Modifier 47 Description, Billing and Reimbursement
Modifier 47 is used to record whether the attending or assistant surgeon gave regional or general anesthesia. Modifier 47 should be added to the basic service. That does not involve any local anesthetic. Now use the 47 modifiers for CPT codes 10021 through 69990. It should be reported in the second modifier slot.

Description of Modifier 47

Anesthesia by Surgeon can be charged using the 47 modifiers. Report modification 47 to the basic service, but leave out the local anesthesia. The CPT manual defines the modifier as “general or regional or anesthesia delivered by the surgeon.”

Billing Procedures

  • The anesthesiologist use modifier 47.
  • If the anesthetic services are rendered by the same doctor, adding modifier 47 to CPT 00100 – CPT 01999 is not permitted. Anesthesia services bundled cannot be recorded in conjunction with a medical/surgical procedure.
  • Modifier 47 should not be used for local anesthesia.
  • When the Surgeon administers moderate sedation, report modifier 47 along with the surgical operation code. CPT codes 99143 through 99145 can be found here.
  • If the Surgeon is overseeing general anesthesia administered by an anesthesiologist, CRNA, resident, or intern, do not use this modifier.
  • Do not report CPT 96260 – CPT 96376 for anesthetic agent delivery during the procedure.
  • The physician can record a subarachnoid/epidural infusion.

If it is medically appropriate and essential for the anesthesia practitioner to execute the surgical procedure, provider two may bill for a particular anesthesia service. When anesthesia services are not individually reported, institutions and physicians should not remove components of anesthesia and submit them instead of an anesthetic code. Separate payment for anesthetic services is not permitted if provided by the same doctor who performed the surgical or medical treatment.

Inappropriate use

  • This modifier should be added to CPT codes 00100 through 01999 Anesthesia Codes.
  • This modifier is used for local anesthesia.
  • if the Surgeon is supervising general anesthesia administered by an anesthesiologist, Certified Registered Nurse Anesthetist (CRNA), resident, or intern, do not use this modification.
  • When the Surgeon gives local or general anesthesia, do not add modifier 47 to the CPT code. Medicare does not pay for this procedure.
  • When the Surgeon administers mild sedation, do not include modifier 47 with the medical procedure code.

Reimbursement for 47 Modifiers

If the same physician performs anesthesia and surgery, the anesthesia is considered part of the surgery. There is no distinct or extra benefit for anesthesia. Modifier 47 is strictly for informative purposes and has no bearing on reimbursement. A surgeon who is paid under a worldwide payment policy must provide postoperative pain management services and cannot be reimbursed for them.

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