Summary & Overview

CPT 00402: Anesthesia for Integumentary Procedures on Extremities, Trunk, Perineum

CPT code 00402 denotes anesthesia services rendered for surgical procedures on the integumentary system of the extremities, anterior trunk, and perineum, and includes reconstructive procedures on the breast. This is a nationally relevant anesthesia code because it applies to a wide range of common and reconstructive skin and soft-tissue surgeries that require perioperative anesthetic management. Accurate coding affects clinical documentation, facility scheduling, and payment adjudication across payers.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Coverage policies and payment methodologies for anesthesia services using CPT code 00402 vary by payer and clinical setting; the code is relevant to hospital and ambulatory surgical facility workflows as well as professional anesthesia billing.

Readers will find a concise overview of the clinical context for CPT code 00402, the typical sites of service, and how the code maps to anesthesia practice for integumentary and reconstructive procedures. The publication summarizes common billing considerations, associated clinical scenarios, and related procedural codes to help finance, coding, and clinical teams align documentation with national payer expectations and reimbursement frameworks. Data not available in the input for payer-specific rates or utilization benchmarks.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 00402anesthesiaintegumentary systembreast reconstructionoperative anesthesiasurgical billingprocedure codingperioperative care

Billing Code Overview

CPT code 00402 represents anesthesia services provided for procedures on the integumentary system of the extremities, anterior trunk, and perineum, and includes reconstructive procedures on the breast. The service covers anesthesia care for surgical interventions involving skin, subcutaneous tissue, and related soft-tissue structures in these anatomic regions.

Service type: Anesthesia for integumentary system procedures (extremities, anterior trunk, perineum, and breast reconstruction)

Typical site of service: Operating room or procedure suite for surgical and reconstructive procedures involving the integumentary system of the extremities, anterior trunk, perineum, and breast.

Clinical & Coding Specifications

Clinical Context

A 58-year-old male with a history of chronic hoarseness is diagnosed with a malignant lesion of the glottis (C32.0) and scheduled for surgical excision with possible reconstruction of adjacent integumentary tissues of the anterior neck. The patient has intermittent stridor and prior partial vocal cord paralysis (J38.00), and a prior tracheostomy with scarring and a documented tracheostomy complication (J95.02). Preoperative evaluation by the anesthesiology team documents abnormal sputum production (R09.3) and congenital laryngomalacia as a childhood history (Q31.5) noted in the records.

The clinical workflow:

Preoperative assessment by the anesthesiology physician or Certified Registered Nurse Anesthetist (CRNA) including airway evaluation, review of prior tracheostomy details, and risk stratification.
Preparation for potential difficult airway management: plan for awake fiberoptic intubation or inhalational induction, availability of tracheostomy tray and surgical airway team, and consideration of postoperative airway monitoring.
Intraoperative anesthesia is provided for resection of the glottic malignancy and any reconstructive procedures on the anterior neck or breast integumentary tissues; anesthesia management includes airway control, hemodynamic monitoring, and potential blood loss management.
Postoperative care includes monitoring in PACU or ICU for airway compromise, suctioning for abnormal sputum, and management of any tracheostomy-related issues.

This scenario aligns with anesthesia services reported under for procedures on the integumentary system of the extremities, anterior trunk, and perineum, including reconstructive procedures on the breast, when such procedures involve the anterior neck/upper trunk region and require specialized airway and anesthetic management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when anesthesia case is unusually complex or requires substantially greater effort documented in the record.
`23`	Unusual anesthesia	Use when general anesthesia is administered for procedures that normally do not require it.
`50`	Bilateral procedure	Use when identical anesthetic services are provided for bilateral procedures if applicable.
`52`	Reduced services	Use when anesthesia service is partially reduced or incomplete.
`53`	Discontinued procedure	Use when anesthesia is discontinued due to patient-related or surgical cancellation after induction.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons and anesthesia supports both.
`78`	Unplanned return to OR by same physician following initial procedure for a related procedure	Use when the patient returns to the operating room for a related procedure during the global period requiring additional anesthesia.
`AA`	Anesthesia by anesthesiologist	Use to indicate services personally performed by an anesthesiologist.
`AD`	Medical supervision by a physician: more than four concurrent anesthesia procedures	Use when a physician supervises more than four concurrent CRNA-administered anesthesia services.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service for anesthesiology	Use when these practitioners provide the anesthesia service under appropriate state rules.
`QX`	CRNA service: CRNA medically directed by a physician	Use when a CRNA furnishes the anesthesia service and a physician medically directs.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when an anesthesiologist medically directs a single CRNA during the case.
`QS`	Monitored anesthesia care (MAC) service	Use when MAC is provided instead of general anesthesia for the procedure.
`XE`	Separate encounter, a service that is distinct because it occurred during a separate encounter	Use when anesthesia services are reported for a separate encounter from the primary procedure.

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology Physician	Physician providing or supervising anesthesia management for perioperative care.
`367500000X`	Certified Registered Nurse Anesthetist	CRNA delivering anesthesia services, often under medical direction or supervision.
`207RA0401X`	Anesthesiology Assistant	Anesthesiology assistant participating in anesthesia delivery under physician supervision.

CPT Code	Description	Relationship to This Procedure
`31500`	Intubation, endotracheal, emergency procedure	May be performed emergently if airway compromise occurs or during difficult airway management.
`31575`	Laryngoscopy, flexible; diagnostic	Used preoperatively or intraoperatively for airway assessment and visualization of glottic lesions.
`31600`	Tracheostomy, planned (separate procedure)	Performed when a planned surgical airway is required; prior tracheostomy status affects anesthetic plan.
`60240`	Thyroidectomy, total or complete	May be performed concomitantly or in the same operative field for neck masses; anesthesia considerations overlap with anterior neck procedures.

ICD-10 Code	Description	Clinical Relevance
`C32.0`	Malignant neoplasm of glottis	Primary diagnosis often necessitating surgical excision with anesthesia in the airway and anterior neck region.
`J38.00`	Paralysis of vocal cords and larynx, unspecified	Preexisting vocal cord dysfunction increases airway management complexity during anesthesia.
`J95.02`	Tracheostomy complication	Prior tracheostomy issues can alter airway anatomy and affect perioperative anesthetic planning.
`Q31.5`	Congenital laryngomalacia	History of upper airway structural abnormality that may contribute to difficult airway or postoperative airway obstruction.
`R09.3`	Abnormal sputum	Active sputum production increases aspiration risk and informs anesthesia induction and suctioning strategies.

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