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June 10, 2019

The Field Avoidance Cheat Sheet for 2019

June 10, 2019

In an ideal world, all patients would be easy to sedate - flat on their backs, in a controlled environment, with no adverse reactions. Of course, this is never the case, so there are a thousand different ways in which anesthesia is administered and monitored. A tiny divergence in procedure can sometimes mean life and death for a patient. And when the procedure is over, a tiny divergence in coding, one wrong integer, can mean life and debt for a patient. Great anesthesia providers and their billing teams understand this, and stay on top of changes in the system

One of the trickiest qualifying circumstances to code can be field avoidance. Anesthesia providers haven’t had to pay close attention to this for a while, as the definition has, more or less, stayed the same. For 2019, however, there is a significant change. The definition of Field Avoidance has become more flexible as the requirements for documenting it have become more rigid. It is imperative coders and anesthesia providers communicate on these changes, as thorough notation of a patient’s position and reason for field avoidance are singularly important in the successful coding of this payout.

Let’s look at the language change from the Relative Value Guide:

  • 2018 RVG:  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 Base Value of 5 regardless of any lesser base value assigned to such procedure.

This definition is fine, but does not account for cases where a patient is supine, but field avoidance must still be performed (ie., with morbidly obese patients).

  • 2019 RVG: Whenever access to the airway is limited (eg, field avoidance), the anesthesia work required may be substantially greater compared to the typical patient.  This anesthesia care has a minimum base unit value of 5 regardless of any lesser base unit valued assigned to such procedure.

The flexibility of this definition is meant to include the variation of the types of procedures that anesthesia providers must deal with daily. However, the one question the anesthesiologist must answer to the payor is: Is it justifiable to add the additional anesthesia reimbursement for this procedure?

Points to Remember

  • Field avoidance can be applied to surgeries performed in any position other than the supine or lithotomy positions.
    • The exceptions to this are procedures involving morbidly obese patients, or surgeries involving the head, neck, or shoulder.
    • Anesthesiologists are now no longer as strictly limited to anatomical position while still being covered by the payor.
  • Documentation of field avoidance must be accurate, detailed, and stress the difficulty of gaining access to the airway in the usual way.
    • Documentation must be marked on the patient’s anesthesia record. Anything recorded on internal billing documents is not considered part of the patient’s record and will not be covered as such.
  • The modifier -22 has to be added to the usual base value 5 code for field avoidance billing.
    • This modifier alerts the payor that the work required to provide the service (anesthesia) was substantially greater than the work typically required.
    • This absolutely applies to field avoidance, as it significantly increases patient risk during a procedure.
    • There are 83 codes with a base value of less than 5 units - that means there’s a good chance your anesthesia providers will qualify for this additional payment.
  • This only applies to payors that aren’t the CMS.
    • Medicaid unfortunately does not cover field avoidance.

Make sure you advise your anesthesia providers on these stricter documentation requirements, as crude stick drawings or unclear notations are no longer sufficient to cover this increased billing. Maximize your payouts by staying up to date with other 2019 medical billing changes.

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