Back in 2019, there was a significant change to the ASA RVG in regards to field avoidance. We discussed it back when the ASA made this change, but it’s always a good time to brush up on the details. The RVG can seem like an arbitrarily moving target, but the changes are intended to evolve with the ever-changing practice of anesthesia. The descriptions of certain procedures sound good and inclusive on paper, but complications always arise in practice. This new definition of field avoidance is in some ways better as field avoidance is automatically included in the base units of certain procedures. In other ways it may seem worse, however, as the majority of procedures that involve lack of airway access already have a base unit value of at least five, which makes field avoidance essentially a non-billable item.
The basic change in RVG wording goes from “any procedure around the head, neck, or shoulder girdle...or any procedure requiring a position other than supine or lithotomy,” to “whenever access to the airway is limited.” This opens up the definition, but also opens up the need for extremely detailed and accurate documentation of the circumstances that led to field avoidance. If a procedure is performed in the supine position, for example, it is nearly impossible to bill for the special positioning that would require field avoidance. This also means that procedures to the head, neck, and shoulder don’t automatically qualify for increasing the base value units to five. Documentation must support the request for increased anesthesia reimbursement rates.
Anesthesia Codes and Base Units
There are over 80 anesthesia codes, however, that have a base value unit of less than five that may, in rare situations, require special positioning or field avoidance. In addition to documentation, there are some payors that will request the patient’s medical record as well in order to substantiate the claim. There are a few special circumstances that would trigger adding field avoidance to a procedure where positioning issues with the patient would increase a procedure with a base unit value of three or four to a base value unit of five:
- Obese patients
- Patients with diabetes
- Patients with peripheral vascular disease
- Patients with hereditary peripheral neuropathy
- Patients that are thin or at risk for peripheral nerve injury during surgery
When determining whether to report special positioning, remember to check if the anesthesia base value is fewer than five units, and consider the documented patient position as well as the patient’s medical history. If you’re in doubt, the RVG has information on how to request additional units with the magical Modifier 22. This modifier prompts the adding of base units to cover increased procedural services.
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Working With Medical Business Management
Don’t leave any billing opportunities on the table! Make sure your team is aware of the changes to the ASA RVG in regards to field avoidance. Issues with airway access require additional work and care by the anesthesia provider for the patient - make sure you are properly reimbursed.
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