Anesthesia Coding Alert

What statements like 'airway shared with surgeon' mean for your reimbursement Last month our experts tackled a situation coders aren't always sure how to handle: legitimately increasing a procedure's base units - and your reimbursement - because of field avoidance. But your job as the coder handling these cases doesn't stop with reporting the extra units: You also need to educate your physicians about the importance of great documentation if they want to collect safely for the extra units. Encourage Detailed Documentation The patient's chart must have a notation regarding field avoidance before you can add any extra units for it. Some coders say this can be as basic as two items:
  documentation of the procedure itself, because any cases involving the patient's head, neck or shoulder girdle have a good chance of including field avoidance; or
  notes regarding the patient's position during surgery (such as prone), because this could cause the anesthesiologist to have difficulty accessing the patient's airway if problems arise. However, other coders say you need more details before jumping to conclusions about field avoidance.
 
Example: If the chart states that the surgeon turned the table during surgery, these coders prefer that the anesthesiologist also include information about how the surgeon actually turned the table. They say that notes such as "Table turned to surgeon," "Airway shared with surgeon" or "Head and airway draped out" can be sufficient documentation to merit charging extra units.
 
But some experts, such as Leslie S. Johnson, CCS-P, CPC, an anesthesia coder with Medical Income Concepts Inc., in Houston, look for even more details. She wants to know the distance the surgeon turned the table (such as "Table turned 45 degrees" or "HOB [head of bed] 180 degrees"). "If the degrees aren't stated, I don't bill field avoidance even if the record says, 'Table turned,' " she says.
 
This certainly is a safe standpoint, but other coders aren't sure such details are necessary - partly because other information such as the procedure itself or the patient's position can indicate field avoidance, says Karen Glancy, CCS-P, director of coding with Anesthesia Management Partners in Chicago.
 
"The ASA description regarding field avoidance also states that 'any position other than supine or lithotomy' also qualifies for these extra units," Glancy says. "Documentation of them can be sufficient to support billing for field avoidance."
 
Cases that might qualify for field avoidance because of the patient's position can include:
  shoulder or elbow tendon procedures such as 23330 (Removal of foreign body, shoulder; subcutaneous). This crosses to anesthesia code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified), which is 3 base units. The procedure qualifies for extra units (a [...]