Anesthesia Coding Alert

How? It’s all thanks to these circumstances.

As an anesthesia coder, you know that the number of base units assigned to an anesthesia code is a vital component of the reimbursement equation. There are times, however, when you’re justified in billing a higher number of units for a procedure than is listed in CPT^® or the Anesthesia Relative Value Guide (RVG^®).

Case in point: Sometimes your anesthesia provider does not have direct access to the patient’s face or airway during a procedure because of how the patient is positioned. This situation is known as field avoidance. The lack of direct access to the patient’s airway makes the procedure more complicated for the anesthesiologist, so they’re able to earn higher reimbursement for the service.

Read on to know when — and how — to document field avoidance so your provider can collect payment for those extra units as deserved.

Step 1: Understand the Circumstances

According to the ASA RVG^®, the definition of field avoidance is: “Whenever access to the airway is limited (eg, field avoidance), the anesthesia work required may be substantially greater compared to the typical patient. This anesthesia care has a minimum base unit value of 5 regardless of any lesser base unit valued assigned to such procedure in the body of the Relative Value Guide. Refer to the text in Modifier 22, page xvi.”

Field avoidance is built into most anesthesia codes for procedures on the facial area (such as 00120, Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified, with a base value of 5 and 00162, Anesthesia for procedures on nose and accessory sinuses; radical surgery, with a base value of 7)— which is why they are each valued at five units or more.

However, sometimes the situation might justify adding additional units to reach the five-unit threshold for field avoidance (provided you have clear documentation supporting the claim).

“If a procedure meets field avoidance criteria, you can charge five base units for it even if it is normally valued at less than five,” says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl.

Step 2: Gather All the Details

Teach your anesthesia providers to document the degree of field avoidance to help their chances of adding additional base units to their fee. The better their documentation, the better you can support the claim for additional units; and, as every provider knows, every unit adds up over time.

Example: Ankle tendon repair procedure 27658 (Repair, flexor tendon, leg; primary, without graft, each tendon) crosses to 01470 (Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified) with a base unit of three. This procedure is commonly (though not always) done with the patient in the prone position. If that’s the case and your anesthesia provider documented the prone position, you can bump the base value to five. Although policies differ, according to the RVG^®, you can include modifier 22 (Increased procedural services) to explain the increased procedural service.

Watch the notes: You might see a note in the surgical record that the “table is turned” during the procedure. This means that the OR table was unlocked and turned 45, 90, or maybe even 180 degrees to help the surgeon better visualize things. This would also qualify for increasing the base units for field avoidance, so getting your providers to specifically document the number of degrees will only strengthen your case for the additional base units.

Extra tip: Most anesthesia records have a place for the doctor to indicate the patient’s position; if not, the table turning is a good indication of position. You must consider all the available information (such as the patient’s position and where on the body the procedure is performed) to determine whether coding for field avoidance is appropriate.

Step 3: Know Whether Payers Allow the Extra Units

Some payers — including traditional Medicare — don’t reimburse extra units for field avoidance. Medicaid’s stance on field avoidance, however, seems to vary by region so be sure to verify specifics for your state. And while many commercial insurers might follow Medicare guidelines and refuse payment, others don’t.

Caution: If you learn that the payer in question allows extra units for field avoidance, ask about other requirements you must meet for payment. For example, some insurers want a paper claim for field avoidance. Some want you to append modifier 22. Others want no modifier but expect to see the term “field avoidance” or something similar on the claim.

Once you learn what the payer’s policy on field avoidance is, get a copy in writing and ask for an update each time you renew your contract. Ask about these things when discussing field avoidance with your payers:

• Whether the insurer in question has a policy regarding field avoidance
• If so, what that policy is
• Whether your contract with the payer states that payment for documentation of “field avoidance” or “patient position” will be paid
• How to code correctly for field avoidance according to the insurer’s guidelines