# Field Avoidance/Prone position



## hanoz420@hotmail.com (Mar 2, 2010)

I was wondering, what kind of documentation is required in order for my physician to charge this?  Is a simple statement of "Field Avoidance" noted on the Anesthesia record, acceptable?  

Any feedback would be greatly appreciated!

Thanks!


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## kmaher (Mar 4, 2010)

That's a great question!  I would love to know that too.  Do you know if there is a certain code to bill for the field avoidance?  I posted a similiar question a while back and haven't heard back on that yet.


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## hanoz420@hotmail.com (Mar 4, 2010)

Hi,
You actually would append modifier 23 to the anesthesia code.  However one of our local carriers here in Hawaii, well they state that only for specific anesthesia codes, that they'll accept the mod 23.  For example, if a patient had surgery on the popliteal vein due to phlebitis and the administration of the anesthesia was complicated by the patients prone postion, then I can code it as 01430-23. On the other hand if the patient was having a total hip replacement and administration of anesthesia was complicated because of the prone position I am not able to code 01214 w/mod 23 because that anesthesia code is not on the acceptaple cpt code list.....anyway, I hope that helps you.
I understand that policies vary by payors.......So not only do we wear our coding hats, but biller hats also!  Would you agree?

Have a great day!


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## vanessa10 (Mar 4, 2010)

actually you would use modifer 22. it is in the anesthesia answer book to use mod 22 and you can bump the base units upto 5 if it is less than that. there is no other code for field avoidance. do you have access to an anesthesia answer book? depending on the year of i a could give you page numbers.also in the relative value guide on page xiii in the 5th paragraph down it explains field avoidance and how you can bump the base to 5 units. that's the only thing you get out of it though. and medicare does not pay for it.


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## hanoz420@hotmail.com (Mar 4, 2010)

Thanks Vanessa10!!!  This is good information.  I've used mod 22 for some of my extensive ortho cases......BTW, I don't have that anesthesia answer book.  That book must have some good answers.....anything in there about interscalene block performed during shoulder surgery?  I know the physician needs to order this.....but I'm wondering if it's even getting paid?  

Have a great day!


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## hgolfos (Mar 5, 2010)

The Anesthesia Answer Book can be found online at: 

http://www.anesthesiapainanswers.com/Default.aspx

It is an excellent resource, for anesthesia and pain management billing.  As for your question about ISBs during shoulder surgery, you can bill for and get paid for them.  Make sure you have a record of the surgeon's order for it.  Also, make sure that if your docs are providing it before surgery that their anesthesia time doesn't include the time spent to give the injection.  You can also bill a continuous ISB 64416 with follow up days 99231 if your docs document e/m type visit each day.


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