Anesthesia Coding Alert

Question: A patient had shoulder surgery that was performed in the beach chair position. The anesthesiologist provided anesthesia while the patient was on the bed, then the patient was moved to the beach chair position. I realize this is a change in position, but don’t think it’s considered a major position change that would affect reimbursement. Am I correct? And, if so, what is an example of what does constitute a major position change and how should it be documented and coded?

Kansas Subscriber

Answer: Administering anesthesia while a patient is in the beach chair position qualifies as field avoidance. That would allow you to increase the base units to 5, but most procedures done in the beach chair position already have a base unit of 5.  

You speak of induction in the supine position and then moving the patient to beach chair. All inductions are done in the supine position and then the patient is positioned – prone for back surgery, lithotomy for GYN surgery, etc. Additional payment is awarded for that surgical position if the base units for the procedure don’t already total 5 or more.

It’s important to research your payer policy regarding how to report special positions or field avoidance. Some payers require a modifier. For example, Medi-Cal requires modifier 22 (Increased procedural services) for prone position and field avoidance, but some Blue Cross payers require modifier 23 (Unusual anesthesia) instead. Other payers, such as Florida Blue Cross, do not reimburse for lithotomy, lateral, prone, sitting or field avoidance.

Here’s an examples of when reimbursement would increase for a position change. Code 01470 (Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified) with a base unit of 3 may require the patient to be in the prone position. According to individual payer policy, this may or may not qualify for an additional 2 base units to reach a total of 5 because of the position.