CPT 00474: Anesthesia for Partial Rib Resection
CPT code 00474 designates anesthesia services for partial rib resection procedures, including cases with more extensive corrective measures such as those undertaken for pectus excavatum. This code captures anesthetic management for thoracic operative procedures where removal of part of the rib(s) is performed and is relevant across inpatient and outpatient surgical settings. Nationally, accurate reporting of this code supports appropriate payment for complex thoracic anesthesia care and aligns clinical documentation with procedural risk and resource use.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of clinical context for 00474, typical sites of service, common coding relationships, and nationally relevant considerations for billing and coverage. The discussion highlights how this code fits among related anesthesia codes for closed chest and thoracic procedures and outlines typical clinical indications tied to thoracic conditions.
This publication is oriented to billing professionals, anesthesiology departments, and revenue cycle staff seeking a concise reference on CPT code 00474, including where it is typically used and what clinical scenarios commonly trigger its reporting. Data not available in the input: detailed payer-specific reimbursement benchmarks and utilization statistics.
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Billing Code Overview
CPT code 00474 describes anesthesia services provided for a patient undergoing a partial rib resection in which the surgical provider removes a portion of the ribs. The procedure may involve radical measures when used to treat conditions such as pectus excavatum, a hollow depression in the center of the lower chest.
Service Type: Anesthesia for thoracic surgery involving partial rib resection
Typical Site of Service: Operating room (inpatient or outpatient surgical setting)
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a history of non–small cell lung cancer (C34.90) presents with pain and a localized rib mass requiring a partial rib resection for diagnostic and palliation purposes. Preoperative assessment documents a right-sided pleural effusion (J94.9) and prior rib fracture (S22.3) from recent trauma. The surgical team plans a partial rib resection under general endotracheal anesthesia with possible chest tube placement and intraoperative blood loss management.
The anesthesia workflow includes preoperative evaluation by an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) with airway assessment, review of pulmonary status given J98.4 (other disorders of lung), and optimization of oxygenation. Intraoperative management consists of general anesthesia, invasive monitoring as indicated, ventilator management for one-lung or compromised pulmonary function, analgesic plan including regional block or epidural if needed, and readiness for intraoperative conversion to more extensive chest procedures. Postoperative care includes monitoring in PACU or ICU for respiratory compromise, chest tube management if placed, pain control, and coordination with surgical and oncology teams for pathology results and further treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia complexity or time substantially exceeds usual for partial rib resection due to extensive comorbidity or unexpected procedure difficulty. |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary for an otherwise non‑operative/diagnostic procedure or when added anesthesia complexity is required. |
50 | Bilateral procedure | Use when partial rib resections are performed on both sides of the chest during the same operative session. |
52 | Reduced services | Use when the planned rib resection was partially completed or scope reduced significantly. |
53 | Discontinued procedure | Use when the procedure is started but terminated for patient safety reasons before completion. |
54 | Surgical care only | Use if billing is separated and the anesthesiologist provides only intraoperative anesthesia while another clinician bills perioperative care. |
55 | Postoperative care only | Use if the anesthesia practitioner bills for postoperative management only. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons for complex thoracic reconstruction or extensive resections. |
78 | Unplanned return to operating room | Use when patient requires immediate return to OR for a related procedure during the global period. |
AA | Anesthesia by anesthesiologist | Use when services are personally performed by a physician anesthesiologist. |
QK | Medical direction of two, three, or four CRNAs | Use when the anesthesiologist medically directs multiple CRNAs during the case. |
QS | Monitored anesthesia care service | Use if the service provided is monitored anesthesia care rather than general endotracheal anesthesia. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | Use when a supervising anesthesiologist oversees multiple concurrent anesthesia cases including this one. |
QX | CRNA service with medical direction by anesthesiologist | Use when a CRNA performs the anesthesia under medical direction by an anesthesiologist. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists typically direct or perform anesthesia for thoracic procedures. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs commonly provide anesthesia services in operative and monitored settings. |
207LC0200X | Critical Care Medicine (Anesthesiology) | Relevant when postoperative or perioperative critical care management is required for respiratory compromise. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J98.4 | Other disorders of lung | Indicates underlying lung pathology that may complicate anesthesia and ventilation management during rib resection. |
J94.9 | Pleural effusion, unspecified | May necessitate intraoperative thoracostomy or chest tube placement and affects anesthetic planning. |
S22.3 | Fracture of one rib | Direct indication for partial rib resection in cases of nonhealing, displaced, or symptomatic fractures. |
S42.001A | Fracture of unspecified part of right clavicle, initial encounter for closed fracture | Concomitant shoulder girdle injury that may affect positioning and perioperative analgesia. |
C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung | Tumor involvement of ribs or chest wall prompting resection for diagnostic, staging, or palliative intent. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00520 | Anesthesia for closed chest procedures | Applicable for anesthesia when closed-chest surgical approaches are used during rib resection or associated thoracic work. |
00528 | Anesthesia for procedures on the esophagus | Relevant if intraoperative esophageal evaluation or repair is needed during extensive mediastinal or chest wall surgery. |
00530 | Anesthesia for procedures on the trachea and bronchi | Used when airway or bronchial procedures occur concurrently, such as bronchoscopy or airway repair. |
00532 | Anesthesia for procedures on the mediastinum | Applicable when mediastinal exploration or resection accompanies partial rib resection for conditions like pectus excavatum or tumor involvement. |