Summary & Overview
CPT 00404: Anesthesia for Integumentary Procedures and Radical/Modified Breast Surgery
CPT code 00404 denotes anesthesia services for procedures on the integumentary system of the extremities, anterior trunk, and perineum, and specifically includes radical or modified radical procedures on the breast. This code captures the anesthesia component of operative care for dermatologic, reconstructive, and oncologic breast surgeries and is critical for accurate perioperative billing and national claims reporting. Clear assignment of this code supports appropriate payment for anesthesia providers and accurate aggregation of procedural volumes for health system planning.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an outline of clinical context for when CPT code 00404 is applicable, common billing modifiers and coding considerations, and typical ICD-10 diagnoses associated with these procedures. The publication also reviews payer coverage patterns and benchmark comparisons, common documentation elements that support code selection, and how related anesthesia codes are used for nearby surgical sites.
This summary is intended for a national audience of clinicians, coders, and policy analysts seeking concise guidance on the purpose and usage context of CPT code 00404, including what clinical encounters it represents and which payers commonly reimburse these services.
Billing Code Overview
CPT code 00404 describes anesthesia services provided for procedures on the integumentary system of the extremities, anterior trunk, and perineum, including radical or modified radical procedures on the breast. The service type is anesthesia for integumentary and breast surgery, encompassing perioperative anesthesia management during these surgical procedures.
Typical site of service for CPT code 00404 is the operating room or surgical suite where integumentary procedures and radical or modified radical breast surgeries (including mastectomy-related operations) are performed. These services cover intraoperative anesthesia care for patients undergoing surgical treatment of the skin, underlying tissues of the extremities and anterior trunk, perineal procedures, and breast procedures requiring radical or modified radical approaches.
Clinical & Coding Specifications
Clinical Context
A 52-year-old female with a history of right-sided lobular carcinoma in situ (D05.11) and prior mastectomy presenting for immediate breast reconstruction following mastectomy (Z42.1). Preoperative assessment documents general anesthesia risk P2 due to well-controlled hypertension. The anesthesia team provides perioperative management for a modified radical mastectomy with immediate reconstruction on the anterior trunk and breast, consistent with anesthesia code 00404. The workflow begins with a preoperative anesthesia evaluation, documentation of informed consent for anesthesia, intraoperative general endotracheal anesthesia with appropriate monitoring and regional blocks as indicated, and postoperative handoff to PACU with documented anesthetic duration, medications administered, fluids, estimated blood loss, and any intraoperative events such as a difficult airway or significant hemorrhage. Billing and coding capture the base anesthesia code 00404 with applicable modifiers for concurrent circumstances (for example, bilateral procedure, professional component, or unusual anesthesia complexity) and the primary ICD-10 diagnosis code reflecting the malignant or reconstructive breast condition. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for verification of coverage and preauthorization requirements prior to surgery.
Coding Specifications
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