Anesthesia Coding Alert

Know when your payers will allow you to add extra units.

When your anesthesiologist does not have direct access to the patient’s face (or airway) because of the patient’s position during a procedure, you would call this “field avoidance.” Field avoidance makes the procedure more complicated for the anesthesiologist, so she’s able to earn higher reimbursement. By following three simple steps, you can ensure her payment for cases involving field avoidance is correct every time.

Step 1: Remember the Number “5”

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.”

In other words: That means you can charge 5 base units for a procedure meeting field avoidance criteria even if it is normally less than 5 base units, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl.

Tip 1: Teach your anesthesiologists and CRNAs to document the degree of field avoidance to help their chances of gaining up to two extra base units for their fee. For example, your provider might document “Table turned 45 degrees” or “HOB [head of bed] 180 degrees.” That helps support your claim for additional units; and although two units might not seem like a lot, they add up over time.

Tip 2: Most anesthesia records have a place for the doctor to indicate the patient’s position; if not, the table turning is a good indication of position. You must consider all of the available information (such as the patient’s position and where on the body the procedure is performed) to determine whether coding for field avoidance is appropriate.

Step 2: Double Check the Payer’s Stance

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 will pay for extra units.

Caution: Even carriers that pay 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); others want no modifier but expect to see the term “field avoidance” or something similar on the claim.

This wide range of policies is why you should always talk with each payer before submitting a claim with field avoidance. Once you learn what the policy is, get a copy in writing and ask for an update each time you renew your contract.

Focus on four things when talking with a payer about field avoidance:

• Whether the carrier in question has a policy regarding field avoidance

• What the policy is

• Whether your contract with the carrier states that payment for “field avoidance” or “patient position” will be paid

• How to code correctly for field avoidance according to the carrier's guidelines.

Step 3: Verify the Service’s Base Value

If the payer allows extra units for field avoidance, check your ASA Relative Value Guide for each service’s base value. Many anesthesia services that require field avoidance have a base value of five or greater, so insurers don’t usually allow additional reimbursement. But if the base value for your physician’s procedure is less than five, you can increase the base value to five.

Example: A patient is in the prone position during a repair of his ankle tendon (27658, Repair, flexor tendon, leg; primary, without graft, each tendon). This crosses to anesthesia code 01470 (Anesthesia for procedures on nerves, muscles, tendons, and fascia of lower leg, ankle, and foot; not otherwise specified), which has three base units. You can add two additional units to the procedure (for a total of five) because of his prone position.

Then, add the correct amount to the bottom line. The physician’s base fee determines what you charge for each procedure, so be sure to multiply his base fee by five when you report field avoidance.

Example: Fees vary by region and by anesthesia group, but let’s use $75 as the unit charge. In the case above, you’ll report 01470, which is a 3-base-unit procedure. You would normally charge $225 plus time (3 base units x $75 = $225). If the case involves field avoidance, bill $375 plus time (5 base units x $75 = $375).