Extreme Positioning


Bristol, Virginia
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I am new to the anesthesia coding field and am billing for CRNAs. I was wondering - when the CRNAs speak of extreme positioning, what is it and is it separatley billable and what is the proper documentation format for it in the medical record. Any assistance would be greatly appreciated. :confused:


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I don't know the meaning of "extreme positioning" and how your providers are using this term.

In anesthesia, "position" is literally how the patient is placed when surgical procedures are performed. Sometimes a patient is placed in such a way that the airway is/may be compromised and/or the anesthesiologist/CRNA can't see or reach it as they would under "regular" circumstances. As you can guess, this may present an added risk to the case.

This must be documented on the anesthesia record. Sometimes they'll write it, sometimes they will draw stick pictures representing the type of position. Some will write "field avoidance" as well and this counts, too.

When a surgical procedure has a base value of LESS THAN 5 units, extra units to equal 5 may be added to the procedure for some carriers if the patient is placed in a position *other than* supine or lithotomy. If the surgical procedure is more than 5 base units, then positioning - extreme or otherwise - is already built into the RVU and extra units may not be added.

Ex: 01710 - 3 base units; patient is placed in a prone position, so 2 extra base units are added.

I usually add in Box 19 the type of position so that there's no guesswork. You may need to appeal denials of these extra units, but payment is carrier specific.

To become more familiar with these guidelines, I heartily recommend that you visit http://www.asahq.org and check out their online bookstore. If you don't have the RVG (Relative Value Guide) Book, you are billing & coding blind, IMHO. This will tell you about positions and other important things to know about coding/billing for anesthesia.

Leslie Johnson, CPC