CPT 00214: Anesthesia for Intracranial Burr Hole Procedures
CPT code 00214 represents anesthesia services for intracranial procedures that involve burr holes and may include ventriculography. This code captures perioperative anesthesia for targeted intracranial access rather than broader craniotomies, and it is relevant to hospitals, surgical centers, and anesthesia practices managing neurosurgical caseloads. Nationally, accurate use of this code affects payment for complex intracranial anesthesia and supports proper clinical documentation for neurosurgical episodes.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of clinical context for burr hole and ventriculographic procedures, common coding relationships to nearby intracranial anesthesia codes, and discussion of documentation elements that typically accompany anesthesia coding for intracranial work. The publication also outlines benchmarking considerations and common payer interactions relevant to this service.
The content is organized to help billing managers, anesthesia providers, and revenue cycle staff understand where 00214 fits among related intracranial anesthesia codes, the expected clinical setting, and the types of neurosurgical procedures that generate this anesthesia code. Data not provided in the input are noted as unavailable where applicable.
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Billing Code Overview
CPT code 00214 describes anesthesia services provided for intracranial procedures involving burr holes and possible ventriculography. The service type is anesthesia for intracranial surgical procedures. The typical site of service is an operating room or interventional suite where intracranial burr hole procedures and ventriculography are performed.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with progressive headaches, focal neurologic deficits, and radiographic evidence of a chronic subdural hygroma requiring burr hole drainage and possible ventriculography for CSF pathway assessment. The neurosurgical team schedules a burr hole procedure under general anesthesia due to potential need for cerebrospinal fluid sampling and intracranial pressure control. Preoperative assessment documents relevant comorbidities, airway evaluation, and ASA physical status. The anesthesia team performs induction, endotracheal intubation, invasive monitoring as indicated, intraoperative management of ventilation, hemodynamics, and neuroanesthetic needs (e.g., blood pressure targets, avoidance of hypo- or hypercarbia). If ventriculography is required, contrast administration and imaging coordination with radiology occur intraoperatively. Postoperative transfer to post-anesthesia care unit or neurosurgical ICU includes handoff of neurologic exam, intracranial pressure concerns, and pain management plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the anesthesia service required substantially greater work due to complexity beyond typical intracranial burr hole anesthesia. |
23 | Unusual anesthesia | Use when an emergency situation requires anesthesia services that are markedly different from elective services. |
50 | Bilateral procedure | Use if bilateral burr holes are performed and payer accepts modifier on anesthesia claims. |
52 | Reduced services | Use when anesthesia services were partially reduced or abbreviated. |
53 | Discontinued procedure | Use when the burr hole procedure is started but halted for patient safety prior to completion. |
62 | Two surgeons | Use when two anesthesia-qualified physicians share responsibility for a complex intracranial case (if applicable per payer rules). |
78 | Unplanned return to OR following initial anesthesia | Use for subsequent anesthesia for a return to the operating room related to the original procedure. |
AA | Anesthesia services performed personally by anesthesiologist | Use when the physician anesthesiologist personally performed the anesthesia. |
AD | Medical supervision by a physician; medically directed team | Use when an anesthesiologist medically directs a team of qualified professionals. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia | Use when these providers render anesthesia services per payer rules. |
QK | Medical direction of two, three or four qualified individuals | Use when the anesthesiologist provides medical direction to multiple qualified individuals for the case. |
QS | Monitored anesthesia care service | Use if monitored anesthesia care is provided instead of general anesthesia. |
QX | CRNA service with medical direction by physician | Use when a CRNA provides the anesthesia and a physician directs. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when an anesthesiologist directs a single CRNA. |
QZ | CRNA service without medical direction by a physician | Use when a CRNA provides independent anesthesia services. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Primary specialty for physicians providing anesthesia for intracranial burr hole procedures. |
207LA0401X | Pain Medicine (Anesthesiology) | Applicable when anesthesiologists with pain subspecialty are involved in perioperative pain or intrathecal procedures. |
207LP2900X | Pediatric Anesthesiology | Applicable when the patient is a pediatric case requiring specialized pediatric anesthesia care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M75.100 | Unspecified rotator cuff tear or rupture of unspecified shoulder | Provided diagnosis; may be unrelated to intracranial burr hole anesthesia but could represent a concurrent orthopedic issue in the same patient. |
S43.401A | Sprain of unspecified acromioclavicular joint, initial encounter | Provided diagnosis; represents a separate musculoskeletal injury that may affect perioperative positioning or pain management. |
M19.011 | Primary osteoarthritis, right shoulder | Provided diagnosis; chronic degenerative shoulder disease that may impact positioning, regional anesthesia decisions, or postoperative care. |
M19.012 | Primary osteoarthritis, left shoulder | Provided diagnosis; same relevance as M19.011 for the contralateral side. |
S42.001A | Fracture of unspecified part of right clavicle, initial encounter | Provided diagnosis; acute fracture may influence airway positioning, immobilization needs, or concurrent surgical planning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00210 | Anesthesia, intracranial procedures, not otherwise specified | General anesthesia codes used when a more specific intracranial anesthesia code does not apply; alternative to 00214 for unspecified intracranial cases. |
00211 | Anesthesia for intracranial procedure; craniotomy/ craniectomy for trauma or hematoma | Used for more extensive open cranial procedures; applicable when burr hole evolves into craniotomy. |
00212 | Anesthesia for intracranial procedure; subdural taps | Used for cases specifically limited to subdural taps; may be used instead of 00214 if procedure is exclusively subdural tapping. |
00215 | Anesthesia for intracranial procedure; craniotomy for elevation of depressed skull fracture | Used when intracranial anesthesia is provided for skull fracture elevation rather than burr hole drainage. |
00216 | Anesthesia for intracranial vascular procedures | Used when burr holes are part of an intracranial vascular procedure requiring specialized anesthesia care. |
00218 | Anesthesia for intracranial procedure in sitting position | Used when the intracranial procedure, including burr holes, is performed in the sitting position with attendant anesthetic considerations. |
00220 | Anesthesia for intracranial procedure; cerebrospinal fluid shunting procedure | Used when burr hole approach is part of shunt placement or revision requiring anesthesia. |
00222 | Anesthesia for intracranial procedure; electrocoagulation of intracranial nerve | Used when the procedure involves intracranial nerve electrocoagulation rather than simple burr hole drainage. |