Anesthesia Coding Alert

Hint: Positions can make a difference

A chart hits your desk with notes about field avoidance during the procedure. What exactly does "field avoidance" mean? Is it something you should be concerned about?
 
The answer, experts say, is yes.
 
"Field avoidance" basically means the anesthesiologist doesn't have direct access to the patient's airway during surgery, says Karen Glancy, CCS-P, director of coding with Anesthesia Management Partners in Chicago. Whether it's due to the nature of the case itself or because the surgeon has the patient in a different position than normal, field avoidance makes it a higher risk for the anesthesiologist.
 
And a higher-risk case might mean higher anesthesia reimbursement than usual. If the documentation supports field avoidance, the anesthesiologist can charge a minimum of 5 base units for the procedure. How? By taking a lower-base procedure code and adding 1 or 2 units for a total of 5 because of field avoidance.
 
Example: A surgeon removes a growth from the back of a patient's lower leg. You report 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified), which is a 3-unit code. Because the patient is in the prone position - and therefore qualifies for field avoidance - you can increase the procedure's base from 3 to 5 units.
 
The American Society of Anesthesiologists' Relative Value Guide addresses the issue in its Anesthesia Guidelines section: "Any procedure around the head, neck or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum Basic Value of 5 regardless of any lesser basic value assigned to such procedure in the body of the Relative Value Guide." So keep an eye out for those details and watch your  bottom line grow.