# Modifier 22 - Can some please clarify



## pajohnson (Dec 30, 2013)

Can some please clarify for me if we can append modifier 22 for anesthesia when the patient is sitting, or laterally?  I know that we can use it for the prone position, but I am getting conflicting answers for the other positions.  Please help!!

Thanks for any input


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## Michele Hannon (Dec 30, 2013)

Modifier 22 is generally not appended to anesthesia codes. 
That being said, be familiar with your payer policy. i.e. Medi-Cal requires Modifier 22 for prone positioning and field avoidance.......there are always exceptions.


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## LeslieJ (Jan 2, 2014)

*Modifier 22*

Hello,

There's no cookie cutter way to bill for patient positioning.  Some payers want modifier 22 and some payers want modifier 23.  Still, some payers don't recognize either and won't pay any extra for patient positioning. Ditto field avoidance.

In direct answer to your question:  for those payers who do recognize patient position, it's for when the patient is either is either lying prone (on their stomachs) or when they are in the lateral decubitus (side) position.  Supine, sitting & lithotomy positions aren't factored in the position, except when there's brain surgery & for some CPT codes you'd use the anesthesia code that crosswalks over to the sitting position.

Some payers recognize that if your patient is prone, the automatic base value = 5 for example, if an integumentary procedure normally worth 3 base units is done on the back of the leg & the patient is prone or on his/her side, the procedure is automatically given a base value of 5 by the payer.  This would need to be indicated with either a note in the comments field (Box 19) stating the patient's position or by using modifier 22 or 23.

The only way you're going to know what your payer expects is by checking out their anesthesia policy manual online (if they even have one) and/or by reading your company's contract for those pieces of information that might be carved out, such as P-stats, qualifying circumstances & patient position.

If the payer allows you to use modifier 22 or 23, be prepared to get what looks like a denial from the payer.  It's not a true denial; it's that payment is pending the anesthesia notes so that the payer can know what/how to pay it.  If you know that, then you're way ahead of the game in that you can supply the needed information & get the claim adjudicated quickly.

Hope this helps!

L J


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## pajohnson (Jan 13, 2014)

Thank you for both of your responses.  So it really all depends on the payer.  I guess I should have known that....LOL


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