Summary & Overview
CPT 00539: Anesthesia for Thoracotomy with Cardiopulmonary Bypass
CPT code 00539 represents anesthesia for thoracotomy procedures involving the lungs, pleura, diaphragm, and mediastinum, specifically when cardiopulmonary bypass is utilized. This code is significant nationally due to its application in high-acuity surgical cases that require advanced anesthesiology expertise. The procedures covered by this code are typically performed in inpatient hospital settings and are associated with critical interventions for conditions such as pulmonary disorders, pleural effusions, and cardiac valve issues.
Major commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT code 00539. The publication offers insights into payer coverage, clinical benchmarks, and policy updates relevant to this anesthesia service. Readers will gain an understanding of the clinical context for the code, typical sites of service, and its role in supporting complex thoracic and cardiac surgeries. The summary also highlights related codes and modifiers commonly used in conjunction with 00539, providing a comprehensive overview for stakeholders in anesthesiology and hospital billing.
CPT Code Overview
CPT code 00539 is used to report anesthesia services for thoracotomy procedures involving the lungs, pleura, diaphragm, and mediastinum when cardiopulmonary bypass is required. This code falls under the anesthesiology service type and is typically performed in an inpatient hospital setting (Place of Service 21). These procedures are complex and require specialized anesthesia care due to the involvement of major thoracic structures and the use of cardiopulmonary bypass.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient admitted to an inpatient hospital for a thoracotomy procedure due to a complex pulmonary or cardiac condition. The patient may present with pleural effusion, pneumothorax, pulmonary hypertension, or mitral valve insufficiency, requiring surgical intervention involving the lungs, pleura, diaphragm, or mediastinum. The procedure necessitates the use of cardiopulmonary bypass, and anesthesia is provided by an anesthesiologist or a certified registered nurse anesthetist (CRNA) under medical direction. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care in a critical care setting.
Coding Specifications
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Modifiers:
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QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia. -
QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia services under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty Name