Anesthesia Coding Alert

Question: Can you remind me of the rules of field avoidance? What is required for documentation by the anesthesiologist so that we can bill for the field avoidance?

Pennsylvania Subscriber

Answer: According to the ASA Relative Value Guide, “Any procedure around the head, neck, or shoulder girdle, requiring field avoidance or a procedure requiring a position other than supine or lithotomy, has a minimum Base Value of 5 regardless of any lesser base value assigned to such procedure in the body of the Relative Value Guide.”

Field avoidance is built into all anesthesia codes for procedures on the facial area – which is why they are each five-unit procedures.

However, sometimes the situation might merit you adding additional units to reach the five-unit threshold for field avoidance.

For example, ankle tendon repair procedure 27658 (Repair, flexor tendon, leg; primary, without graft, each tendon) crosses to 01470 (Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified) with a base unit of three. This procedure is commonly (though not always) done with the patient in the prone position. If that’s the case and your anesthesia provider documented the prone position, you can bump the base value to five and might not even need to include a modifier.

Caveat: Some payers do ask you to append modifier 22 (Increased procedural services) in these cases and include a description of the procedure in Field 19 (or the electronic equivalent).

Sometimes during surgery you could see a note that the “table is turned.” This means that the OR table was unlocked and turned 45, 90, or maybe even 180 degrees in order to help the surgeon better visualize things. This would also qualify for increasing base units for field avoidance, so getting your providers to specifically document the number of degrees will only strengthen your case for the additional base units.