CPT 00754: Anesthesia for Omphalocele (Upper Abdominal Hernia Repair)
CPT code 00754 designates anesthesia services for surgical repair of an omphalocele—hernia repair of the upper abdomen where abdominal organs protrude through the umbilical base due to congenital abdominal wall defects. This code is important nationally because it captures perioperative anesthesia care for complex congenital abdominal procedures, often involving neonatal or pediatric anesthesiology expertise and specialized perioperative resources. Accurate use affects clinical documentation, case mix classification, and payment for high-acuity pediatric surgical care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find clinical context for the procedure, typical site-of-service expectations (operating room in inpatient or outpatient surgical facilities), and the role of anesthesia in managing congenital abdominal wall defects. The publication provides benchmarks and coding context relevant to anesthesia services for omphalocele repair, highlights clinical considerations tied to pediatric and specialized anesthesiology taxonomies, and links related surgical codes for cross-reference. It also outlines common modifiers used with anesthesia billing and lists relevant ICD-10 diagnoses associated with upper abdominal and shoulder conditions when present in patient records.
This summary is written for a national audience to inform coding accuracy, billing processes, and administrative oversight tied to anesthesia services for congenital abdominal wall repairs.
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Billing Code Overview
CPT code 00754 describes anesthesia services provided for a patient undergoing hernia repair in the upper abdomen for an omphalocele, a congenital malformation in which abdominal contents protrude into the base of the umbilical cord. The procedure involves surgical correction of the abdominal wall defect.
Service type: Anesthesia for congenital abdominal wall repair (omphalocele)
Typical site of service: Operating room / inpatient or outpatient surgical facility
Clinical & Coding Specifications
Clinical Context
A 3-month-old infant with a congenital omphalocele is scheduled for surgical repair of an upper abdominal hernia under general anesthesia. The neonate presents with a midline abdominal wall defect at the base of the umbilical cord with protrusion of intestinal loops and omentum. Preoperative evaluation includes assessment of cardiopulmonary stability, fluid status, temperature regulation, and potential associated anomalies (cardiac, pulmonary, chromosomal). The anesthesia team (often a pediatric anesthesiologist) coordinates with pediatric surgery, neonatal intensive care, and nursing for operative planning: induction in the operating room with standard ASA monitors, appropriate sized endotracheal tube, temperature control measures, and intravenous access; maintenance of anesthesia with volatile agent or intravenous agents per institutional practice; intraoperative management of potential fluid shifts, blood loss, and ventilatory changes due to abdominal domain reduction on closure; and postoperative disposition to the neonatal intensive care unit or pediatric recovery area for ongoing ventilatory and hemodynamic support. Family communication about anesthetic plan, risks, and expected postoperative course occurs preoperatively.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
AA | Anesthesia service performed personally by anesthesiologist | Use when a physician anesthesiologist personally performs the anesthesia for the procedure. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | Use when supervising multiple concurrent anesthetics exceeding four patients.
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia | Use when qualifying nonphysician provider delivers or assists with anesthesia under supervision per payer rules.
QK | Medical direction of two, three, or four concurrent anesthetizees with qualified CRNAs | Use when the anesthesiologist directs multiple CRNAs for concurrent cases.
QX | CRNA service; CRNA with medical direction by physician | Use when a CRNA performs anesthesia under physician medical direction.
QS | Monitored anesthesia care service | Use when the service provided is monitored anesthesia care rather than general anesthesia.
62 | Two surgeons | Use when two surgeons are required to complete complex closure or combined procedures.
78 | Unplanned return to the operating room for a related procedure during postoperative period | Use when patient requires return to OR for anesthesia related to the same surgical site.
23 | Unusual anesthesia | Use when clinically appropriate because of emergency or unusual circumstances requiring significantly more anesthesia resources.
50 | Bilateral procedure | Use if the repair involves bilateral anatomic sites and payers require bilateral modifier reporting.
52 | Reduced services | Use when the anesthesia service is partially reduced or abbreviated.
53 | Discontinued procedure | Use when the procedure (and anesthesia) is terminated due to patient condition or other valid reasons.
56 | Preoperative assessment only | Use when only the preoperative anesthesia evaluation is provided and no intraoperative anesthesia occurred.
62 | (listed above) | (Duplicate rows avoided in table—see first 62 entry)
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207LP2900X | Pediatric Anesthesiology | Primary specialty for neonatal and infant anesthesia for congenital abdominal wall defects. |
207L00000X | Anesthesiology | General anesthesiology services for perioperative care.
207LA0401X | Pain Medicine Anesthesiologist | May be involved for regional analgesia planning or postoperative pain management.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M75.100 | Unspecified rotator cuff tear or rupture of unspecified shoulder | Present in the input list; not clinically related to omphalocele repair but included from provided dataset. |
S43.401A | Sprain of unspecified acromioclavicular joint, initial encounter | Included in input; unrelated to abdominal wall congenital repair.
M19.011 | Primary osteoarthritis, right shoulder | Included in input; not relevant to neonatal omphalocele repair.
M19.012 | Primary osteoarthritis, left shoulder | Included in input; not relevant to neonatal omphalocele repair.
S42.001A | Fracture of unspecified part of right clavicle, initial encounter | Included in input; unrelated to omphalocele repair.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | Not directly related to omphalocele repair; listed in the input as related shoulder procedures — may appear in the dataset but not applicable to this abdominal neonatal procedure. |
23412 | Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic | Not applicable to omphalocele repair; represents open shoulder tendon repair in adults.
20610 | Arthrocentesis, aspiration and/or injection into a joint or bursa | Not applicable to omphalocele repair; included in input as a commonly paired procedure in shoulder care datasets.
29826 | Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty | Not applicable to omphalocele repair; related to shoulder arthroscopy procedures.