Anesthesia Coding Alert

Carriers might allow extra units that boost bottom lines

A chart crosses your desk that includes field avoidance" in the case notes. You code the procedure and move on, but did you miss out on potential reimbursement by not paying attention to the field avoidance? Many coders say yes, depending on the procedure and the physician's documentation. Understand What's Happening  Before a coder knows that a notation about field avoidance might merit extra units, she must know what the term "field avoidance" actually means.

"Basically, field avoidance is when the anesthesiologist does not have direct access to the patient's face (or airway)," says Karen Glancy, CCS-P, director of coding with Anesthesia Management Partners in Chicago. "That makes it a higher-risk case, so the anesthesiologist gets to charge a little more."

The surgeon's preference and the procedure being performed dictate whether field avoidance comes into play. Possibility 1: Procedure Dictates Field Avoidance Certain procedures are virtually always done the same way, so the anesthesiologist or CRNA knows beforehand that the case will probably involve field avoidance. Cases falling into this category involve the surgeon and anesthesiologist sharing the patient's airway, including:
  intracranial surgery
  oral surgery
  some dental surgery. As Glancy notes, procedures involving the patient's head, neck or shoulder girdle are good candidates for field avoidance.
 
But don't automatically assume that field avoidance comes into play anytime you code a particular procedure, says Leslie S. Johnson, CCS-P, CPC, an anesthesia coder with Medical Income Concepts Inc., in Houston. "I see many procedures performed bythe same surgeon where some involve field avoidance and others don't," she says. "The surgeon uses a different technique for whatever reason that means field avoidance is not a factor." Possibility 2: Patient's Position Meets Field Avoidance Criteria At other times, field avoidance applies when the surgeon needs to have the patient in a certain position for the procedure. The main consideration from your coding perspective is that the patient's position could cause the anesthesiologist to have difficulty accessing the patient's airway if problems arise during surgery - and that could mean extra units for field avoidance.

"The majority of field avoidance cases I see are based on the patient's position," Glancy says.

She and Johnson share some examples of several procedures that could involve field avoidance because of the patient's position:
  The patient might be in the prone position (lying face down) during a repair of his ankle tendon (27658, Repair, flexor tendon, leg; primary, without graft, each tendon). This crosses to anesthesia code 01470 (Anesthesia for procedures [...]