Anesthesia Coding Alert

Question: A child would not cooperate for an MRI procedure, so the provider asked our anesthesiologist to assist. Can we bill modifier 23 with CPT^® code 01922?

Michigan Subscriber

Answer: The typical code for anesthesia during an MRI is 01922 (Anesthesia for non-invasive imaging or radiation therapy). Because your physician was providing anesthesia but not conducting the MRI, you can report 01922 with modifier 23 (Unusual anesthesia) and a clear explanation of why anesthesia was necessary during the test.

Two other points to keep in mind when reporting 01922-23 for a pediatric patient:

• The patient must be 17 years of age or younger; and
• There must be patient-specific reasons why the procedure could not be performed without anesthesia services. Documentation of these reasons must be kept in the patient’s medical record.

Remember that modifier 23 is an informational modifier that helps explain circumstances to the payer. Including it on the claim does not affect your physician’s reimbursement.

Also note: Coding edits dictate that some MRI codes include the service associated with 01922 and do not allow you to append a modifier to “break” the edit bundle and report both codes. If you ever have a claim for one physician administering the anesthesia and billing for the MRI, you might not be able to code separately for the anesthesia. Check the payer’s guidelines before submitting the claim; including modifier 23 isn’t always necessary for pediatric patients.