Summary & Overview
CPT 00926: Anesthesia for Procedures on the Perineum
CPT code 00926 is a national billing code used to report anesthesia services for procedures performed on the perineum. This code is relevant for hospitals and anesthesia providers who deliver care in inpatient settings, ensuring accurate documentation and reimbursement for anesthesia during perineal surgeries. The code is recognized by major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, making it a standard reference for coverage and policy review across the United States.
This publication provides a comprehensive overview of CPT code 00926, including its clinical context, typical site of service, and payer coverage. Readers will gain insight into the benchmarks for anesthesia services in perineal procedures, recent policy updates, and the broader implications for hospital billing and compliance. The analysis also highlights common modifiers and associated provider taxonomies, offering clarity on how this code fits within the larger framework of anesthesia billing. By understanding the specifics of CPT code 00926, stakeholders can better navigate the complexities of medical coding, payer requirements, and clinical documentation for anesthesia services.
CPT Code Overview
CPT code 00926 is designated for anesthesia services provided during procedures on the perineum. This code is used to report the administration of anesthesia by qualified professionals for surgical interventions involving the perineal region. The typical site of service for procedures billed under CPT code 00926 is the inpatient hospital setting, specifically place of service 21. As an anesthesia code, it encompasses the preoperative, intraoperative, and immediate postoperative care related to perineal procedures.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient admitted to an inpatient hospital for surgical repair of a hernia located in the perineal region. The patient may present with symptoms such as discomfort, swelling, or pain in the perineum, and is scheduled for a procedure requiring anesthesia. An anesthesia provider, such as an anesthesiologist, certified registered nurse anesthetist, or anesthesiologist assistant, administers anesthesia for the duration of the surgical intervention. The clinical workflow includes preoperative assessment, induction and maintenance of anesthesia, intraoperative monitoring, and postoperative care in the hospital setting.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.QX: CRNA service with medical direction by a physician. Used when a certified registered nurse anesthetist (CRNA) provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
367H00000X | Anesthesiologist Assistant |
367500000X | Certified Registered Nurse Anesthetist |
- Specialties Represented:
- Anesthesiology: Physicians specializing in anesthesia care.
- Anesthesiologist Assistant: Non-physician anesthesia providers.
- Certified Registered Nurse Anesthetist: Advanced practice nurses specializing in anesthesia.
Related Diagnoses
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K40.90: Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent- Relevant for patients undergoing anesthesia for repair of a unilateral inguinal hernia in the perineal region.
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K41.90: Bilateral femoral hernia, without obstruction or gangrene, not specified as recurrent- Indicates a patient with bilateral femoral hernias, which may require surgical repair and anesthesia.
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K42.9: Umbilical hernia without obstruction or gangrene- Used for patients with umbilical hernias, potentially requiring anesthesia for surgical intervention.
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K43.9: Ventral hernia without obstruction or gangrene- Applies to patients with ventral hernias, relevant for anesthesia during surgical repair.
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K44.9: Diaphragmatic hernia without obstruction or gangrene- Indicates diaphragmatic hernia cases, where anesthesia is necessary for surgical correction.
Related CPT Codes
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49505: Repair initial inguinal hernia, age 5 years or older; reducible- Commonly performed in conjunction with anesthesia for perineal procedures. The anesthesia code
00926is used when anesthesia is provided for this surgical repair.
- Commonly performed in conjunction with anesthesia for perineal procedures. The anesthesia code
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49585: Repair umbilical hernia, age 5 years or older; reducible- May require anesthesia services similar to those described by
00926if the procedure involves the perineal region.
- May require anesthesia services similar to those described by
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49650: Laparoscopy, surgical; repair initial inguinal hernia- Laparoscopic hernia repairs may also necessitate anesthesia services, and
00926may be used if the procedure is on the perineum.
- Laparoscopic hernia repairs may also necessitate anesthesia services, and
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00840: Anesthesia for intraperitoneal procedures in lower abdomen- This code is an alternative to
00926when the procedure is intraperitoneal and not limited to the perineum.
- This code is an alternative to
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00830: Anesthesia for procedures in lower abdomen, not otherwise specified- Used as an alternative when the procedure is in the lower abdomen but not specifically on the perineum.
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Common Usage:
00926is typically used with surgical CPT codes for hernia repair when the procedure is on the perineum. Codes00840and00830are alternatives based on the anatomical location of the surgery.
National Reimbursement Benchmarks
National mean rates for CPT code 00926 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, at $226.85 and $248.88 respectively, while UnitedHealth Group is notably lower at $65.57. The BUCA (average commercial) mean rate stands at $134.81, which is significantly higher than typical Medicare rates for similar codes, though Medicare-specific data is not available in the input.
Rate dispersion varies widely across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($24.96), indicating less variability in payment rates. In contrast, Cigna exhibits the widest dispersion ($258.00), reflecting substantial variability in reimbursement. Aetna also shows a broad range ($260.00), while Blue Cross Blue Shield and BUCA have moderate spreads. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 00926, with Blue Cross Blue Shield offering the highest mean rate at $269.23 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 ($74.20), indicating significant variability in payments, while Aetna and UnitedHealth Group have minimal spread ($0.00 and $4.00, respectively), suggesting more consistent rates.
Compared to national averages, Alaska's mean rates for Aetna, Blue Cross Blue Shield, and Cigna are higher, while UnitedHealth Group's rate is only slightly above the national mean. The table and chart below present the full breakdown of payer-specific reimbursement benchmarks for Alaska.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer in Alaska for CPT 00926, with a mean rate of $269.23.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Aetna and Cigna rates in Alaska are notably higher than their national averages, while Blue Cross Blue Shield's mean rate is also above the national benchmark.
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