for a procedure that does not normally require it or administered anesthesia due to unusual circumstances.

It is appended to an anesthesia procedure that typically requires local, regional, or no anesthesia.

The physician must document the reason(s) why they administered general anesthesia, and medical documentation supporting the use of unusual anesthesia must be included when submitting claims to the payer.

2. When to use the 23 modifier?

Modifier 23 should be used when the provider administers general anesthesia for a procedure that does not usually require it or administers anesthesia due to unusual circumstances.

Examples of situations that may require unusual anesthesia include a trauma patient who is combative when providers attempt any treatment for injuries, a patient undergoing dental procedures who cannot remain awake due to extreme anxiety, a mentally ill patient who physically abuses providers, and a small child who is anxious and uncooperative.

3. Description

The official definition of modifier 23 is “unusual anesthesia.”

It indicates that the provider administered general anesthesia for a procedure that does not usually require it or administered anesthesia due to unusual circumstances.

4. Examples

Examples of procedures that may require modifier 23 include a patient with a severe phobia of needles who requires general anesthesia for a blood draw, a patient with a severe allergy to local anesthesia which requires general anesthesia for a dental procedure, and a patient with a severe mental illness who requires general anesthesia for a minor surgical procedure.

5. Documentation

To use modifier 23, the physician must document the reason(s) why they administered general anesthesia.

Medical documentation supporting unusual anesthesia must be included when submitting claims to the payer. The documentation should clearly explain the unusual circumstances that required general anesthesia and why local, regional, or no anesthesia was not appropriate.

6. Billing

When billing for a procedure with modifier 23, some payers have guidelines for when to report it.

For example, some payers require modifier 23 to indicate a physician’s presence for induction when used with modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures). Therefore, knowing the payer’s guidelines and including all necessary documentation when submitting claims is essential.

7. Common mistakes

One common mistake when using modifier 23 is failing to include sufficient documentation to support the use of general anesthesia.

It is essential to clearly explain the unusual circumstances that required general anesthesia and why local, regional, or no anesthesia was inappropriate. Another common mistake is failing to follow the payer’s guidelines for reporting modifier 23.

8. Other modifiers related to modifier 23

Other modifiers related to modifier 23 include modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures) and modifier QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals).

Modifier AD indicates that a physician was present for induction when more than four concurrent anesthesia procedures were performed.

Modifier QK indicates that a physician medically directed two, three, or four concurrent anesthesia procedures involving qualified individuals.

9. Tips

When using modifier 23, it is vital to ensure that the physician has documented the reason(s) why they administered general anesthesia and that medical documentation supporting the use of unusual anesthesia is included when submitting claims to the payer.

10. Conclusion

Modifier 23 indicates that the provider administered general anesthesia for a procedure that does not usually require it or administered anesthesia due to unusual circumstances.

It is essential to ensure that the physician has documented the reason(s) why they administered general anesthesia and that medical documentation supporting the use of unusual anesthesia is included when submitting claims to the payer.