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.
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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
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When identical operative procedures are performed on both breasts during the same operative session. |
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct portions of the procedure. |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | For an unplanned intra- or postoperative reoperation related to the original breast procedure requiring additional anesthesia. |
52 | Reduced services | When the anesthesia service or surgical procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | When the procedure is started but halted due to extenuating circumstances (e.g., unstable patient). |
22 | Increased procedural services | When the anesthesia care is substantially greater than typically required (documented increased complexity or time). |
59 | Distinct procedural service | To indicate a separate and distinct anesthesia-related service or procedure when required to distinguish from other billed services. |
62 | Two surgeons | See above; included when appropriate for shared operative responsibility. |
AA | Anesthesia by the anesthesiologist | When the anesthesiologist personally performs the anesthesia services. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | When the anesthesiologist supervises multiple concurrent anesthesia cases beyond four. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia | When a qualified non-physician anesthesia provider furnishes the service under appropriate supervision. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | When the anesthesiologist medically directs multiple concurrent cases (2–4) with qualified individuals. |
QX | CRNA service with medical direction | When a CRNA performs the anesthesia and the anesthesiologist medically directs. |
QS | Monitored anesthesia care service | When monitored anesthesia care is provided rather than general anesthesia, if clinically applicable. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Primary providers of intraoperative anesthesia and perioperative care for 00404 procedures. |
207N00000X | Dermatology | May perform integumentary procedures on the trunk/extremities but less commonly for radical breast procedures; involved if skin-specific reconstruction or oncologic resections overlap. |
208200000X | Plastic Surgery | Frequently performs breast reconstruction and reconstruction-related procedures following mastectomy; coordinates with anesthesia for operative planning. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Indicates right breast cancer requiring oncologic resection and anesthesia for modified radical mastectomy or related procedures. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Indicates left breast cancer requiring surgical resection and anesthesia for oncologic breast procedures. |
Z42.1 | Encounter for breast reconstruction following mastectomy | Supports anesthesia for reconstructive surgery following prior mastectomy; commonly billed with 00404 when reconstruction involves the anterior trunk/breast. |
Z85.3 | Personal history of malignant neoplasm of breast | Documents prior breast cancer history relevant to reconstructive planning and perioperative risk assessment. |
D05.11 | Lobular carcinoma in situ of right breast | Indicates high-risk or premalignant lesion of the breast that may prompt surgical excision or risk-reducing surgery with associated anesthesia services. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00404 | Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast | Primary anesthesia code describing services for modified radical mastectomy and related breast procedures on the anterior trunk. |