CPT 00836: Anesthesia for Infant Lower Abdominal Hernia Repair
CPT code 00836 designates anesthesia services for repair of a lower abdominal hernia in an infant born at fewer than 37 weeks gestational age and younger than 50 weeks at the time of surgery. This code covers anesthesia for procedures in the lower abdomen not otherwise specified by other anesthesia codes and is focused on a high-risk neonatal/pediatric population. Nationally, accurate use of this code affects clinical documentation, payment pathways, and case mix reporting for pediatric surgical care.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of the clinical context for neonatal and infant anesthesia in lower abdominal hernia repair, comparisons to related anesthesia codes used for similar procedures, and the common coding scenarios that drive appropriate selection of this code. The publication also outlines typical sites of service and the clinical population covered by the code.
This summary is intended to help coding professionals, anesthesiology departments, billing teams, and policy analysts understand when CPT code 00836 applies, how it relates to adjacent anesthesia codes, and the operational context in which it is commonly used. Data not available in the input.
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Billing Code Overview
CPT code 00836 describes anesthesia services for repair of a lower abdominal hernia in an infant born prematurely (less than 37 weeks gestational age) who is younger than 50 weeks gestational age at the time of surgery. The service type is anesthesia for neonatal/pediatric lower abdominal hernia repair (unspecified procedure within this category). The typical site of service is an operating room or surgical suite in an inpatient or outpatient hospital setting.
Clinical & Coding Specifications
Clinical Context
A 6-week-old infant born at 35 weeks gestational age presents for elective repair of a congenital inguinal hernia. The infant is now 6 weeks postnatal age (younger than 50 weeks post-conceptual age) and requires general endotracheal anesthesia for open bilateral inguinal hernia repair. Preoperative evaluation is performed in the pediatric preoperative clinic, including review of neonatal course (apnea of prematurity), current weight, feeding schedule, and medications. The anesthesia team documents preoperative risk classification (e.g., P3 if significant comorbidity), plans airway management with appropriately sized endotracheal tube, and prepares thermoregulation and neonatal monitoring.
On the day of surgery the patient is transported to the pediatric operating room. Standard monitors (ECG, pulse oximetry, noninvasive blood pressure, end-tidal CO2, temperature) are applied. Intravenous access is obtained; induction is performed with inhalational or intravenous agents per pediatric anesthesiology standards. The anesthesiologist provides intraoperative management including maintenance anesthesia, fluid management, and perioperative analgesia (regional block or local infiltration as appropriate). At procedure end the patient is extubated when criteria are met and transferred to the post-anesthesia care unit (PACU) or neonatal intensive care unit (NICU) depending on stability and prematurity-related needs. Documentation includes anesthesia start and stop times, airway technique, monitored parameters, intraoperative events, and justification for any applicable modifiers (for example 23 for unusual anesthesia circumstances).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
AA | Anesthesia services performed personally by anesthesiologist | Use when the physician anesthesiologist personally performs the anesthesia care. |
AD | Medical supervision by physician; more than four concurrent anesthesia procedures | Use when supervising more than four concurrent cases as the physician medical director. |
AS | Physician assistant, nurse anesthetist, or anesthetist service (when applicable) | Use when CRNA/AA provides anesthesia services in facilities where AS is recognized. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when the anesthesiologist medically directs multiple concurrent CRNAs and meets CMS direction requirements. |
QX | CRNA service; medically directed by a physician | Use when a CRNA performs the anesthesia under physician direction and billing requires the CRNA identifier. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when the anesthesiologist directs a single CRNA and meets CMS direction rules. |
QZ | CRNA service without medical direction by a physician | Use when the CRNA furnishes anesthesia without physician direction. |
P1 | Patient status: healthy, normal | Use to document ASA physical status when applicable. |
P2 | Patient status: mild systemic disease | Use when infant has mild comorbidity (e.g., controlled anemia). |
P3 | Patient status: severe systemic disease | Use when the infant has significant conditions (e.g., bronchopulmonary dysplasia). |
P4 | Patient status: severe systemic disease that is a constant threat to life | Use when the infant has life-threatening comorbidities. |
23 | Unusual anesthesia | Use when unusual circumstances require general anesthesia for a procedure normally not done under general anesthesia or when additional work is required. |
52 | Reduced services | Use when the anesthesia service is partially reduced or curtailed at the physician's discretion. |
53 | Discontinued procedure | Use when anesthesia was started but procedure was terminated for medical reasons before completion. |
78 | Return to operating room for a related procedure during the postoperative period | Use when the patient returns to the OR for a related anesthesia-requiring procedure in the global period. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | General anesthesiology services including pediatric cases. |
207LP2900X | Pediatric Anesthesiology | Specialists providing anesthesia care to neonates and infants; typical for this patient. |
207LA0401X | Pain Medicine (Anesthesiology) | Relevant when regional/nerve block techniques are used for perioperative analgesia. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K40.20 | Bilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent | Common indication for bilateral inguinal hernia repair in infants; anesthetic management considers bilateral procedure duration and postoperative monitoring. |
K41.90 | Unilateral or unspecified femoral hernia, without obstruction or gangrene, not specified as recurrent | Femoral hernia in infants is a surgical indication for repair; influences operative approach and anesthesia planning. |
K42.9 | Umbilical hernia without obstruction or gangrene | Umbilical hernia repair in infants may be performed under general anesthesia; often shorter procedure with specific postoperative considerations. |
K43.9 | Ventral hernia without obstruction or gangrene | Ventral hernia repair in infants requires lower abdominal anesthesia coverage; may alter anesthetic time and analgesia needs. |
K44.9 | Diaphragmatic hernia without obstruction or gangrene | Diaphragmatic hernia repair involves thoracoabdominal considerations and may require more advanced neonatal anesthetic care; indicates higher perioperative risk. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00834 | Anesthesia for hernia repairs in lower abdomen (child younger than 1 year of age) | Alternative anesthesia code used specifically for infants under one year undergoing lower abdominal hernia repair; select based on payer and coding guidelines. |
00840 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy | Used when the hernia repair is performed intraperitoneally or laparoscopically; affects base anesthesia code selection. |