Summary & Overview
CPT 00404: Anesthesia for Radical Breast and Integumentary Procedures
CPT code 00404 is a critical billing code for anesthesia services provided during radical or modified radical breast procedures, as well as surgeries involving the integumentary system on the extremities, anterior trunk, and perineum. This code is widely recognized across the United States and is integral to ensuring proper reimbursement and documentation for anesthesiology services in both hospital inpatient and ambulatory surgical center settings.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, cover services billed under CPT code 00404, making it relevant for providers and facilities seeking to understand payer policies and coverage nuances.
This publication offers a comprehensive overview of CPT code 00404, including its clinical context, typical sites of service, and associated benchmarks. Readers will gain insights into policy updates, billing practices, and the importance of accurate coding for anesthesia care during complex breast and integumentary procedures. The analysis also highlights common modifiers and related taxonomies, providing a well-rounded perspective for stakeholders in anesthesiology, dermatology, and plastic surgery.
CPT Code Overview
CPT code 00404 is used to report anesthesia services for radical or modified radical procedures on the breast, as well as procedures on the integumentary system involving the extremities, anterior trunk, and perineum. This code falls under the anesthesiology service type and is typically performed in a hospital inpatient setting or an ambulatory surgical center (place of service 21 or 24). The code is essential for accurately documenting and billing anesthesia care provided during complex surgical interventions on the breast and related anatomical regions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a female patient admitted to a hospital inpatient unit or ambulatory surgical center for a radical or modified radical breast procedure, such as mastectomy or breast reconstruction. The patient may have a history of breast cancer, lobular carcinoma in situ, or require surgery following a previous mastectomy. An anesthesiologist or certified registered nurse anesthetist (CRNA) provides anesthesia services during the surgical intervention, ensuring patient comfort and safety throughout the procedure.
Coding Specifications
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Modifiers:
Modifier Code Description When Used QSMonitored anesthesia care service Used when anesthesia is provided as monitored anesthesia care rather than general anesthesia. QXCRNA service with medical direction by a physician Used when a CRNA provides anesthesia services under the medical direction of a physician.