Surgical Positions

Understanding Surgical Positions: A Guide for Medical Coding Professionals

In the field of surgical coding, accuracy is crucial for proper documentation and billing. One of the critical aspects of documenting surgical procedures involves understanding the various surgical positions. These positions are essential because they can affect the approach, technique, and even the coding of a surgical procedure.

Surgical procedures require proper patient positioning to keep the patient comfortable and safe during surgery. Proper positioning also gives the surgeon easy, unobstructed access to the surgical site. Many factors influence the decision of how to position a patient during a procedure:

• The patient’s overall condition
• Length of procedure
• Techniques to be used during the procedure
• Required exposure at the operative site
• Expected anatomical and physiological changes associated with anesthesia

Furthermore, various risk factors may lead to a patient’s vulnerability to injury from improper positionings, such as:

• Long procedures (3+ hours)
• Bone and joint conditions
• Skin breakdown due to aging
• Malnutrition, hypovolemia, anemia, paralysis, obesity, extreme thinness, or diabetes

Here’s a comprehensive overview of the 12 common surgical positions. Medical coding professionals should be familiar with these positions to ensure accurate coding and billing.

1. Supine Position

• Description: The patient lies flat on their back with the face-up.
• Common Procedures: Abdominal surgeries, chest surgeries, and many orthopedic procedures.
• Coding Notes: In particular, surgeons often use it for procedures requiring easy access to the anterior aspect of the body. Ensure the coding reflects the positioning if it affects the surgical approach.

2. Prone Position

• Description: The patient lies face down with the back up.
• Common Procedures: Spinal surgeries, certain types of back surgeries.
• Coding Notes: Prone position may require specific codes if it influences the type of incision or approach.

3. Lithotomy Position

• Description: The lithotomy position, also called the dorsal lithotomy position, places the patient on the back with the hips and knees flexed and the legs raised, separated, and supported in stirrups.
• Common Procedures: Gynecological, urological, and colorectal surgeries, and childbirth.
• Types of Lithotomy Position: In the low or modified lithotomy position, the legs are raised only slightly, which is common in laparoscopic pelvic surgery. In the high lithotomy position, the legs are raised further for better access to the perineum.
• Stirrups: Allen stirrups support the foot and calf in a padded boot and suit longer cases. Candy cane stirrups suspend the foot from a pole with straps and suit shorter procedures.
• Coding Notes: This position is crucial for access to the pelvic region. Therefore, coding should reflect any specific modifications or supports used.

4. Trendelenburg Position

• Description: The patient lies on their back with the head lower than the legs.
• Common Procedures: Used to improve venous return and manage hypotension during surgeries.
• Coding Notes: The Trendelenburg position can affect blood flow and visibility. As a result, it can potentially influence the coding for certain interventions.

5. Reverse Trendelenburg Position

• Description: The patient lies on their back with the legs lower than the head.
• Common Procedures: Used in abdominal surgeries to facilitate access to the upper abdomen.
• Coding Notes: This position can impact the approach and exposure. As a result, it affects the surgical coding.

6. Fowler’s Position

• Description: The patient sits with the back inclined, often at an angle of 45 to 90 degrees.
• Common Procedures: Head, neck, and upper chest surgeries.
• Coding Notes: Fowler’s position facilitates access to the upper body. Ensure coding reflects this positioning if it affects the surgical approach.

7. Semi-Fowler’s Position

• Description: The patient reclines with the head at a 30 to 45-degree angle of elevation.
• Common Procedures: Similar to Fowler’s, used for upper body access and comfort.
• Coding Notes: Providers often use it for comfort and access. Therefore, ensure the record correctly documents the position if it influences the procedure.

8. Lateral Position

• Description: The patient lies on their side with one side up. This is also called the lateral decubitus position.
• Common Procedures: Kidney surgeries, thoracic (chest) surgeries, certain types of hip surgeries.
• Coding Notes: The lateral position can alter the approach and exposure. Therefore, accurate coding should reflect this positioning.

9. Sim’s Position

• Description: The patient lies on their left side with the left leg extended and the right knee bent.
• Common Procedures: Rectal examinations, some gynecological procedures.
• Coding Notes: Surgeons use this position for specific types of access. Also, ensure coding reflects any modifications based on patient comfort or procedure needs.

10. Jackknife Position

• Description: The jackknife position, also called the prone jackknife or Kraske position, places the patient face down with the table flexed at the hips, so the hips are raised and the head and feet are lowered.
• Common Procedures: Rectal and lower abdominal procedures, including hemorrhoidectomy and pilonidal cyst excision.
• Coding Notes: This position provides better access to the rectal and lower abdominal areas. Therefore, code accurately to reflect any adjustments or supports used.

11. Knee-Chest Position

• Description: The patient kneels on the operating table with the chest and face down, buttocks elevated.
• Common Procedures: Certain gynecological and rectal procedures.
• Coding Notes: Surgeons may also use this position for specific access or visibility. Also, ensure that the coding captures the positional needs and adjustments made.

12. Lithotomy-Trendelenburg Position

• Description: A combination of lithotomy and Trendelenburg positions.
• Common Procedures: Complex pelvic surgeries that need both positions.
• Coding Notes: This combined position requires careful documentation to ensure accurate coding. Accurate coding then reflects the complexity and specific needs of the procedure.

In conclusion, understanding surgical positions is essential for medical coding professionals to ensure accurate documentation and billing. Each position has implications for the approach and technique used during surgery, and proper coding helps reflect these details accurately. Therefore, by familiarizing yourself with these 12 common surgical positions, you can improve your coding precision. You can also contribute to effective healthcare management.

steris.com: Complete Guide To Patient Positioning

NCBI StatPearls reference

 

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Other Surgical Positions Coders Should Know

• Beach chair position: a semi sitting position used most often for shoulder surgery, such as arthroscopy and rotator cuff repair.

Surgical Positions FAQs

What is the most common surgical position?

Supine, with the patient lying flat on the back, is the most common surgical position. Surgeons use it for most abdominal, chest, and many orthopedic procedures.

What is the lithotomy position used for?

Surgeons use lithotomy for gynecologic, urologic, and rectal procedures, such as hysteroscopy, cystoscopy, and hemorrhoidectomy.

What does lithotomy position mean?

Lithotomy position means the patient lies on the back with the hips and knees flexed and the legs raised and supported in stirrups. Dorsal lithotomy is another name for the same position, since dorsal refers to lying on the back.

What is the difference between low and high lithotomy?

The difference is how far the legs are raised. Low lithotomy, also called modified lithotomy, raises the legs only slightly and is common in laparoscopic pelvic surgery. High lithotomy raises the legs further to give the surgeon more access to the perineum.

What surgeries use the prone position?

Surgeons use the prone position for procedures on the back of the body, such as spinal surgery, including laminectomy and spinal fusion. The prone jackknife variation is used for rectal procedures.

What is the jackknife position?

Jackknife, also called Kraske, is a prone position with the hips raised and the head and feet lowered. It gives access to the rectal and perineal area for procedures such as pilonidal cyst excision.

Does patient position change the CPT code?

Position usually does not change the CPT code by itself. However, the operative report documents it, and it helps confirm the surgical approach and site you are coding.