Anesthesia Coding Alert

Question: Are there certain codes to bill for the field avoidance? What kind of documentation is required in order for my physician to charge this? Is a simple statement of “field avoidance” noted in the anesthesia record enough? 

Alabama Subscriber

Answer: When your anesthesiologist does not have direct access to the patient’s face (or airway) because of the patient’s position during a procedure, it is considered “field avoidance.” Field avoidance makes the procedure more complicated for the anesthesiologist, so he or she is able to earn higher reimbursement.

The American Society of Anesthesiologist’s Relative Value Guide states in its Anesthesia Guidelines section that, “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.” That means you can charge a total of 5 base units for a procedure meeting field avoidance criteria even if it is normally less than 5 base units.

Medicare and some private insurers 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 will pay for extra units.

Caution: Even private payers that reimburse for field avoidance have different criteria for submitting your claims. For example, some insurers want a paper claim for field avoidance. Some want you to append modifier 22 (Unusual procedural services); some want modifier 23 (Unusual anesthesia); others want no modifier but expect to see the term “field avoidance” or something similar on the claim.

Other documentation: Indications for performing the service in a prone position or by field avoidance should be in Block 19 of the CMS 1500 claim form. Electronic claims should include indications in the comments field.