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For many years, the ASA has guided anesthesiologists as to what constitutes “field avoidance” with guidance from the ASA Relative Value Guide (RVG) that states:

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 in the body of the Relative Value Guide. 

In 2019, there has been a significant change in that guidance from the ASA RVG:

Whenever access to the airway is limited (e.g., 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 in the body of the Relative Value Guide. 

What does this mean to Anesthesiologists?

No longer would procedures “around the head, neck, or shoulder girdle….or any procedure requiring a position other than supine or lithotomy” automatically qualify as field avoidance.

While there is little to no specific guidance here, prudent documentation would ensure that, when appropriate, his/her documentation would stress the difficulty of gaining access to the airway. This documentation would support a request for increased anesthesia reimbursement rates from payors for those procedures having less than the 5 unit values.

This guidance could be advantageous to anesthesiologists since they would no longer be limited as to anatomical location or position should they run into difficulty in managing the patient’s airway. For example, the patient is in a supine position, the procedure is in some other area of the body rather than the head, neck, or shoulder girdle, and the airway is in some way compromised causing increased work and skill in gaining and managing the airway. As long as the documentation clearly supports the difficulty, with this new guidance, it would be justifiable to request additional reimbursement via the use of the -22 modifier (Increased Procedural Services). The wording for modifier -22 states:

When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient’s condition, physical and mental effort required).

While the reasoning is sound, not all payors reimburse for the additional work signified by the -22 modifier. Payors that do would almost certainly request the medical record to substantiate the claim for increased anesthesia reimbursement.

For more information read the ASA article, 2019 Relative Value Guide Updates Include Anesthesia Time and Field Avoidance posted on December 17, 2018.

Interested in other 2019 coding updates? Read about ultrasonic guidance for needle placement here and request a copy of abeo’s Anesthesia and Pain Management Guide.

Request abeo's 2020 Anesthesia & Pain Management Guide


abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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