Cracking the Code

Anesthesia Modifiers

Modifiers that are related to anesthesia services can be located in Appendix A of our CPT and in Appendix B of HCPCS Level II. The CPT modifiers are two digits and the anesthesia-related HCPCS Level II modifiers are two alpha characters. For today’s Crack the Code we will be reviewing the CPT modifiers found in Appendix A.

  • Modifier 23 (Unusual Anesthesia) This modifier describes a procedure usually not requiring anesthesia (either none or local), but due to unusual circumstances, is performed under general anesthesia. For example, a pediatric patient may require general anesthesia for the surgeon to perform a procedure not requiring anesthesia under usual circumstances.
  • Modifier 47 (Anesthesia by Surgeon) This modifier is appended to CPT surgery codes when the surgeon provides regional or general anesthesia but does not apply to local anesthesia. This modifier is not reported with anesthesia CPT codes and not reported by anesthesia providers.
  • Modifier 53 (Discontinued Procedure) This modifier is reported by the provider to indicate that a procedure was started and, due to extenuating circumstances, was discontinued. Check with the payer. Usually, modifier 53 is used with surgical and diagnostic CPT codes. Many payers do not require modifier 53 for anesthesia CPT codes. Anesthesia reports the anesthesia code and the time for the discontinued procedure after the start of anesthesia. If the payer requires modifier 53, it is reported as the last modifier after the anesthesia modifiers.
  • Modifier 59 (Distinct Procedural Service) This modifier indicates a procedure or service is distinct or independent from other non-E/M procedures. Documentation must support a different session, procedure, surgery, site, organ system, incision/excision, or injury. This modifier is often appended to postoperative pain management services to disassociate them from the anesthesia administered during surgery.
Q: A 36-year-old female patient is having emergency surgery as she has a ruptured appendix. An anesthesiologist was not available to administer general anesthesia. The surgeon administers regional anesthesia with an epidural spinal block and performs the surgery. Which modifier indicates the surgeon administered the anesthesia?
A: Modifier 47. Rationale: Modifier 47 is reported by the surgeon when he also provides regional or general anesthesia for the surgical service. This does not apply to local anesthesia. Modifier 47 would be added to the appendectomy code. Remember, this modifier is not to be reported with anesthesia CPT procedure codes. Anesthesia providers do not report this modifier.
Reference: 2023 CPT
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