# major position changes



## jsecor (Sep 5, 2013)

I need to know if an anesthesia provider can get reimbursed for a major position change.  My example: The patient is having a shoulder surgery which is going to be done, beach chair position.  The anesthesiologist provided the anesthesia while patient was on the bed, then the patient was moved to the beach chair position - I don't think this is considered major position change. YES, a change in position, but is that scenario reimbursed any differently.  If this isn't considered a major position change - what is an example of and how should that be documented or what modifiers should be used to get that reimbursed. 

Any information is much appreciated.


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## TKeck (Oct 31, 2013)

*Beach Chair Position*

I am just curious if you have had any responses to your question?


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## Michele Hannon (Nov 3, 2013)

Beach chair positioning would qualify as field avoidance......which would allow you to increase the base unit to 5. That being said, most procedures done in the beach chair position already have a base unit of 5.
You speak of induction in the supine position and then changing to beach chair. All inductions are done in the supine position and then the patient is positioned......prone for back surgery, lithotomy for GYN surgery. Additional payment is awarded for that surgical position (if the base unit is not already 5).
It is important to research your payer policy. Some payers require a modifier.........Medi-Cal requires Modifier 22 for prone and field avoidance.......HA Blue Cross requires Modifier 23 for prone and field avoidance......FL Blue Cross does not reimburse for lithotomy, lateral, prone , sitting or field avoidance.
Examples of where reimbursement would increase for a position change:
CPT 01470 with a base unit of 3 may require the patient to be in the prone position which (according to payer policy) may or may not qualify for an additional 2 base units........i.e. Achilles tendon repair


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