Summary & Overview
CPT 00400: Anesthesia for Skin and Soft Tissue Procedures on Extremities and Trunk
CPT code 00400 covers anesthesia for procedures on the integumentary system of the extremities, anterior trunk, and perineum that are not otherwise specified. This code is significant for hospitals and surgical centers nationwide, as it applies to a broad spectrum of skin and soft tissue surgeries requiring anesthesia. The publication examines coverage and billing practices for this code across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into the clinical context of CPT code 00400, including its typical use in operating room settings and its relevance to anesthesiology professionals. The summary highlights key policy updates, common modifiers, and associated provider taxonomies. Additionally, the publication provides benchmarks and comparisons with related CPT codes, offering a comprehensive overview of how this anesthesia service is coded and reimbursed. This information is essential for understanding payer requirements, clinical documentation, and billing nuances for anesthesia services in skin and soft tissue procedures.
CPT Code Overview
CPT code 00400 is used to report anesthesia services for procedures performed on the integumentary system of the extremities, anterior trunk, and perineum when not otherwise specified. This code falls under the anesthesiology service type and is typically utilized in the operating room setting (Place of Service 21). It is relevant for a wide range of surgical interventions involving the skin and underlying tissues in these anatomical regions.
Clinical & Coding Specifications
Clinical Context
A patient presents with a severe cutaneous abscess on the right ankle requiring surgical intervention. The procedure is performed in the operating room (Place of Service 21) under general anesthesia. An anesthesiology physician or a certified registered nurse anesthetist (CRNA) provides anesthesia care for the surgical excision and drainage of the abscess. The clinical workflow involves preoperative assessment, induction of anesthesia, intraoperative monitoring, and postoperative recovery. The anesthesia service is coded with 00400 for procedures on the integumentary system of the extremities, anterior trunk, or perineum that are not otherwise specified.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia under the medical direction of an anesthesiology physician.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207L00000XAnesthesiology Physician 367500000XCertified Registered Nurse Anesthetist (CRNA) 207RA0401XAnesthesiology Assistant
These taxonomies represent the specialties eligible to provide and bill for anesthesia services under 00400.
Related Diagnoses
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L03.90: Cellulitis, unspecified- Relevant for cases where anesthesia is required for surgical management of cellulitis affecting the extremities, anterior trunk, or perineum.
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L02.91: Cutaneous abscess, unspecified- Indicates a skin abscess requiring surgical intervention under anesthesia.
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L98.9: Disorder of the skin and subcutaneous tissue, unspecified- Used for unspecified skin disorders that necessitate procedures requiring anesthesia.
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S80.811A: Abrasion, right knee, initial encounter- Represents a traumatic skin injury on the extremity, possibly requiring surgical repair under anesthesia.
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S91.001A: Open wound of right ankle, initial encounter- Indicates an open wound on the extremity, which may require surgical closure or debridement under anesthesia.
Each diagnosis is clinically relevant as it may necessitate a procedure on the integumentary system of the extremities, anterior trunk, or perineum, for which anesthesia services coded as 00400 are provided.
Related CPT Codes
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00402: Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (e.g., reduction or augmentation mammoplasty, muscle flaps)- Used when the procedure involves reconstructive breast surgery, often as an alternative to
00400for specified breast procedures.
- Used when the procedure involves reconstructive breast surgery, often as an alternative to
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00404: Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast- Applied for radical or modified radical breast surgeries, distinct from the general procedures covered by
00400.
- Applied for radical or modified radical breast surgeries, distinct from the general procedures covered by
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00406: Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast with internal mammary node dissection- Used when internal mammary node dissection is performed in addition to radical breast procedures.
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00410: Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; electrical conversion of arrhythmias- Used for anesthesia during electrical conversion of arrhythmias, which may be performed in the same anatomical regions but for a different clinical indication.
These codes are alternatives or complements to 00400 depending on the specific surgical procedure performed.
National Reimbursement Benchmarks
National mean rates for CPT code 00400 show that Aetna has the highest average reimbursement at $260.89, followed by Blue Cross Blue Shield at $200.65 and Cigna at $198.40. UnitedHealth Group's mean rate is significantly lower at $65.62, while the BUCA average commercial rate stands at $150.42. Medicare rates are not available in the input.
Comparing BUCA (average commercial) to the available commercial payers, BUCA's mean rate is lower than Aetna, BCBS, and Cigna, but higher than UnitedHealth Group. Rate dispersion, measured by the difference between the 75th and 25th percentiles, is widest for Aetna ($320.00) and tightest for UnitedHealth Group ($25.42), indicating greater variability in Aetna's rates and more consistency in UnitedHealth Group's rates.
The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska's reimbursement rates for CPT code 00400 show a wide spread across payers, with Blue Cross Blue Shield offering the highest mean rate at $220.55 and UnitedHealth Group the lowest at $75.12. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($87.92) and BUCA ($87.33), indicating significant variability in payment levels. In contrast, Aetna and UnitedHealth Group display much narrower spreads ($30.00 and $4.00, respectively), suggesting more consistent rates among providers.
Compared to national averages, Alaska's mean rates for most payers are higher, except for Cigna and UnitedHealth Group, which fall below their respective national benchmarks. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the differences in reimbursement levels across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00400, with a mean rate of $220.55.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Cigna's mean rate in Alaska ($89.33) is notably lower than its national average ($198.40), indicating a substantial deviation.
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