Anesthesia Coding Alert

However, other coders say you need more details before jumping to conclusions about field avoidance.
 
Example: If the chart states that the surgeon turned the table during surgery, these coders prefer that the anesthesiologist also include information about how the surgeon actually turned the table. They say that notes such as "Table turned to surgeon," "Airway shared with surgeon" or "Head and airway draped out" can be sufficient documentation to merit charging extra units.
 
But some experts, such as Leslie S. Johnson, CCS-P, CPC, an anesthesia coder with Medical Income Concepts Inc., in Houston, look for even more details. She wants to know the distance the surgeon turned the table (such as "Table turned 45 degrees" or "HOB [head of bed] 180 degrees"). "If the degrees aren't stated, I don't bill field avoidance even if the record says, 'Table turned,' " she says.
 
This certainly is a safe standpoint, but other coders aren't sure such details are necessary - partly because other information such as the procedure itself or the patient's position can indicate field avoidance, says Karen Glancy, CCS-P, director of coding with Anesthesia Management Partners in Chicago.
 
"The ASA description regarding field avoidance also states that 'any position other than supine or lithotomy' also qualifies for these extra units," Glancy says. "Documentation of them can be sufficient to support billing for field avoidance."
 
Cases that might qualify for field avoidance because of the patient's position can include:
 

Some carriers - such as Medicare and many Blue Cross or Blue Shield carriers - don't reimburse extra units for field avoidance. Medicaid's stance on field avoidance seems to vary by region. But don't give up hope, because some commercial carriers - such as Better Health Plans of Tennessee - will pay.
 
Even carriers that pay for field avoidance have different criteria for submitting your claims.
 
Example: Better Health Plans of Tennessee wants a paper claim for field avoidance. Some carriers want a modifier and no paperwork; others want no modifier but the term "field avoidance" or something similar somewhere on the claim.
 
This wide range of policies is why Glancy and Johnson stress the importance of talking to individual payers. You're searching for information related to four key areas:
 

Get It in Writing

Your final step in learning how to code for a particular carrier involves getting a copy of the policy in writing. "This avoids confusion and helps maintain compliance," Johnson says. "It also saves you time with appeals if you already have information in writing from the carrier."
 
Is all of this paperwork worth the extra bit of reimbursement you might recoup? Yes, according to Johnson and Glancy.
 
"If the anesthesiologist (or CRNA) will document the degree of field avoidance, he stands to gain up to 2 extra base units for his fee," Johnson says. "This might not seem like a lot, but after a while it adds up."
 
"I think it is difficult to get paid for field avoidance," Glancy says. "But if you're contracted with an insurance plan and can get it written into your contract, it will increase reimbursement."