Summary & Overview
CPT 00104: Anesthesia for Electroconvulsive Therapy
CPT code 00104 covers anesthesia services for patients undergoing electroconvulsive therapy, a procedure frequently used in the management of severe psychiatric disorders. This code is nationally recognized and utilized by anesthesiology providers in both hospital and ambulatory surgical center settings. The publication examines coverage and policy considerations from major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into the clinical context of CPT code 00104, including its role in facilitating safe anesthesia care during electroconvulsive therapy. The summary provides an overview of payer coverage, typical sites of service, and associated billing practices. Key benchmarks and policy updates relevant to anesthesiology and procedural billing are highlighted, offering a comprehensive understanding of how this code is applied in practice. The publication also addresses related codes and modifiers, supporting accurate reporting and compliance in medical billing. This resource is designed for healthcare professionals, administrators, and policy analysts seeking clarity on anesthesia billing for electroconvulsive therapy.
CPT Code Overview
CPT code 00104 is designated for anesthesia services provided during electroconvulsive therapy. This code is used by anesthesiology professionals to report the administration and management of anesthesia specifically for patients undergoing electroconvulsive therapy procedures. The typical site of service for CPT code 00104 includes hospital settings or ambulatory surgical centers (Place of Service codes 22 or 24). This code is integral to ensuring safe and effective anesthesia care during a procedure that is commonly used in the treatment of certain psychiatric conditions.
Clinical & Coding Specifications
Clinical Context
A patient is scheduled for electroconvulsive therapy (ECT) in a hospital or ambulatory surgical center. ECT is typically performed for severe psychiatric conditions such as major depressive disorder, bipolar disorder, or schizophrenia when other treatments have not been effective. Prior to the procedure, an anesthesiologist evaluates the patient, reviews medical history, and ensures the patient is fit for anesthesia. On the day of the procedure, the anesthesiologist administers anesthesia to induce unconsciousness and muscle relaxation, allowing the ECT to be performed safely. The anesthesia service is coded with CPT code 00104. The workflow includes pre-anesthesia assessment, administration of anesthesia, monitoring during the procedure, and post-anesthesia care.
Coding Specifications
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Modifier
QS: Indicates that monitored anesthesia care (MAC) was provided. Used when the anesthesiologist is present and monitoring the patient throughout the procedure. -
Modifier
P1: Denotes a normal healthy patient. Used to indicate the physical status of the patient receiving anesthesia.
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